ABSTRACT
Saprochaete capitata is a yeast-like fungus of the Dipodascaceae family, capable of colonizing the skin and the respiratory and gastrointestinal tracts. We present a 56-year-old man with diabetes mellitus who was admitted to the hospital presenting with fever, cough and hemoptysis. The diagnosis of necrotizing pneumonia was made by direct microscopy of the bronchoalveolar lavage fluid showed and Saprochaete capitata was identified by Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight (MALDI-TOF MS®). Treatment consisted of itraconazole 200 mg every 12 hours orally for 30 days, leading to clinical and radiological improvement. Saprochaete capitata infection is a rare cause of pulmonary mycoses.
ABSTRACT
Pulmonary histoplasmosis is caused by inhaling Histoplasma capsulatum. Less than 1% develops the disease. Risk factors in immunocompetent individuals are environmental exposures in endemic areas. The objective of this study is to determine the frequency, clinical, and microbiological characteristics in immunocompetent patients. A retrospective case series study of patients diagnosed with pulmonary histoplasmosis was performed in a respiratory care unit in Mexico City from 2000 to 2020. Each patient had bronchial lavage, and three patients underwent thoracoscopy for the lung tissue sample taken for the culture in Sabouraud Dextrose Agar. Twelve patients were identified, 8 males and 4 females; the predominant symptoms were fever (83%), dyspnea (75%), chest pain (66%), hemoptysis (41%), and weight loss (33%). The computed tomography of the chest showed the following findings: patchy consolidation 12 (100%), hilar adenopathy 6 (50%), pleural effusion 6 (50%), caverns 3 (25%), and solitary pulmonary nodule in one patient (8%). Histoplasma capsulatum was found in the culture of all twelve patients. The signs and symptoms of the disease are mediated by the immune status of the host. The clinical picture is often confused with systemic diseases. It is important to have a high degree of clinical suspicion to make a timely diagnosis.
ABSTRACT
INTRODUCTION: Pulmonary aspergilloma is commonly associated with comorbidities that cause immunodeficiency such as diabetes mellitus, tuberculosis, human immunodeficiency virus/acquired immunodeficiency syndrome and/or a pre-existing parenchymal lung disease such as chronic obstructive pulmonary disease. Predisposing factors can further increase the risk of acquiring this mycosis. Our objective was to determine the frequency, clinical and microbiological characteristics of pulmonary aspergilloma in immunocompromised patients. METHODOLOGY: Retrospective case series of patients diagnosed with pulmonary aspergilloma in a respiratory care unit in Mexico City from 2000 to 2019 was studied. Bronchoalveolar lavage cultures on Sabouraud-dextrose agar and serum galactomannan determination were performed on each patient. RESULTS: We identified twenty-four patients with pulmonary aspergilloma (sixteen male and eight female), thirteen had a history of tuberculosis (54%), seven of diabetes mellitus (29%), three of human immunodeficiency virus/acquired immunodeficiency syndrome (13%) and one of chronic obstructive pulmonary disease (4%). The most commonly reported symptoms were hemoptysis in eighteen patients (75%), dyspnea in sixteen patients (67%) and chest pain in thirteen patients (54%). Aspergillus fumigatus was identified in all cultures and galactomannan was positive in 21 serum samples (87%). CONCLUSIONS: Coexistence of diseases that could suppress the immune system predispose to pulmonary aspergilloma; clinical presentation is often confused with other systemic diseases. A high degree of clinical suspicion is important for early detection.
Subject(s)
Acquired Immunodeficiency Syndrome , Pulmonary Aspergillosis , Pulmonary Disease, Chronic Obstructive , Tuberculosis , Female , Humans , Immunocompromised Host , Male , Pulmonary Aspergillosis/complications , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/epidemiology , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/epidemiology , Respiratory Care Units , Retrospective Studies , Tuberculosis/complicationsABSTRACT
Seriously ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and hospitalized in intensive care units (ICUs) are commonly given a combination of drugs, a process known as multi-drug treatment. After extracting data on drug-drug interactions with clinical relevance from available online platforms, we hypothesize that an overall interaction map can be generated for all drugs administered. Furthermore, by combining this approach with simulations of cellular biochemical pathways, we may be able to explain the general clinical outcome. Finally, we postulate that by applying this strategy retrospectively to a cohort of patients hospitalized in ICU, a prediction of the timing of developing acute kidney injury (AKI) could be made. Whether or not this approach can be extended to other diseases is uncertain. Still, we believe it represents a valuable pharmacological insight to help improve clinical outcomes for severely ill patients.
Subject(s)
Acute Kidney Injury , COVID-19 Drug Treatment , Acute Kidney Injury/drug therapy , Drug Interactions , Humans , Intensive Care Units , Retrospective Studies , SARS-CoV-2ABSTRACT
BACKGROUND: Crusted (Norwegian) scabies is a rare disease that occurs in patients with compromised immune system like patients with HIV/AIDS. We report 15 cases of crusted scabies in patients with HIV/AIDS successfully treated with oral ivermectin. CLINICAL CASES: The mean age of the patients was 43.7±8.06 and the diagnosis was made at a median of 5 months. All patients were diagnosed with HIV/AIDS treatment with antiretroviral therapy. Patients were treated with repeated doses of oral ivermectin with different schemes with good tolerance and efficacy with full resolution and without recurrence. CONCLUSIONS: Ivermectin is the treatment of choice for crusted scabies; it is tolerable and accessible to the patient. Immunosuppressed patients are those with the highest risk of acquiring that disease; we highlight the importance of lesion scraping to perform a correct and early diagnosis.
Introducción: la sarna costrosa (Noruega) es una enfermedad rara que se presenta en pacientes con un sistema inmunológico comprometido, como los pacientes con infección por VIH/SIDA. Reportamos 15 casos de sarna costrosa en pacientes con infección por VIH/SIDA tratados exitosamente con ivermectina oral. Casos clínicos: la media de edad de los pacientes fue de 43.7 ± 8.06 y el diagnóstico se hizo en una mediana de cinco meses. Todos los pacientes tenían diagnóstico de infección por VIH/SIDA en tratamiento con terapia antirretroviral. Los pacientes fueron tratados con dosis repetidas de ivermectina oral con diferentes esquemas; tuvieron una buena tolerancia y el tratamiento fue eficaz, pues hubo una resolución completa y sin recidiva. Conclusiones: la ivermectina es el tratamiento de elección de la sarna costrosa. Es un medicamento tolerable y accesible para el paciente. Los pacientes inmunosuprimidos son los que presentan más riesgo de contraerla; resaltamos la importancia del raspado de las lesiones para hacer un diagnóstico correcto y temprano.
Subject(s)
AIDS-Related Opportunistic Infections/diagnosis , Scabies/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Administration, Oral , Adult , Antiparasitic Agents/therapeutic use , Female , Humans , Ivermectin/therapeutic use , Male , Middle Aged , Scabies/drug therapyABSTRACT
Introducción: El género Candida comprende varias especies; en años recientes algunas como Candida glabrata ha incrementado su frecuencia con trascendencia clínica. Material y métodos: Se realizó un estudio para determinar la frecuencia de Candida glabrata en 468 pacientes con sintomatología clínica para candidosis vulvovaginal, así como la sensibilidad de la misma a fluconazol por métodos de difusión en agar con sensidiscos y microdilución en caldo. Resultados: La frecuencia para esta especie fue de 12.6 %. La resistencia de Candida glabrata al tratamiento con fluconazol se corroboró en este estudio: 68.2 % de las cepas fue resistente en pruebas de placas (sensidiscos) y 51.2 % en prueba de microdilución en caldo (método NCLSI), con una concentración mínima inhibitoria de 16 μg/ml. Conclusiones: La frecuencia de Candida glabrata se ha incrementado y presenta resistencia a los tratamientos habituales, lo que influye en la persistencia y recurrencia de infecciones genitales y sistémicas.
BACKGROUND: Candida genus has various species. The incidence of C. glabrata has presented itself with more frequency over the past years with clinical importance. METHODS: A case study was made to determine the frequency of C. glabrata in 468 patients who presented clinical symptomatology for vulvovaginal candidiasis and the in vitro response for fluconazole using two methods: diffusion in agar plates and microdilution in liquid medium [NCLSI (NCCLS) method]. RESULTS: The frequency for this specie was 12.6%, almost double the frequency observed 10 years ago. The resistance of C. glabrata to fluconazole treatment was confirmed in this study, representing 68.2% resistance in all strains on test plates and 51.2% on NCLSI method with a MIC of 16 microg/ml. Conclusions: The frequency of Candida glabrata has increased over the past years. It presents resistance to usual treatments, which promotes the persistence and recurrence of genital and systemic infections.
Subject(s)
Humans , Female , Adult , Middle Aged , Candida glabrata , Candidiasis, Vulvovaginal/microbiology , Opportunistic Infections/microbiology , Candidiasis, Vulvovaginal/drug therapy , Opportunistic Infections/drug therapy , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: Candida genus has various species. The incidence of C. glabrata has presented itself with more frequency over the past years with clinical importance. METHODS: A case study was made to determine the frequency of C. glabrata in 468 patients who presented clinical symptomatology for vulvovaginal candidiasis and the in vitro response for fluconazole using two methods: diffusion in agar plates and microdilution in liquid medium [NCLSI (NCCLS) method]. RESULTS: The frequency for this specie was 12.6%, almost double the frequency observed 10 years ago. The resistance of C. glabrata to fluconazole treatment was confirmed in this study, representing 68.2% resistance in all strains on test plates and 51.2% on NCLSI method with a MIC of 16 microg/ml. CONCLUSIONS: The frequency of Candida glabrata has increased over the past years. It presents resistance to usual treatments, which promotes the persistence and recurrence of genital and systemic infections.
