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1.
Rev. cuba. oftalmol ; 34(3): e983, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1352023

ABSTRACT

Objetivo: Determinar la evolución del resultado visual en pacientes con toxoplasmosis ocular activa. Métodos: Se realizó un estudio observacional prospectivo longitudinal en 101 pacientes inmunocompetentes con toxoplasmosis ocular activa, atendidos en la consulta de Uveítis del Hospital General Docente "Abel Santamaría", desde enero de 2012 a diciembre de 2018. Se evaluaron las variables localización de la lesión, tamaño, número, episodio, grado de inflamación, complicaciones, recurrencia postratamiento y mejor agudeza visual corregida. Se analizaron los resultados utilizando frecuencias absolutas y relativas, la asociación estadística chi cuadrado, las pruebas U Mann-Whitney o Kruskall Wallis, Friedman y de rangos con signos de Wilcoxon. Resultados: Según la localización de la lesión, los resultados visuales inferiores se presentaron en los pacientes con lesiones en zona I y los mejores se obtuvieron cuando hubo afectación en zona III. Se mostró una mejor evolución del resultado visual en los que tuvieron lesiones menores o iguales a un diámetro papilar. Existió diferencia estadística entre los diferentes grados de gravedad de la inflamación, con tendencia al incremento de la mejor agudeza visual corregida en el tiempo, después del tratamiento. Conclusiones: Durante la evolución de los pacientes inmunocompetentes con toxoplasmosis ocular activa se logra mejoría de la visión(AU)


Objective: Determine the evolution of visual results in patients with active ocular toxoplasmosis. Methods: An observational longitudinal prospective study was conducted of 101 immunocompetent patients with active ocular toxoplasmosis attending the Uveitis Service at Abel Santamaría General University Hospital from January 2012 to December 2018. The variables evaluated were injury location, size, number, episode, degree of inflammation, complications, post-treatment recurrence and best corrected visual acuity. Results were analyzed with absolute and relative frequencies, chi-square statistical association, the Mann-Whitney U or Kruskall Wallis tests, the Friedman test and the Wilcoxon signed-rank test. Results: According to injury location, the lowest visual results were obtained in patients with zone I lesions, whereas the best results corresponded to zone III lesions. A better visual result evolution was achieved in patients with lesions smaller than or equal to a papillary diameter. A statistical difference was found between the various degrees of inflammation severity, with a tendency to an increase in best corrected visual acuity with the passing of time after treatment. Conclusions: Visual improvement is achieved during the evolution of immunocompetent patients with active ocular toxoplasmosis(AU)


Subject(s)
Uveitis/etiology , Visual Acuity , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Toxoplasmosis, Ocular/diagnosis , Prospective Studies , Longitudinal Studies , Observational Studies as Topic
2.
Brasília; s.n; 11 ago. 2020.
Non-conventional in Portuguese | PIE, LILACS, BRISA, PIE | ID: biblio-1117979

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referentes ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 14 artigos e 5 protocolos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Ribavirin/therapeutic use , Technology Assessment, Biomedical , Ursodeoxycholic Acid/therapeutic use , Immunoglobulins/therapeutic use , Prednisolone/therapeutic use , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Chloroquine/therapeutic use , Cross-Sectional Studies , Cohort Studies , Interferon-alpha/therapeutic use , Tacrolimus/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Azithromycin/therapeutic use , Ritonavir/therapeutic use , Antibodies, Neutralizing/therapeutic use , Mesenchymal Stem Cells , Lopinavir/therapeutic use , Folic Acid/therapeutic use , Meropenem/therapeutic use , Hydroxychloroquine/therapeutic use , Antibodies, Monoclonal/therapeutic use , Mycophenolic Acid/therapeutic use
3.
Rev. Ateneo Argent. Odontol ; 60(1): 49-53, jul. 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1119832

ABSTRACT

En la actualidad, las tasas que se conocen de colonización de piel y mucosa por el staphylococcus aureus están incrementando día a día. Se ha encontrado una fuerte correlación de la invasión de estos en otras partes del cuerpo (zona axilar, mucosa nasal, entre otras) con la aparición de celulitis y/o abscesos faciales. Se demostró que la flora nasal es muy diversa, encontrándose patógenos como streptococcus viridans, staphylococcus aureus, staphylococcus coagulasa negativa y Corynebacterium sp, pero sin posibilidad de definir con exactitud cuál es la constancia de los mismos pudiendo presentarse variaciones de esta. A su vez, esto se ve agravado por la falta de adherencia al tratamiento por parte de los pacientes y de otras condiciones como, el mismo contagio o predisposición del medio (sudoración, altas temperaturas, mala higiene, etc.), que facilitan la capacidad de dicho microorganismo de tornarse más resistente, incrementar su población y aumentar así la patogenicidad a través de la codificación de una exotoxina llamada Pantón Valentín (SAMR). Se demostrará entonces, la metodología que se llevó a cabo a través de un análisis descriptivo transversal de los casos tratados en el Hospital Mariano y Luciano de La Vega, con el fin de correlacionar causalidad y efecto (AU)


At present, the rates known for skin and mucosa colonization by Sthapylococcus aureus are increasing day by day. A strong correlation has been found of the invasion of these in other parts of the body (axillary area, nasal mucosa, among others, being the latter the most representative), with the appearance of cellulite and/or facial abscesses. It was shown that the nasal flora is very diverse, finding pathogens such as Streptococcus Viridans, Staphylococcus aureus (S aureus), coagulase negative Staphylococcus and Corynebacterium sp, but that has not been defined exactly the constancy of the same, can be presented variations of this. In turn, this is aggravated by the lack of adherence to treatment by patients and other conditions such as the same contagion or predisposition of the medium (sweating, high temperatures, poor hygiene, etc.), which facilitate the capacity of said Microorganism to become more resistant, increase its population and thus increase the pathogenicity through the codification of a exotoxin called Valentín Panty. To prove the methodology that was carried out through a transversal descriptive analysis of the cases treated at the Mariano Hospital and Luciano de La Vega in order to fulfil the objective of correlating causality and Effect (AU)


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Staphylococcal Infections/complications , Staphylococcus aureus/pathogenicity , Staphylococcal Skin Infections/etiology , Nasal Mucosa/microbiology , Argentina , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Epidemiology, Descriptive , Cross-Sectional Studies , Dental Service, Hospital , Methicillin-Resistant Staphylococcus aureus , Cellulite
4.
Medicina (B.Aires) ; 79(3): 167-173, June 2019. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-1020054

ABSTRACT

Las infecciones del pie diabético se asocian a complicaciones graves y constituyen la principal causa de hospitalización relacionada con diabetes y amputación de miembros inferiores. Para evitar su progresión, se requiere una conducta inicial rápida y adecuada que incluye toma de muestras para cultivos e inicio inmediato de tratamiento antibiótico empírico, según las características de las lesiones y la prevalencia local de microorganismos. Por ello, es necesario conocer y vigilar la microbiología local y la resistencia a los antimicrobianos. El objetivo de este trabajo fue describir la frecuencia de gérmenes en infecciones de pie diabético en pacientes ambulatorios asistidos en nuestro hospital en 2018 e identificar el esquema antibiótico con mayor cobertura, en comparación con los resultados de un estudio similar realizado en 2015. Fueron analizadas 72 muestras tomadas mediante punción por piel sana de partes blandas. Entre los 68 gérmenes aislados, los Gram negativos fueron los más frecuentes (47.1%), lo que representa un aumento significativo en relación a la frecuencia observada en 2015 (24.6%) p = 0.01 y un aumento de la sensibilidad a ciprofloxacina de 25% a 62.5% (p=0.03). El esquema con mayor cobertura fue amoxicilina-clavulánico con ciprofloxacina (77.9%) mientras que en 2015 fue amoxicilina-clavulánico con trimetoprima sulfametoxazol. La vigilancia de la microbiología local es fundamental para la elección del antibiótico empírico en las infecciones de pie diabético. En nuestro hospital, cuando la infección es de partes blandas, se recomienda la combinación amoxicilina-clavulánico más ciprofloxacina como esquema antibiótico empírico según los hallazgos de este estudio.


Diabetic foot infections are related to severe complications and constitute the main reason for diabetes-related hospitalization and lower limb amputations. A diabetic foot infection requires prompt actions to avoid progression of the infected wound; a soft tissue sample has to be taken for microbiological culture and empiric antibiotic therapy must be started immediately. Empiric antibiotic schemes should be chosen based on the severity of the infection and the local prevalence of microbial causal agents. Therefore, it is important to monitor these indicators. The aim of this study was to determine which microorganisms were more prevalent in cultures of diabetic foot infections during 2018 and what antibiotic combination was better to cover local microbiology, compared with data available from 2015 for a similar cohort. A total of 68 positive cultures were obtained of 72 soft tissue specimens analyzed. The most frequent microorganisms were Gram negative (47.1%), and resulted significantly more frequent than in 2015 (24.6%) p = 0.01. These Gram negative germs also resulted more sensitive to ciprofloxacin than in 2015 (62.5% vs. 25.0%) p = 0.03. Amoxicillin-clavulanate plus ciprofloxacin was the optimal combination therapy in 2018, while in 2015 it was amoxicillin-clavulanate plus trimethoprim sulfamethoxazole. In agreement with these results, we recommend amoxicillin-clavulanate plus ciprofloxacin as the empiric antibiotic regimen of choice for soft tissue infections in diabetic foot. We consider surveillance of local microbiology to be an important tool in the management of diabetic foot infections.


Subject(s)
Humans , Ciprofloxacin/therapeutic use , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Diabetic Foot/drug therapy , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Anti-Bacterial Agents/therapeutic use , Wound Infection/microbiology , Wound Infection/drug therapy , Microbial Sensitivity Tests , Diabetic Foot/etiology , Diabetic Foot/microbiology , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Drug Therapy, Combination , Gram-Negative Bacteria/classification
5.
Rev. méd. Chile ; 147(3): 390-394, mar. 2019. graf
Article in Spanish | LILACS | ID: biblio-1004362

ABSTRACT

Goodpasture Syndrome is described as a single episode disease entity. It is diagnosed with the demonstration of antiglomerular basement (anti-GBM) antibodies in plasma or renal tissue. Although the recurrence of anti-GBM disease is rare, it has been reported in up to 3% of cases. Recurrence with negative anti-GBM antibodies in plasma is even less frequent We report a 63 years old male in whom anti-GBM disease recurred without detectable anti-GBM antibodies in plasma, despite having positive antibodies at the onset.


Subject(s)
Humans , Male , Middle Aged , Autoantibodies/analysis , Anti-Glomerular Basement Membrane Disease/pathology , Recurrence , Biopsy , Prednisone/therapeutic use , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Fluorescent Antibody Technique , Anti-Glomerular Basement Membrane Disease/drug therapy , Anti-Glomerular Basement Membrane Disease/diagnostic imaging , Cyclophosphamide/therapeutic use , Kidney Diseases/pathology , Kidney Glomerulus/pathology , Anti-Bacterial Agents/therapeutic use
6.
Porto Alegre; Universidade Federal do Rio Grande do Sul. Telessaúde; 2018. ilus.
Non-conventional in Portuguese | LILACS | ID: biblio-995587

ABSTRACT

Sintomas de prostatite são muito comuns na população, ocorrendo com uma prevalência média de 8,2%. Estima-se que 35% a 50% dos homens apresentarão esses sintomas em algum momento de sua vida. Entre as formas de prostatite, a apresentação mais comum é a Prostatite Crônica/ Síndrome da Dor Pélvica Crônica (PC/SDPC). PC/SDPC é uma síndrome clínica definida essencialmente pela presença de dor pélvica crônica não causada por patologias identificáveis. Apesar do termo "prostatite", parcela significativa dos casos não tem sinal de inflamação ("-ite") da próstata. Infecções causadas por Clamídia, Micoplasma ou Ureaplasma geralmente não são responsáveis pela PC/SDPC. Tampouco se sabe em que extensão a próstata é responsável pelos sintomas. Além de prevalente, a PC/SDPC prejudica a qualidade de vida dos homens e tem importante impacto econômico. Está frequentemente associada a dor genital, dor ejaculatória, dor abdominal, sintomas do trato urinário inferior e disfunção erétil. Ansiedade e medo de doenças graves são achados comuns em pacientes com PC/SDPC e podem contribuir com os sintomas. Múltiplas consultas, investigações e procedimentos também são riscos aos quais esses pacientes estão sujeitos. Pouca atenção tem sido dada à essa condição, o que resulta em literatura relativamente escassa sobre o assunto. Considerando a diversidade e severidade dos sintomas, assim como as comorbidades sistêmicas que frequentemente estão associadas (como síndrome do intestino irritável e fibromialgia), abordagens terapêuticas uniformes e monoterápicas raramente funcionam. Não surpreende que a PC/SDPC seja uma condição associada a significativa frustração, tanto nos pacientes quanto nos médicos. É necessário, portanto, que o diagnóstico e tratamento adequado seja feito na Atenção Primária à Saúde (APS), em vistas a melhorar a qualidade de vida do paciente e evitar encaminhamentos desnecessários ao urologista. Esta guia apresenta informação que orienta a conduta para casos de prostatite crônica/síndrome da dor pélvica crônica no contexto da Atenção Primária à Saúde, incluindo: Classificação, Sinais e Sintomas, Diagnóstico, Tratamento, Encaminhamento para serviço especializado, Referências, Anexo.


Subject(s)
Humans , Prostatitis , Prostatitis/diagnosis , Pelvic Pain/diagnosis , Pelvic Pain/therapy , Primary Health Care , Referral and Consultation , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Doxazosin/therapeutic use
7.
Rev. chil. infectol ; 34(4): 347-351, ago. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899722

ABSTRACT

Resumen Introducción: La infección por Cystoisospora belli es una de las causas más frecuentes de diarrea acuosa en pacientes con infección por VIH y ocasiona altas tasas de morbilidad y mortalidad. Métodos: Se realizó un estudio retrospectivo en pacientes infectados con VIH y diarrea por C. belli. Características clínicas y de laboratorio fueron recolectadas mediante el análisis de historias clínicas. Resultados: Se identificaron siete casos. Cuatro presentaron diarrea recurrente a pesar de recibir profilaxis secundaria con cotrimoxazol y tratamiento específico, dos de los cuales tuvieron buena respuesta viral e inmunológica al tratamiento anti-retroviral de gran actividad (TARGA) al momento del diagnóstico y tratamiento antiparasitario. Mientras que, los tres restantes no recibían profilaxis, tampoco TARGA (dos de ellos), pero respondieron bien al tratamiento. Conclusiones: C. belli es causa importante de diarrea en pacientes VIH con TARGA y profilaxis, pudiendo tener distinta evolución clínica. Sugerimos que la infección persistente puede ser debido al fallo farmacológico por causas intrínsecas o extrínsecas al parásito, o a defectos en la restauración del sistema inmune intestinal, o ambos.


Introduction: Cystoisospora belli infection is one of the most important causes of watery diarrhea in patients with HIV and causes high rates of morbidity and mortality. Methods: A retrospective study was conducted in patients with HIV and diarrhea by C. belli. Clinical and laboratory characteristics were collected by analyzing clinical records. Results: Four had recurrent diarrhea despite receiving secondary prophylaxis with cotrimoxazole and specific treatment, two of which had a good viral and immunological response to highly active antiretroviral therapy (HAART) at the time of diagnosis and antiparasitic treatment. While the remaining three did not receive prophylaxis, neither did HAART (two of them), but they responded well to treatment. Conclusions: C. belli is an important cause of diarrhea in HIV patients on HAART and prophylaxis, being able to have different clinical evolution. We suggest that persistent infection may be due to drug failure by intrinsic or extrinsic to the parasite causes, or to defects in restoration of the intestinal immune system, or both.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Coccidiosis/microbiology , AIDS-Related Opportunistic Infections/microbiology , Sarcocystidae/microbiology , Diarrhea/microbiology , Peru , HIV Infections/drug therapy , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Retrospective Studies , AIDS-Related Opportunistic Infections/complications , Antiretroviral Therapy, Highly Active , Diarrhea/etiology
8.
Rev. med. interna Guatem ; 21(1): 21-24, ene.-abr. 2017. ilus
Article in Spanish | LILACS | ID: biblio-995533

ABSTRACT

Necrólisis Epidérmica Tóxica (NET) es una rara pero grave emergencia caracterizada por difusa exfoliación de la piel y las membranas mucosas debido a pérdida de la epidermis, mediada por respuesta inmune que puede llevar a sepsis y fallo ventilatorio. El Trimetropin-Sulfametoxazol es un antibiótico ampliamente utilizado que es causa de dicha entidad. El diagnóstico prematuro y el tratamiento agresivo es esencial para la reducción de los elevados niveles de morbilidad y mortalidad asociadas con esta enfermedad. Presentamos un caso que fue precipitado debido al uso de Trimetropin-Sulfametoxazol en un hombre de 22 años de edad...(AU)


Toxic Epidermal Necrolysis (TEN) is a rare but serious emergency characterized by diffuse exfoliation of the skin and mucous membranes due to loss of the epidermis, mediated by immune response that can lead to sepsis and ventilatory failure. Trimetropin-Sulfamethoxazole is a widely used antibiotic that causes this entity. Premature diagnosis and aggressive treatment is essential for reducing the high levels of morbidity and mortality associated with this disease. We present a case that was precipitated due to the use of Trimetropin-Sulfamethoxazole in a man of 22 years of age ... (AU)


Subject(s)
Humans , Male , Adult , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Stevens-Johnson Syndrome/complications , Stevens-Johnson Syndrome/drug therapy , Adrenal Cortex Hormones/administration & dosage , Trimethoprim Resistance/drug effects , Guatemala
9.
Med. infant ; 24(1): 63-65, marzo 2017.
Article in Spanish | LILACS | ID: biblio-879294

ABSTRACT

Trimetoprima-sulfametoxazol (TMP-SMX) tiene actividad in vitro contra cepas de Staphylococcusaureus, en especial las cepas resistentes a la meticilina de la comunidad (SAMR-Co), Éste es considerado un antibiótico útil debido a su bajo costo, amplio espectro y posibilidad de administración por vía oral dada su adecuada biodisponibilidad y sabor agradable. Se realizó esta revisión narrativa de la literatura para evaluar el uso de TMP-SMX en comparación con otras opciones disponibles en el tratamiento de las infecciones por SAMR-Co en niños (AU)


Trimethoprim/sulfamethoxazole (TMP-SMX) has in vitro activity against Staphylococcus aureus, especially against community-acquired methicillin-resistant (CAMR) strains. It is considered to be a useful antibiotic because of its low cost, broad spectrum, and possibility of oral administration because of its adequate bioavailability and agreeable flavor. A review of the literature was performed to evaluate the use of TMP-SMX compared to available options for the treatment of CAMR infections in children (AU)


Subject(s)
Humans , Infant , Child, Preschool , Child , Community-Acquired Infections , Methicillin-Resistant Staphylococcus aureus/drug effects , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/drug therapy , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
10.
Rev. chil. infectol ; 34(1): 77-80, feb. 2017. ilus
Article in Spanish | LILACS | ID: biblio-844449

ABSTRACT

The most common clinical presentation of Toxoplasma gondii in HIV patients is encephalitis; however, the intramedullary involvement has been reported in a few cases. We report a case of intramedullary toxoplasmosis in a female patient diagnosed with HIV/tuberculosis co-infection, and history of poor adherence to antiretroviral therapy. The patient developed subacute paraparesis with compromise of sensory function and urinary sphincter. The nuclear magnetic resonance evaluation showed a single intramedullary ring-enhanced lesion at the T-8 level which was solved after an anti-Toxoplasma therapy with trimethoprim/sulfamethoxazole.


El compromiso encefálico por Toxoplasma gondii en pacientes con VIH es la localización más frecuente, no obstante, la localización intramedular ha sido escasamente reportada. Comunicamos un caso de toxoplasmosis intramedular en una mujer con diagnóstico de coinfección por VIH y tuberculosis, con mala adherencia a la terapia antirretroviral, que desarrolló de forma subaguda un cuadro de paraparesia con compromiso sensitivo y de esfínteres. La resonancia magnética mostró una lesión única intramedular con captación de contraste periférico en anillo a nivel T-8, que se resolvió tras recibir tratamiento anti-toxoplasmosis con cotrimoxazol.


Subject(s)
Humans , Female , Adult , Spinal Cord Diseases/parasitology , Toxoplasmosis/diagnostic imaging , AIDS-Related Opportunistic Infections/diagnostic imaging , Spinal Cord Diseases/drug therapy , Spinal Cord Diseases/diagnostic imaging , Dexamethasone/therapeutic use , Magnetic Resonance Imaging , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Toxoplasmosis/drug therapy , AIDS-Related Opportunistic Infections/parasitology , AIDS-Related Opportunistic Infections/drug therapy , Central Nervous System Protozoal Infections/parasitology , Central Nervous System Protozoal Infections/drug therapy , Central Nervous System Protozoal Infections/diagnostic imaging , Coinfection , Anti-Bacterial Agents/therapeutic use
11.
Article in English | LILACS | ID: biblio-842763

ABSTRACT

ABSTRACT This study reports two cases of chronic paracoccidioidomycosis with sarcoid-like cutaneous lesions. The patients began the treatment in 2013 at Hospital Universitário Clementino Fraga Filho (HUCFF) of the Universidade Federal do Rio de Janeiro (UFRJ). The first case (mild form) was treated with trimethoprim-sulfamethoxazole (8 mg /kg per day, orally) for three months and, then, with half the dose for nine months; the second (moderate form), with itraconazole (200 mg per day, orally) for 12 months. We point out the rareness of the sarcoid-like cutaneous lesions and the differential diagnoses for other granulomatous diseases.


Subject(s)
Humans , Male , Middle Aged , Paracoccidioidomycosis/complications , Sarcoidosis/complications , Antifungal Agents/therapeutic use , Chronic Disease , Itraconazole/therapeutic use , Paracoccidioidomycosis/drug therapy , Paracoccidioidomycosis/pathology , Sarcoidosis/pathology , Severity of Illness Index , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
12.
Rev. Soc. Bras. Clín. Méd ; 14(4): 234-236, 2016.
Article in Portuguese | LILACS | ID: biblio-827446

ABSTRACT

Descrevemos um caso de doença de Whipple diagnosticada em paciente com síndrome diarreica crônica, emagrecimento intenso, pesquisa de DNA da Tropheryma whipplei positiva em fluido biológico e resposta excelente ao tratamento antibiótico.


A case of Whipple's disease diagnosed in a patient with chronic diarrhea syndrome, intense weight loss, positive DNA searching for Tropheryma whipplei, and excellent clinical response to antibiotic therapy is described.


Subject(s)
Humans , Male , Whipple Disease/diagnosis , Whipple Disease/drug therapy , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
13.
Rev. chil. infectol ; 32(6): 609-617, graf, tab
Article in Spanish | LILACS | ID: lil-773266

ABSTRACT

Background: Cotrimoxazole is a therapeutic option for bone-related infections but is associated to hyperkalemia and renal failure. Tolerance to this drug may reduce length of stay (LOS) and hospital charges. Aims: To evaluate renal, potassium toxicity, clinical outcome, and use of hospital resources in patients treated with cotrimoxazole for bone-related infections. Methods: Retrospective analysis of adult patients with bone-related infections confirmed by culture and treated with this drug. Serum potassium and creatinine levels were analyzed during follow-up and risk factors for hyperkalemia were searched. Length of stay (LOS) and hospital charges were compared. Clinical outcome was evaluated as a secondary endpoint. Results: From 2011 to 2014, 23 patients were identified (mean age 64.7 years). Diabetes mellitus, peripheral vascular disease, and previous amputations prevalence were high (82.6%, 47.8%, and 43.5%, respectively). Median serum potassium concentration increased significantly at first control (4.35 mEq/L to 4.9 mEq/L; p < 0.001), and also creatinine serum concentration (0.9 to 1.1 mg/dL; p < 0.05). Seven patients developed hyperkalemia. Cotrimoxazole was discontinued in 10 patients (43.5%), and in 6, discharge was postponed. Drugs active against the renin-angiotensin system (DAARAS) were associated with kyperkalemia (OR 10.8 IC95 1.37-85; p < 0.05). LOS was higher among patients with cotrimoxazole toxicity (median LOS 56 versus 30 days, p < 0.05). Patients with no cotrimoxazole interruption had less drug-related hospital charges (median values of 563 versus 2820 USD, respectively; p < 0.01). Conclusions: Cotrimoxazole use must be monitored in order to detect hyperkalemia or renal toxicity and suspend its prescription. Patients that use DAARAS have a higher risk of kyperkalemia. LOS and drug-related hospital charges are reduced when patients can tolerate cotrimoxazole.


Antecedentes: Cotrimoxazol es una alternativa en infecciones óseas pero se ha asociado al desarrollo de falla renal e hiperkalemia. Objetivo: Evaluar toxicidad renal, hiperkalemia, estadía y gastos hospitalarios y evolución clínica en un grupo de pacientes con infecciones óseas tratados con este compuesto. Pacientes y Métodos: Estudio retrospectivo-descriptivo de pacientes adultos con infecciones óseas confirmadas con cultivos y tratados con este compuesto. Seguimiento de creatinina y kalemia y búsqueda de factores de riesgo para hiperkalemia, comparación de gastos y estadía hospitalaria y análisis de eficacia clínica. Resultados: Desde el año 2011 al 2014 se identificaron 23 pacientes (promedio de edad 64,7 años). La prevalencia de diabetes mellitus tipo 2 (82,6%), enfermedad vascular periférica (47,8%) y amputaciones previas (43,5%) fue elevada. La mediana de la kalemia basal aumentó significativamente al primer control (4,35 a 4,9 mEq/L) al igual que la creatinina plasmática (0,9 a 1,1 mg/dL). Siete pacientes desarrollaron hiperkalemia (30,4%). Se suspendió cotrimoxazol en 10 casos (43,5%) y en 6 casos se postergó el alta. El uso de fármacos activos contra el sistema renina-angiotensina (FASRA) se asoció a hiperkalemia (OR 10,8 IC95 1,37-85; p < 0,05). La estadía hospitalaria fue mayor en el grupo con toxicidad a cotrimoxazol (mediana de 56 versus 30 días; p < 0,05) y los pacientes sin suspensión de terapia tuvieron menos gastos por fármacos (medianas de 563 vs 2.820 USD, p < 0,01). Conclusiones: El uso de cotrimoxazol debe ser monitorizado para detectar hiperkalemia o toxicidad renal y suspender su prescripción. Los pacientes que usan FASRA tienen mayor riesgo de hiperkalemia. La estadía y gastos hospitalarios por fármacos son menores en pacientes que toleran el cotrimoxazol.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anti-Bacterial Agents/adverse effects , Bone Diseases, Infectious/drug therapy , Hyperkalemia/chemically induced , Trimethoprim, Sulfamethoxazole Drug Combination/adverse effects , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/therapeutic use , Creatinine/blood , Health Care Costs , Length of Stay , Potassium/blood , Retrospective Studies , Risk Factors , Trimethoprim, Sulfamethoxazole Drug Combination/economics , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
15.
Acta méd. costarric ; 56(1): 27-30, ene.-mar. 2014. ilus
Article in Spanish | LILACS | ID: lil-700706

ABSTRACT

La Stenotrophomonas maltophilia es un bacilo gram negativo ambiental emergente que ha venido posicionándose entre el grupo de microorganismos multirresistentes como causa de infección en diversos órganos en ambiente hospitalario y en la comunidad. Se reporta este caso de insuficiencia respiratoria con neumonía severa por S.maltophilia adquirida en la comunidad en una paciente inmunocompetente que tuvo una rápida respuesta a tratamiento con trimetoprim sulfametoxazol cuando se logró identificar la bacteria...


Subject(s)
Humans , Female , Aged , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Pneumonia/etiology , Pneumonia/drug therapy , Stenotrophomonas maltophilia
16.
Rev. Asoc. Méd. Argent ; 127(1): 30-33, mar. 2014. ilus
Article in Spanish | LILACS | ID: lil-753344

ABSTRACT

Presentamos el primer caso de pie de madura publicado en Argentina y realizamos una breve actualización de su diagnóstico y terapéutica.


We presented the first case of feet of Madura published in Argentine. We did a review of diagnostic and treatment.


Subject(s)
Humans , Male , Young Adult , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Mycetoma/diagnosis , Mycetoma/etiology , Mycetoma/therapy , Argentina , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Mycetoma/surgery
17.
Rev. argent. microbiol ; 45(1): 50-3, mar. 2013.
Article in Spanish | LILACS, BINACIS | ID: biblio-1171768

ABSTRACT

We herein present the case of an adult male patient who consulted for lower extremity edema, a 2- month history of fever and oppressive chest pain radiating to the left arm. He referred neither contact with breeding animals nor consumption of unpasteurized dairy products. A diagnosis of endocarditis was confirmed by cardiac studies. Since the empirical treatment with cephalotin, ampicillin and gentamicin failed, the patient underwent aortic valve replacement. A total of four blood cultures were positive with a gram-negative rod. Bacterial identification was performed using the API 20 NE technique (bioMÞrieux), the Phoenix automated method (BD) and conventional biochemical tests which were unable to classify the isolate as to genus and species. The strain was sent to the INEI-ANLIS "Dr. Carlos G. Malbrán" where it was identified as Brucella canis. The antimicrobial treatment was switched to doxycycline, rifampicin and trimethoprim-sulfamethoxazole with good evolution of the patient. The clinical significance of this case report lies in the possible failure of the empiric antibiotic therapy administered for endocarditis, since B. canis did not respond to the conventional antimicrobial treatment for this pathology.


Subject(s)
Brucella canis/isolation & purification , Brucellosis/microbiology , Endocarditis, Bacterial/microbiology , Adult , Argentina/epidemiology , Bacteremia/microbiology , Brucella canis/drug effects , Brucellosis/surgery , Brucellosis/epidemiology , Brucellosis/drug therapy , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Chest Pain/etiology , Doxycycline/therapeutic use , Edema/etiology , Endocarditis, Bacterial/surgery , Endocarditis, Bacterial/epidemiology , Endocarditis, Bacterial/drug therapy , Drug Resistance, Multiple, Bacterial , Fever/etiology , Humans , Heart Valve Prosthesis Implantation , Male , Rifampin/therapeutic use , Combined Modality Therapy , Bacterial Typing Techniques , Aortic Valve/surgery , Aortic Valve/microbiology
18.
Indian J Pathol Microbiol ; 2012 Oct-Dec 55(4): 578-579
Article in English | IMSEAR | ID: sea-145670

ABSTRACT

Melioidosis is an emerging disease producing protean manifestations, and is more common in alcoholics and diabetics. The disease can be a trivial localized lesion or a fatal septicemia. Early diagnosis and appropriate antimicrobial treatment greatly reduces the mortality rate. We report a case of localized form of the disease in an elderly male with no known predisposing medical disease who responded well to oral amoxycillin-clavulanic acid and cotrimoxazole treatment.


Subject(s)
Aged , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Burkholderia pseudomallei/drug effects , Burkholderia pseudomallei/pathogenicity , Diagnosis , Humans , India , Rural Population , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
19.
Rev. Inst. Med. Trop. Säo Paulo ; 54(5): 293-297, Sept.-Oct. 2012. ilus
Article in English | LILACS | ID: lil-648566

ABSTRACT

Whipple's disease is a rare systemic infectious disorder caused by the bacterium Tropheryma whipplei. We report the case of a 61-year-old male patient who presented to emergency room complaining of asthenia, arthralgia, anorexia, articular complaints intermittent diarrhea, and a 10-kg weight loss in one year. Laboratory tests showed the following results: Hb = 7.5 g/dL, albumin = 2.5 mg/dL, weight = 50.3 kg (BMI 17.4 kg/m²). Upper gastrointestinal endoscopy revealed areas of focal enanthema in the duodenum. An endoscopic biopsy was suggestive of Whipple's disease. Diagnosis was confirmed based on a positive serum polymerase chain reaction. Treatment was initiated with intravenous ceftriaxone followed by oral trimethoprim-sulfamethoxazole. After one year of treatment, the patient was asymptomatic, with Hb = 13.5 g/dL, serum albumin = 5.3 mg/dL, and weight = 70 kg (BMI 24.2 kg/m²). Whipple's disease should be considered a differential diagnosis in patients with prolonged constitutional and/or gastrointestinal symptoms. Appropriate antibiotic treatment improves the quality of life of patients.


Doença de Whipple é uma rara infecção sistêmica causada pelo Tropheryma whipplei. Caracteriza-se por fase prolongada de sintomas inespecíficos, levando longo período até o seu diagnóstico. Sem tratamento, pode ser grave e fatal, mas com antibioticoterapia tem ótima resposta clínica e laboratorial. Relatamos o caso de paciente masculino, 61 anos, internado por astenia, anorexia, diarréia intermitente e perda de 10 kg em um ano. Apresentava-se com hemoglobina (Hb) 7,5 g/dL, albumina de 2,5 mg/dL, peso 50,3 kg (IMC 17,4). Endoscopia digestiva alta com áreas de enantema focal da mucosa duodenal e biópsia compatível com doença de Whipple. O diagnóstico foi confirmado com PCR sérica positiva, sendo instituído tratamento com ceftriaxone seguido de sulfametoxazol-trimetropim. Após um ano de tratamento, encontrava-se assintomático, com Hb 13,5 g/dL, albumina sérica de 5,3 mg/dL e peso de 70 kg. Doença de Whipple deve fazer parte da lista de diagnósticos diferenciais em pacientes com sintomas constitucionais e/ou com queixas gastrointestinais com evolução prolongada. O tratamento antibiótico pode curar a infecção, recuperando a qualidade de vida do paciente.


Subject(s)
Humans , Male , Middle Aged , Rare Diseases/diagnosis , Whipple Disease/diagnosis , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Delayed Diagnosis , Rare Diseases/drug therapy , Treatment Outcome , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Whipple Disease/drug therapy
20.
West Indian med. j ; 61(7): 703-707, Oct. 2012. ilus, tab
Article in English | LILACS | ID: lil-672988

ABSTRACT

OBJECTIVE: Increase in resistance pattern of urinary tract pathogens to conventional antimicrobial agents used for urinary tract infections (UTIs) is gaining the attention of many microbiologists worldwide in respect to treatment of UTIs. The aim of the present study was to obtain data on resistance patterns of pathogens responsible for UTIs to currently used antimicrobial agents in Sher-I-Kashmir Institute of Medical Sciences (tertiary healthcare hospital). METHOD: A total of 2842 samples were collected from both outpatient and inpatient departments. The majority of samples in this study were midstream urine specimens, others included catheterized urine samples. Standard parameters were followed for isolation and identification of clinical isolates and further antimicrobial susceptibility test was done by Kirby Bauer disk diffusion method. RESULTS: Out of 2842 samples, 1980 (67%) were culture positive. Escherichia coli (E coli) was the most prevalent isolate (OP 63%, IP 45.5%) followed by Klebsiella pneumonia (K pneumonia) as the second commonest UTI-causing agent (OP 15.9%, IP 21.7%). High percentage of isolates showed resistance to sulfa drugs such as cotrimoxazole. First generation cephalosporins were ineffective, while aminoglycosides and third generation cephalosporins were effective against E coli, K pneumoniae, Pseudomonas aeruginosa (P aeruginosa), Enterococcus faecalis and Staphyococcus aureus (Staph aureus). Furthermore, this study noticed that glycopeptide drugs such as vancomycin are highly effective against E faecalis and Staph aureus UTIs. CONCLUSION: This study reveals the increased trend in resistance pattern of uropathogens in the valley region. These data may aid health professionals in choosing the appropriate treatment for patients with UTI in the region and hopefully will prevent the misuse of antibiotics.


OBJETIVO: El aumento del patrón de resistencia de los patógenos de las vías urinarias frente a los agentes antimicrobianos convencionales usados para las infecciones de las vías urinarias (IVU) está ganando la atención de muchos microbiólogos a nivel mundial, en relación con el tratamiento de las IVU. El objetivo del presente estudio fue obtener datos sobre los patrones de resistencia de los patógenos responsables de las IVU en el Instituto de Ciencias Médicas Sher-I-Cachemira (hospital de atención terciaria a la salud) frente a los agentes antimicrobianos de uso común. MÉTODO: Se recogieron un total de 2842 muestras provenientes de los departamentos de pacientes externos e internos. La mayoría de las muestras en este estudio fueron especimenes de orina de mitad de micción; otros incluyeron muestras de orina cateterizada. Se siguieron los parámetros estándar para el aislamiento y la identificación de los aislados clínicos, y posteriormente se realizó la prueba de susceptibilidad antimicrobiana mediante el método Kirby-Bauer de difusión por disco. RESULTADOS: De 2842 muestras, 1980 (67%) fueron cultivos positivos. Escherichia coli (E coli) fue el aislado más frecuente (OP 63%, IP 45.5%) seguido por Klebsiella pneumonia (K pneumonia) como el segundo agente más común causante de IVU (OP 15.9%, IP 21.7%). Un alto porcentaje de aislados mostró resistencia a los medicamentos de sulfa, por ejemplo el cotrimoxazole. Las cefalosporinas de primera fueron ineficaces, mientras que los aminoglucósidos y las cefalosporinas de tercera generación fueron efectivas frente a E coli, K pneumoniae, Pseudomonas aeruginosa (P aeruginosa), Enterococcus faecalis y Staphyococcus aureus (Staph aureus). Además, en este estudio se observó que los medicamentos glicopéptidos, tales como la vancomicina, son altamente efectivos frente a las IVU por E faecalis y Staph aureus. CONCLUSIÓN: Este estudio revela un aumento en la tendencia del patrón de resistencia de los uropatógenos en la región del Valle. Estos datos pueden ayudar a los profesionales de la salud a escoger el tratamiento apropiado para los pacientes con IVU en la región, y es de esperar que asimismo ayuden a prevenir el uso inadecuado de antibióticos.


Subject(s)
Female , Humans , Male , Anti-Bacterial Agents/therapeutic use , Drug Resistance, Bacterial , Urinary Tract Infections/drug therapy , Aminoglycosides/therapeutic use , Anti-Infective Agents, Urinary/therapeutic use , Cephalosporins/therapeutic use , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/microbiology , India , Microbial Sensitivity Tests , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Urinary Tract Infections/microbiology , Vancomycin/therapeutic use
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