ABSTRACT
Lasiodiplodia species are environmental fungi that have been reported as a cause of infection in both immunocompetent and immunocompromised patients. We present a case of fungal osteomyelitis caused by Lasiodiplodia species in a patient with multiple myeloma after autologous stem cell transplant. The patient was successfully treated with a combination of surgery and oral voriconzole. To the best of our knowledge, this is the first reported case of fungal osteomyelitis caused by Lasiodiplodia species.
Subject(s)
Antifungal Agents/therapeutic use , Ascomycota/isolation & purification , Hematopoietic Stem Cell Transplantation/adverse effects , Multiple Myeloma/therapy , Osteomyelitis/microbiology , Osteomyelitis/therapy , Aged , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Amputation, Surgical , Antifungal Agents/administration & dosage , Antineoplastic Agents/administration & dosage , Antineoplastic Agents/therapeutic use , Biopsy , Blood Cell Count , Fatal Outcome , Humans , Immunocompromised Host , Magnetic Resonance Imaging , Male , Osteomyelitis/blood , Osteomyelitis/pathology , Skin/pathology , Toes/pathology , Transplantation, Autologous/adverse effects , Treatment Refusal , Voriconazole/administration & dosage , Voriconazole/therapeutic useABSTRACT
La faringoamigdalitis aguda (FAA) es una de las enfermedades más comunes en la infancia. La etiología más frecuente es vírica. Entre las causas bacterianas, el principal agente responsable es Streptococcus pyogenes o estreptococo beta hemolítico del grupo A (EbhGA). Las escalas de valoración clínica son una buena ayuda para seleccionar a qué niños se deben practicar las técnicas de detección rápida de antígeno estreptocócico (TDR) y/o el cultivo de muestras faringoamigdalares. Sin su empleo, se tiende al sobrediagnóstico de FAA estreptocócica, con la consiguiente prescripción innecesaria de antibióticos, muchas veces de amplio espectro. Los objetivos del tratamiento son: acelerar la resolución de los síntomas, reducir el tiempo de contagio y prevenir las complicaciones supurativas locales y no supurativas. Idealmente, solo deben tratarse los casos confirmados. En caso de no disponibilidad de la TDR, o en algunos casos, ante un resultado negativo, se recomienda obtener cultivo e iniciar tratamiento a la espera de los resultados, solo si la sospecha clínica es alta. Los antibióticos de elección para el tratamiento de la FAA estreptocócica son penicilina y amoxicilina. Amoxicilina-clavulánico no está indicado de forma empírica en la infección aguda. Los macrólidos tampoco son un tratamiento de primera elección; su uso debe reservarse para pacientes con alergia inmediata a penicilina o como tratamiento erradicador, en los casos indicados. Es urgente y prioritario en nuestro país adecuar la prescripción de antibióticos a la evidencia científica disponible (AU)
Acute tonsillopharyngitis is one of the most common childhood diseases. Viruses are the most frequent origin. Group A Streptococcus (Streptococcus pyogenes) is the main bacterial cause. A culture or a rapid antigen-detection test of a throat-swab specimen should only be done on the basis of clinical scores, in order to avoid over-diagnosis of bacterial origin and unnecessary antibiotic prescription. The objectives of treatment are: the reduction of symptoms, reduce the contagious period, and prevent local suppurative and systemic complications. Ideally, only confirmed cases should receive antibiotics. If there is no possibility to perform a rapid antigen-detection test, or in some cases if the result is negative, it is recommended to perform a culture and, if there is high suspicious index, to prescribe antibiotics. Penicillin is the treatment of choice, although amoxicillin is also accepted as the first option. Amoxicillin/clavulanate is not indicated in any case as empirical treatment. Macrolides are not a first choice antibiotic, and should be reserved for those patients with immediate penicillin allergy reaction or for the treatment of streptococcal carriers. It is of primordial importance to adapt the prescribing of antibiotics to the scientific evidence (AU)
Subject(s)
Humans , Male , Female , Child , Tonsillitis/diagnosis , Tonsillitis/therapy , Anti-Bacterial Agents/therapeutic use , Streptococcus pyogenes/isolation & purification , Infections/diagnosis , Infections/etiology , Amoxicillin/therapeutic use , Tonsillitis/drug therapy , Tonsillitis/physiopathology , Infection Control/trends , 51426ABSTRACT
Acute tonsillopharyngitis is one of the most common childhood diseases. Viruses are the most frequent origin. Group A Streptococcus (Streptococcus pyogenes) is the main bacterial cause. A culture or a rapid antigen-detection test of a throat-swab specimen should only be done on the basis of clinical scores, in order to avoid over-diagnosis of bacterial origin and unnecessary antibiotic prescription. The objectives of treatment are: the reduction of symptoms, reduce the contagious period, and prevent local suppurative and systemic complications. Ideally, only confirmed cases should receive antibiotics. If there is no possibility to perform a rapid antigen-detection test, or in some cases if the result is negative, it is recommended to perform a culture and, if there is high suspicious index, to prescribe antibiotics. Penicillin is the treatment of choice, although amoxicillin is also accepted as the first option. Amoxicillin/clavulanate is not indicated in any case as empirical treatment. Macrolides are not a first choice antibiotic, and should be reserved for those patients with immediate penicillin allergy reaction or for the treatment of streptococcal carriers. It is of primordial importance to adapt the prescribing of antibiotics to the scientific evidence.
Subject(s)
Pharyngitis/diagnosis , Pharyngitis/drug therapy , Tonsillitis/diagnosis , Tonsillitis/drug therapy , Acute Disease , Algorithms , Child , Humans , Pharyngitis/complications , Practice Guidelines as Topic , Tonsillitis/complicationsABSTRACT
Recognizing the patients believes and attitudes towards their disease and treatment as well as facilitating basic information are essential for a satisfactory compliance. In this respect, and in order to know the state of things, personal interviews were carried out following a pre-established protocol and evaluating the degree of acceptance of information oriented to the outpatient. Two hundred and seven questionnaires were collected. Populations mean age was 50 years, 60% were women and there was a high percentage of illiterate patients or with only primary school level (69.8%), with a medium-low social status (98%). In general, they were aware of the indication of treatment (80%) although 56% of patients did not know the consequences of a poor control of their disease. Seventy eight percent wished to receive more information and 147 (96%) patients preferred the physician as the provider of it. The opinion regarding the information leaflets oriented towards the outpatient was unanimously favorable being the most interesting aspects those regarding the instructions on the use of drugs and adverse effects. The educational level was the factor influencing most significantly the patient's attitude. We conclude saying that in order to carry out a pharmacological treatment educational program it is necessary to evaluate the knowledge, needs and attitudes of the population towards whom it is directed.
