ABSTRACT
COVID-19 has proven to be particularly aggressive in patients with chronic kidney disease (CKD). The lower immune response rate and the greater susceptibility to progress to severe forms of the disease have contributed to this phenomenon, which has persisted in the post-vaccination era of the pandemic. Paradoxically, CKD has been excluded from most clinical trials of the main therapeutic tools developed against SARS-CoV-2. However, experience in the use of these drugs has been accumulating in different stages of CKD, supporting their use with guarantees of efficacy and safety. The objective of this review is to gather all treatment indications for COVID-19 in the different phases of the disease, tailored to CKD in its various stages, including renal replacement therapy.
Subject(s)
COVID-19 , Renal Insufficiency, Chronic , Humans , COVID-19/complications , COVID-19/prevention & control , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/therapy , Antiviral Agents/therapeutic use , COVID-19 Drug Treatment , SARS-CoV-2 , Renal Replacement Therapy , COVID-19 VaccinesABSTRACT
La COVID-19 ha demostrado ser especialmente agresiva con los pacientes con enfermedad renal crónica (ERC). La menor tasa de respuesta inmunológica y la mayor facilidad para la progresión a formas graves de enfermedad ha propiciado este hecho, que se ha mantenido en la era posvacunal de la pandemia. Paradójicamente, la ERC ha sido excluida de la mayoría de los ensayos clínicos de las principales herramientas terapéuticas desarrolladas frente a SARS-CoV-2. Sin embargo, se ha ido reuniendo experiencia de uso de estos fármacos en distintos estadios de la ERC que avala su uso con garantías de eficacia y seguridad. El objetivo de esta revisión es reunir todas las indicaciones de tratamiento frente a la COVID-19 en los distintos estadios de la enfermedad adaptadas a la ERC en sus distintas fases, incluyendo el tratamiento sustitutivo renal.(AU)
COVID-19 has proven to be particularly aggressive in patients with chronic kidney disease (CKD). The lower immune response rate and the greater susceptibility to progress to severe forms of the disease have contributed to this phenomenon, which has persisted in the post-vaccination era of the pandemic. Paradoxically, CKD has been excluded from most clinical trials of the main therapeutic tools developed against SARS-CoV-2. However, experience in the use of these drugs has been accumulating in different stages of CKD, supporting their use with guarantees of efficacy and safety. The objective of this review is to gather all treatment indications for COVID-19 in the different phases of the disease, tailored to CKD in its various stages, including renal replacement therapy.(AU)
Subject(s)
Male , Female , /prevention & control , Renal Insufficiency, Chronic/drug therapy , Renal Insufficiency, Chronic/prevention & control , /drug therapy , /epidemiology , Nephrology , Kidney Diseases/drug therapy , Antibiotic ProphylaxisABSTRACT
Objetivo: Describir la epidemiología y hallazgos en tomografía computarizada (TC) de las infecciones pulmonares por micobacterias no tuberculosas (IPMNT) y su evolución según el tratamiento. Material y métodos: Estudio retrospectivo de 131 pacientes consecutivos con cultivos positivos para micobacterias no tuberculosas (MNT) entre 2005 y 2016. Se seleccionaron los que cumplían con los criterios diagnósticos de IPMNT. Se analizaron los datos epidemiológicos, clínicos, microbiológicos, radiológicos, el tratamiento recibido y la evolución en función de este. Resultados: Se incluyeron 34 pacientes con una edad media de 55 años, el 67,6% hombres. El 50% estaba inmunodeprimido (VIH positivos, el 58,8%); el 20,6% tenía EPOC; el 5,9%, neoplasias conocidas; el 5,9%, fibrosis quística; y el 29,4% no presentaba comorbilidades. El 20,6% presentaba antecedentes de tuberculosis y el 20,6% estaba infectado por otros microorganismos. Mycobacterium avium complex fue el germen más frecuentemente aislado (52,9%). Siete pacientes (20,6%) presentaron además infecciones por otros microorganismos. En la TC, los hallazgos más frecuentes fueron: nódulos (64,7%), patrón en árbol en brote (61,8%), nódulos centrolobulillares (44,1%), consolidaciones (41,2%), bronquiectasias (35,3%) y cavidades (32,4%). Se realizó un estudio comparativo de los hallazgos entre hombres y mujeres y entre pacientes inmunodeprimidos e inmunocompetentes. El 67,6% recibió antituberculostáticos (el 72% mostró mejoría) y el 20,6%, antibióticos convencionales (todos con mejoría radiológica). Conclusión: El diagnóstico de la IPMNT es complejo. Los hallazgos clínicos y radiológicos son inespecíficos y un porcentaje importante de pacientes puede presentar otras infecciones concomitantes.(AU)
Objective: To describe the epidemiology and CT findings for nontuberculous mycobacterial lung infections and outcomes depending on the treatment. Material and methods: We retrospectively studied 131 consecutive patients with positive cultures for nontuberculous mycobacteria between 2005 and 2016. We selected those who met the criteria for nontuberculous mycobacterial lung infection. We analyzed the epidemiologic data; clinical, microbiological, and radiological findings; treatment; and outcome according to treatment. Results: We included 34 patients (mean age, 55 y; 67.6% men); 50% were immunodepressed (58.8% of these were HIV+), 20.6% had COPD, 5.9% had known tumors, 5.9% had cystic fibrosis, and 29.4% had no comorbidities. We found that 20.6% had a history of tuberculosis and 20.6% were also infected with other microorganisms. Mycobacterium avium complex was the most frequently isolated germ (52.9%); 7 (20.6%) were also infected with other organisms. The most common CT findings were nodules (64.7%), tree-in-bud pattern (61.8%), centrilobular nodules (44.1%), consolidations (41.2%), bronchiectasis (35.3%), and cavities (32.4%). We compared findings between men and women and between immunodepressed and immunocompetent patients. Treatment was antituberculosis drugs in 67.6% of patients (72% of whom showed improvement) and conventional antibiotics in 20.6% (all of whom showed radiologic improvement). Conclusion: The diagnosis of nontuberculous mycobacterial lung infections is complex. The clinical and radiologic findings are nonspecific and a significant percentage of pateints can have other, concomitant infections.(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Lung Diseases, Fungal/diagnostic imaging , Lung Diseases, Fungal/epidemiology , Lung Diseases, Fungal/therapy , Immunocompromised Host , Nontuberculous Mycobacteria , Retrospective Studies , Tomography, X-Ray Computed , Medical RecordsABSTRACT
OBJECTIVE: To describe the epidemiology and CT findings for nontuberculous mycobacterial lung infections and outcomes depending on the treatment. MATERIAL AND METHODS: We retrospectively studied 131 consecutive patients with positive cultures for nontuberculous mycobacteria between 2005 and 2016. We selected those who met the criteria for nontuberculous mycobacterial lung infection. We analysed the epidemiologic data; clinical, microbiological, and radiological findings; treatment; and outcome according to treatment. RESULTS: We included 34 patients (mean age, 55 y; 67.6% men); 50% were immunodepressed (58.8% of these were HIV+), 20.6% had COPD, 5.9% had known tumors, 5.9% had cystic fibrosis, and 29.4% had no comorbidities. We found that 20.6% had a history of tuberculosis and 20.6% were also infected with other microorganisms. Mycobacterium avium complex was the most frequently isolated germ (52.9%); 7 (20.6%) were also infected with other organisms. The most common CT findings were nodules (64.7%), tree-in-bud pattern (61.8%), centrilobular nodules (44.1 %), consolidations (41.2%), bronchiectasis (35.3%), and cavities (32.4%). We compared findings between men and women and between immunodepressed and immunocompetent patients. Treatment was antituberculosis drugs in 67.6% of patients (72% of whom showed improvement) and conventional antibiotics in 20.6% (all of whom showed radiologic improvement). CONCLUSION: The diagnosis of nontuberculous mycobacterial lung infections is complex. The clinical and radiologic findings are nonspecific and a significant percentage of pateints can have other, concomitant infections.
Subject(s)
Cystic Fibrosis , Mycobacterium Infections, Nontuberculous , Pneumonia , Male , Humans , Female , Middle Aged , Nontuberculous Mycobacteria , Mycobacterium Infections, Nontuberculous/diagnostic imaging , Mycobacterium Infections, Nontuberculous/drug therapy , Retrospective Studies , Cystic Fibrosis/microbiology , Antitubercular Agents/therapeutic use , LungABSTRACT
58 years old male, with a history of lung squamous carcinoma undergoing chemotherapy, is admitted to the Internal Medicine ward due to chest pain that radiate to the cervical area and increases with ingestion. The pain is accompanied by low-grade fever, nausea, and general malaise. Differential diagnoses are ruled out by performing various complementary tests. Various differential diagnoses are ruled out by performing various complementary tests. Finally, a diagnosis is made. (AU)
Varón de 58 años con carcinoma escamoso de pulmón en tratamiento con quimioterapia, que ingresa en el servicio de Medicina Interna por dolor centrotorácico que irradia a la zona cervical y aumenta con la ingesta. Se acompaña de febrícula, náuseas y malestar general. Diversos diagnósticos diferenciales son descartados mediante la realización de diversas pruebas complementarias, llegándose finalmente a un diagnóstico. (AU)
Subject(s)
Humans , Male , Middle Aged , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/drug therapy , Chest Pain , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/drug therapy , Diagnosis, DifferentialABSTRACT
Objectives: To assess the efficacy of long-term treatment with nebulized colistin in reducing the number of respiratory infections, emergency consultations and hospitalizations in oncological patients.MethodsA retrospective, observational, single-centre study including patients with solid or haematologic malignancies, or pulmonary GVHD after HSTC who received treatment with nebulized colistin for at least six-months to prevent recurrent respiratory infections (July 2010 to June 2017).ResultsTwelve patients were included (median age: 54.4, range: 2385), 7 with solid malignancies and 5 with haematologic malignancies (2 with pulmonary GVHD). Pseudomonas aeruginosa was the most frequent microorganism in sputum cultures (11/12 patients), all strains were susceptible to colistin. There was a statistically significant reduction (p=0.01) in respiratory infections in the six-month period after starting colistin (median: 1, range: 04) compared to the six-month period before (median: 4, range: 18). There was also a reduction in emergency consultations (precolistin: median: 1.50, range: 03; postcolistin: median: 0, range: 03) and hospitalizations (precolistin: median: 1.50, range: 03; postcolistin: median: 0, range: 03) due to respiratory infections. No colistin-resistant strains were identified.ConclusionsLong-term treatment with nebulized colistin may be useful to reduce the number of exacerbations in oncological patients with recurrent respiratory infections. (AU)
Objetivos: Evaluar la eficacia de un tratamiento prolongado con colistina nebulizada para reducir el número de infecciones respiratorias, consultas en Urgencias y hospitalizaciones en pacientes oncológicos.MétodosEstudio retrospectivo, observacional y unicéntrico en pacientes con neoplasias sólidas o hematológicas o EICR pulmonar tras TPH tratados con colistina nebulizada al menos 6 meses para prevenir infecciones respiratorias recurrentes (julio del 2010-junio del 2017).ResultadosSe incluyó a 12 pacientes (edad mediana 54,4, rango: 23-85), 7 con cáncer sólido y 5 con neoplasias hematológicas (2 con EICR pulmonar). El microorganismo aislado más frecuentemente en esputos fue Pseudomonasaeruginosa (11/12 pacientes); todas las cepas fueron colistina-sensibles. Se evidenciaron una reducción estadísticamente significativa (p = 0,01) de las infecciones respiratorias en los 6 meses tras iniciar colistina (mediana: 1, rango: 0-4) comparado con los 6 meses previos (mediana: 4, rango: 1-8), y una reducción del número de visitas a Urgencias (precolistina: mediana: 1,50, rango: 0-3; postcolistina: mediana: 0, rango: 0-3) y hospitalizaciones (precolistina: mediana: 1,50, rango: 0-3; postcolistina: mediana: 0, rango: 0-3) por infección respiratoria. No se detectaron cepas resistentes a colistina.ConclusionesUn tratamiento prolongado con colistina nebulizada puede ser útil para reducir el número de exacerbaciones en pacientes oncológicos con infecciones respiratorias recurrentes. (AU)
Subject(s)
Humans , Anti-Bacterial Agents/therapeutic use , Colistin/therapeutic use , Hematologic Neoplasms , Nebulizers and Vaporizers , Pseudomonas Infections/drug therapy , Pseudomonas aeruginosa , Treatment Outcome , Organization and Administration , Retrospective StudiesABSTRACT
Objetivos: La mayoría de los ensayos clínicos realizados sobre pacientes con cáncer escamoso anal (CEA) excluyen pacientes inmunodeprimidos. El objetivo del presente estudio es comparar las características y los resultados oncológicos entre pacientes con CEA inmunocomprometidos e inmunocompetentes. Métodos: Estudio multicéntrico comparativo retrospectivo que incluye 2 cohortes consecutivas de pacientes, inmunocomprometidos e inmunocompetentes, diagnosticados de carcinoma escamoso anal. Se han investigado las características de los pacientes, los tratamientos realizados, la respuesta clínica al tratamiento con quimiorradioterapia (QRT), la recidiva local o a distancia, la supervivencia global (SG) y la supervivencia libre de enfermedad (SLE). Resultados: De enero 2012 a diciembre 2017 hemos estudiado a 84 pacientes, 47 (55,6%) mujeres, afectos de CEA, de los cuales 22 (26%) han sido pacientes inmunocomprometidos y 62 (74%) inmunocompetentes. Los pacientes inmunocomprometidos fueron más jóvenes (53 vs. 61 años; p=0,001), con un menor tamaño tumoral (p=0,044), y presentaban un mayor consumo de tabaco (p=0,034) y de drogas de uso parenteral (p=0,001). No se objetivaron diferencias significativas en los tratamientos administrados (p=0,301), tampoco difirió la respuesta clínica a la QRT (83 vs. 100%). Tampoco se observaron diferencias significativas en la supervivencia global (60 vs. 64%; p=0,756) o en la supervivencia libre de enfermedad a 5 años (SLE) (65 vs. 68%; p=0,338). Conclusiones: En el presente estudio no se observaron diferencias significativas en relación con los resultados oncológicos a largo plazo entre pacientes inmunocompetentes e inmunocomprometidos diagnosticados de CEA, con un grado de cumplimiento del tratamiento similar. Esta evidencia podría deberse al estrecho seguimiento y buen control terapéutico de pacientes infectados por HIV. (AU)
Objective: Most evidence, including recent randomized controlled trials, analysing anal squamous cell carcinoma (SCC) do not consider immunocompromise patient population. The aim of this study was to compare clinical and oncological outcomes among immunocompetent and immunocompromised patients with anal squamous cell carcinoma. Method: Multicentric retrospective comparative study including 2 cohorts of consecutive patients, immunocompetent and immunocompromised, diagnosed with anal SCC. This study evaluated clinical characteristics, clinical response to radical chemoradiotherapy (CRT) and long-term oncological results including both local and distant recurrence, overall survival (OS) and disease-free survival (DFS). Results: A total of 84 patients, 47 (55.6%) female, diagnosed with anal SCC from January 2012 to December 2017 were included, 22 (26%) and 62 (74%) patients in immunocompromised and immunocompetent groups respectively. Patients in immunocompromised group were significantly younger (53 vs. 61 years; P=0.001), with smaller tumoral size (P=0.044) and reported higher rates of substance abuse.including tobacco use (P=0.034) and parenteral drug consumption (P=0.001). No differences were found in administered therapies (P=301) neither in clinical response to chemoradiotherapy (83 vs. 100%). Moreover, similar 5-year OS (60 vs. 64%; P=0.756) and DFS (65 vs. 68%; P=0.338) were observed. Conclusion: The present study shows no significant differences in long-term oncological results among immunocompetent and immunocompromised patients diagnosed with anal SCC, with a similar oncologic treatment. This evidence might be explained due to the close monitoring and adequate therapeutic control of HIV positive patients. (AU)
Subject(s)
Humans , Male , Middle Aged , Aged , Carcinoma, Squamous Cell , Anal Canal , Immunocompromised Host , Retrospective Studies , Survival AnalysisABSTRACT
OBJECTIVE: Most evidence, including recent randomized controlled trials, analysing anal squamous cell carcinoma (SCC) do not consider immunocompromise patient population. The aim of this study was to compare clinical and oncological outcomes among immunocompetent and immunocompromised patients with anal squamous cell carcinoma. METHOD: Multicentric retrospective comparative study including 2 cohorts of consecutive patients, immunocompetent and immunocompromised, diagnosed with anal SCC. This study evaluated clinical characteristics, clinical response to radical chemoradiotherapy (CRT) and long-term oncological results including both local and distant recurrence, overall survival (OS) and disease-free survival (DFS). RESULTS: A total of 84 patients, 47 (55.6%) female, diagnosed with anal SCC from January 2012 to December 2017 were included, 22 (26%) and 62 (74%) patients in immunocompromised and immunocompetent groups respectively. Patients in immunocompromised group were significantly younger (53 vs. 61 years; P = 0.001), with smaller tumoral size (P = 0.044) and reported higher rates of substance abuse including tobacco use (P = 0.034) and parenteral drug consumption (P = 0.001). No differences were found in administered therapies (P = 301) neither in clinical response to chemoradiotherapy (83 vs. 100%). Moreover, similar 5-year OS (60 vs. 64%; P = 0.756) and DFS (65 vs. 68%; P = 0.338) were observed. CONCLUSION: The present study shows no significant differences in long-term oncological results among immunocompetent and immunocompromised patients diagnosed with anal SCC, with a similar oncologic treatment. This evidence might be explained due to the close monitoring and adequate therapeutic control of HIV positive patients.
Subject(s)
Anus Neoplasms , Carcinoma, Squamous Cell , Humans , Female , Male , Retrospective Studies , Anus Neoplasms/therapy , Anus Neoplasms/pathology , Carcinoma, Squamous Cell/therapy , Chemoradiotherapy/methods , Immunocompromised HostABSTRACT
OBJECTIVES: To assess the efficacy of long-term treatment with nebulized colistin in reducing the number of respiratory infections, emergency consultations and hospitalizations in oncological patients. METHODS: A retrospective, observational, single-centre study including patients with solid or haematologic malignancies, or pulmonary GVHD after HSTC who received treatment with nebulized colistin for at least six-months to prevent recurrent respiratory infections (July 2010 to June 2017). RESULTS: Twelve patients were included (median age: 54.4, range: 23-85), 7 with solid malignancies and 5 with haematologic malignancies (2 with pulmonary GVHD). Pseudomonas aeruginosa was the most frequent microorganism in sputum cultures (11/12 patients), all strains were susceptible to colistin. There was a statistically significant reduction (p=0.01) in respiratory infections in the six-month period after starting colistin (median: 1, range: 0-4) compared to the six-month period before (median: 4, range: 1-8). There was also a reduction in emergency consultations (precolistin: median: 1.50, range: 0-3; postcolistin: median: 0, range: 0-3) and hospitalizations (precolistin: median: 1.50, range: 0-3; postcolistin: median: 0, range: 0-3) due to respiratory infections. No colistin-resistant strains were identified. CONCLUSIONS: Long-term treatment with nebulized colistin may be useful to reduce the number of exacerbations in oncological patients with recurrent respiratory infections.
Subject(s)
Graft vs Host Disease , Hematologic Neoplasms , Pseudomonas Infections , Respiratory Tract Infections , Humans , Middle Aged , Colistin/therapeutic use , Pseudomonas Infections/drug therapy , Retrospective Studies , Graft vs Host Disease/drug therapy , Administration, Inhalation , Anti-Bacterial Agents/therapeutic use , Nebulizers and Vaporizers , Pseudomonas aeruginosa , Respiratory Tract Infections/drug therapy , Treatment OutcomeABSTRACT
OBJECTIVE: Most evidence, including recent randomized controlled trials, analysing anal squamous cell carcinoma (SCC) do not consider immunocompromise patient population. The aim of this study was to compare clinical and oncological outcomes among immunocompetent and immunocompromised patients with anal squamous cell carcinoma. METHOD: Multicentric retrospective comparative study including 2 cohorts of consecutive patients, immunocompetent and immunocompromised, diagnosed with anal SCC. This study evaluated clinical characteristics, clinical response to radical chemoradiotherapy (CRT) and long-term oncological results including both local and distant recurrence, overall survival (OS) and disease-free survival (DFS). RESULTS: A total of 84 patients, 47 (55.6%) female, diagnosed with anal SCC from January 2012 to December 2017 were included, 22 (26%) and 62 (74%) patients in immunocompromised and immunocompetent groups respectively. Patients in immunocompromised group were significantly younger (53 vs. 61 years; P=0.001), with smaller tumoral size (P=0.044) and reported higher rates of substance abuse. including tobacco use (P=0.034) and parenteral drug consumption (P=0.001). No differences were found in administered therapies (P=301) neither in clinical response to chemoradiotherapy (83 vs. 100%). Moreover, similar 5-year OS (60 vs. 64%; P=0.756) and DFS (65 vs. 68%; P=0.338) were observed. CONCLUSION: The present study shows no significant differences in long-term oncological results among immunocompetent and immunocompromised patients diagnosed with anal SCC, with a similar oncologic treatment. This evidence might be explained due to the close monitoring and adequate therapeutic control of HIV positive patients.
ABSTRACT
Leuconostoc spp es una bacteria tipo coco gram-positivo; recientemente se ha demostrado su potencial patógeno, sobre todo en pacientes inmunodeprimidos y con factores de riesgo como la patología oncológica. Dentro de los cuadros clínicos que pueden producir destacan: neumonía, meningitis, endocarditis o bacteriemia, siendo estas últimas las más frecuentes. Cabe destacar su resistencia intrínseca al tratamiento con vancomicina, siendo el tratamiento de elección en estos casos la penicilina y otros fármacos pertenecientes al grupo de los beta-lactámicos. (AU)
Leuconostoc spp is a gram-positive bacterium which pathogenic potential has been recently demonstrated, especially in immunocompromised patients and in those with risk factors la oncologic diseases. It can cause infections presented as pneumonia, meningitis, endocarditis or bacteremia, being the last two the most frequent ones. It can be highlighted its intrinsic resistance to vancomycin, which makes penicillin and other beta-lactam antibiotics the first treatment options. (AU)
Subject(s)
Humans , Leuconostoc , Vancomycin , Immunocompromised Host , Neoplasms , BacteremiaABSTRACT
The SARS-CoV-2 (Covid-19) coronavirus pandemic is evolving very quickly and means a special risk for both immunosuppressed and comorbid patients. Knowledge about this growing infection is also increasing although many uncertainties remain, especially in the kidney transplant population. This manuscript presents a proposal for action with general and specific recommendations to protect and prevent infection in this vulnerable population such as kidney transplant recipients.
Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Immunocompromised Host , Kidney , Pandemics/prevention & control , Patient Education as Topic , Pneumonia, Viral/prevention & control , Transplant Recipients , COVID-19 , Comorbidity , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Humans , Immunosuppressive Agents/therapeutic use , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Risk Factors , SARS-CoV-2 , SpainABSTRACT
Invasive yeast diseases are uncommon nowadays in solid organ transplant recipients. Invasive candidiasis (2%) usually presents during the first month after transplantation in patients with risk factors. Both common and transplant-specific risk factors have been identified, allowing very efficacious targeted prophylaxis strategies. The most common clinical presentations are fungaemia and local infections near the transplantation area. Cryptococcosis is usually a late infection. Its incidence remains stable and the specific risk factors have not been identified. When cryptococcosis is detected very early, transmission with the allograft should be considered. The most common clinical presentations include meningitis, pneumonia, and disseminated infection. Intracranial hypertension and immune reconstitution syndrome have to be considered. No therapeutic clinical trials have been conducted in solid organ transplant recipients, thus treatment recommendations are derived from data obtained from the general population. It is particularly important to consider the possibility of drug-drug interactions, mainly between azoles and calcineurin inhibitors. Both invasive candidiasis and cryptococcosis increase the mortality significantly in solid organ transplant recipients.
Subject(s)
Invasive Fungal Infections , Organ Transplantation , Postoperative Complications/microbiology , Antifungal Agents/therapeutic use , Candidiasis, Invasive/diagnosis , Candidiasis, Invasive/drug therapy , Cryptococcosis/diagnosis , Cryptococcosis/drug therapy , Humans , Invasive Fungal Infections/diagnosis , Invasive Fungal Infections/drug therapy , Invasive Fungal Infections/epidemiology , Postoperative Complications/diagnosis , Postoperative Complications/drug therapy , Postoperative Complications/epidemiology , Practice Guidelines as Topic , Risk FactorsABSTRACT
INTRODUCTION AND OBJECTIVES: Cutaneous leishmaniasis is the most common form of leishmaniasis, which is endemic in Spain. The aim of this study was to evaluate the epidemiological and clinical characteristics of cutaneous leishmaniasis seen in our hospital over a period of 20 years, with a particular focus on clinical differences according to immune status and origin of infection MATERIALS AND METHODS: We performed a chart review of 67 cases of cutaneous leishmaniasis diagnosed between 1992 and 2012. Follow-up data were available for 54 patients. RESULTS: Fifty-four patients with cutaneous leishmaniasis were included in the study. Of these, 26 had been diagnosed between 1992 and 2002 and 28 between 2003 and 2012. The mean age at diagnosis was 49 years, there was a predominance of male patients, and the mean time from onset of symptoms to consultation was 3 months. The most common clinical manifestations were plaques and ulcers. Most of the immunodepressed patients and patients with imported leishmaniasis had skin ulcers and/or multiple lesions. During the first decade of the study, diagnosis was based on clinical and histologic findings. These were supported by molecular techniques in the second decade. Pentavalent antimonials were the treatment of choice, producing good results and very few adverse effects CONCLUSION: The number of patients with cutaneous leishmaniasis and with compromised immune status was similar in the periods 1992-2002 and 2003-2013, but more cases of imported leishmaniasis were diagnosed in the second period. Patients with ulcers and/or multiple lesions should be evaluated to rule out immunosuppression or infection by Leishmania species from other parts of the world. Both systemic and intralesional meglumine antimonate was effective and safe.
Subject(s)
Leishmaniasis, Cutaneous/epidemiology , Adolescent , Adult , Africa, Northern/ethnology , Aged , Antiprotozoal Agents/therapeutic use , Comorbidity , Emigrants and Immigrants , Endemic Diseases , Female , HIV Infections/epidemiology , Humans , Immunocompromised Host , Latin America/ethnology , Leishmaniasis, Cutaneous/drug therapy , Male , Meglumine/therapeutic use , Meglumine Antimoniate , Middle Aged , Organometallic Compounds/therapeutic use , Retrospective Studies , Spain/epidemiology , Tertiary Care Centers , Young AdultABSTRACT
INTRODUCTION: Respiratory syncytial virus (RSV) infection is associated with an increase in morbidity and mortality in immunocompromised hosts. METHODS: A description is presented of all cases of RSV infection in immunocompromised pediatric patients in Hematology and Oncology and Immunodeficiency Units between 2008 and 2012. RESULTS: Nineteen patients were diagnosed with RSV infection. Nine patients required in-patient care and 2 required Pediatric Intensive Care Unit. Five patients were treated with specific therapy (ribavirin ± palivizumab). No deaths occurred in the study period. CONCLUSION: RSV infection may be severe in immunocompromised pediatric patients.
Subject(s)
Respiratory Syncytial Virus Infections , Adolescent , Child , Child, Preschool , Female , Hospitals, Pediatric , Humans , Immunocompromised Host , Infant , Male , Respiratory Syncytial Virus Infections/diagnosis , Respiratory Syncytial Virus Infections/drug therapy , Retrospective StudiesABSTRACT
Penicilliosis is an opportunistic infection in HIV-infected and other immunocompromised patients mostly in Southeast Asia, Southern China, Hong Kong, and Taiwan, with respiratory manifestations in about one-third of patients. We report the case of a 26-year-old non-HIV immunocompromised patient presenting with an airway obstruction caused by penicilliosis, together with a review of the literature of this rare condition.
Subject(s)
Airway Obstruction/etiology , Lung Diseases, Fungal/complications , Opportunistic Infections/complications , Penicillium/isolation & purification , Adult , Amphotericin B/therapeutic use , Bronchoscopy , Humans , Immunocompromised Host , Itraconazole/therapeutic use , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/microbiology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/drug therapy , Male , Mycobacterium Infections, Nontuberculous/etiology , Opportunistic Infections/drug therapy , Opportunistic Infections/microbiologyABSTRACT
Objetivos: El linfoma primario del sistema nervioso central (LPSNC) es una entidad rara con un pronóstico fatal. Dado el aumento en el número de casos con inmunosupresión adquirida, nuestros objetivos son estudiar las características epidemiológicas y neurorradiológicas de aquellos pacientes inmunodeprimidos con diagnóstico de LPSNC con afectación cerebral e investigar si existen diferencias entre los pacientes con el virus de la inmunodeficiencia humana (VIH) positivo y negativo.Materiales y métodos: Se realizó un estudio descriptivo y retrospectivo de los pacientes inmunodeprimidos con afectación cerebral por LPSNC, diagnosticados durante los últimos 13 años en 2 hospitales de referencia. Se evaluaron múltiples variables. El nivel de significación estadística utilizado fue p < 0,05.Resultados: El grupo VIH-positivo tenía una media de edad de 36,82 ± 5,4 años, frente a los55,60 ± 21,43 años de los pacientes VIH-negativo (p < 0,022). Los pacientes VIH-positivo tuvieron una media de 1,27 ± 0,65 lesiones por paciente, mientras que en el grupo VIH-negativo fue de 2,60 ± 1,78 (p < 0,039). El 18,2% (n = 2) del grupo VIH-positivo y el 80% (n = 8) del grupo VIH-negativo presentaron lesiones homogéneas (p < 0,005). Ningún paciente VIH-positivo tuvo afectación del cuerpo calloso, pero el grupo VIH-negativo presentó un 50% (n = 5) de afectación(p < 0,012).Conclusiones: El LPSNC en pacientes inmunodeprimidos puede presentar múltiples características en las imágenes. Existen diferencias entre los pacientes VIH positivo y negativo, por lo que es importante reconocerlas para establecer un manejo y tratamiento diferente entre ambos grupos.
Purposes: Primary central nervous system lymphoma (PCNSL) is a rare tumour with poor prognosis. Due to the increased number of patients with acquired immunodeficiency, our purposes are to describe epidemiological and imaging findings in immunodeficient patients with PCNSL of the brain and to study the differences between HIV-positive and HIV-negative patients with PCNSL.Materials and methods: A retrospective, descriptive study was performed with immunodeficient patients diagnosed of PCNSL of the brain during the last 13 years in two reference hospitals. Twenty-one patients fulfilled the inclusion criteria. Multiple variables were evaluated. Significance was defined as p<0.05.Results: HIV-positive group was a mean age of 36,82±5,4 years and the mean age in HIV-negative group was 55,60±21,43 years (p<0,022). The mean number of lesions was 1,27±0,65 in HIV-positive group and 2,60±1,78 in HIV-negative group (p<0,039). The lesions were homogeneous in 18,2% (n=2) HIV-positive group and 80% (n=8) in HIV-negative group (p<0,005). No HIV-positive patient and 50% (n=5) of HIV-negative patients showed corpus callosum involvement (p<0,012).Conclusions: PCNSL in immunodeficient patients is associated with a large spectrum of radiological findings. There were differences between HIV-positive and HIV-negative patients, is important recognize these differences as the therapeutic management of these two groups vary.
Subject(s)
Male , Female , Cerebrum , Lymphoma , HIV , Lymphoma, Non-Hodgkin , Magnetic Resonance Imaging , Neuroimaging , PatientsABSTRACT
Objetivos: El linfoma primario del sistema nervioso central (LPSNC) es una entidad rara con un pronóstico fatal. Dado el aumento en el número de casos con inmunosupresión adquirida, nuestros objetivos son estudiar las características epidemiológicas y neurorradiológicas de aquellos pacientes inmunodeprimidos con diagnóstico de LPSNC con afectación cerebral e investigar si existen diferencias entre los pacientes con el virus de la inmunodefi ciencia humana (VIH) positivo y negativo. Materiales y métodos: Se realizó un estudio descriptivo y retrospectivo de los pacientes inmunodeprimidos con afectación cerebral por LPSNC, diagnosticados durante los últimos 13 años en 2 hospitales de referencia. Se evaluaron múltiples variables. El nivel de significación estadística utilizado fue p < 0,05. Resultados: El grupo VIH-positivo tenía una media de edad de 36,82 ± 5,4 años, frente a los 55,60 ± 21,43 años de los pacientes VIH-negativo (p < 0,022). Los pacientes VIH-positivo tuvieron una media de 1,27 ± 0,65 lesiones por paciente, mientras que en el grupo VIH-negativo fue de 2,60 ± 1,78 (p < 0,039). El 18,2% (n = 2) del grupo VIH-positivo y el 80% (n = 8) del grupo VIH-negativo presentaron lesiones homogéneas (p < 0,005). Ningún paciente VIH-positivo tuvo afectación del cuerpo calloso, pero el grupo VIH-negativo presentó un 50% (n = 5) de afectación (p < 0,012). Conclusiones: El LPSNC en pacientes inmunodeprimidos puede presentar múltiples características en las imágenes. Existen diferencias entre los pacientes VIH positivo y negativo, por lo que es importante reconocerlas para establecer un manejo y tratamiento diferente entre ambos grupos.(AU)
Purposes: Primary central nervous system lymphoma (PCNSL) is a rare tumour with poor prognosis. Due to the increased number of patients with acquired immunodeficiency, our purposes are to describe epidemiological and imaging findings in immunodeficient patients with PCNSL of the brain and to study the differences between HIV-positive and HIV-negative patients with PCNSL. Materials and methods: A retrospective, descriptive study was performed with immunodeficient patients diagnosed of PCNSL of the brain during the last 13 years in two reference hospitals. Twenty-one patients fulfilled the inclusion criteria. Multiple variables were evaluated. Significance was defined as p<0.05. Results: HIV-positive group was a mean age of 36,82±5,4 years and the mean age in HIV-negative group was 55,60±21,43 years (p<0,022). The mean number of lesions was 1,27±0,65 in HIV-positive group and 2,60±1,78 in HIV-negative group (p<0,039). The lesions were homogeneous in 18,2% (n=2) HIV-positive group and 80% (n=8) in HIV-negative group (p<0,005). No HIV-positive patient and 50% (n=5) of HIV-negative patients showed corpus callosum involvement (p<0,012). Conclusions: PCNSL in immunodeficient patients is associated with a large spectrum of radiological findings. There were differences between HIV-positive and HIV-negative patients, is important recognize these differences as the therapeutic management of these two groups vary.(AU)
ABSTRACT
Fundamento: La criptococosis meníngea es una enfermedad oportunista que resurge en las últimas décadas, asociada a la inmunodepresión. Esta patología puede ser ignorada y no diagnosticarse si no existe el conocimiento y la sospecha de su presencia, y debido a esto confundirse con otras causas de meningoencefalitis lo que favorece errores de terapéutica, impide la curación, y provoca complicaciones o la muerte en los casos más severos. Presentación de caso: Se presenta el caso de una paciente femenina de 75 años, de raza negra, con antecedentes de paludismo que acude a consulta por pérdida de la sensibilidad y la motilidad y cefalea. Se le diagnosticó criptococosis meníngea y sida con el estudio del líquido cefalorraquídeo y las diferentes pruebas para VIH. Recibió tratamiento médico con antimicóticos y antirretrovirales Conclusiones: El diagnóstico certero más la combinación de medicamentos antimicóticos y antirretrovirales fueron la base del éxito para salvar la vida de esta paciente y la regresión de la mayoría de los síntomas neurológicos(AU)
Background: Cryptococcal meningitis is an opportunistic disease that re-emerged in recent decades, associated with immunosuppression. This disease can be ignored and undiagnosed if one does not have the knowledge and suspicion of its presence, a situation that causes confusion with other causes of meningitis and brings about therapeutic errors, prevents healing and causes complications or death in severe cases. Case presentation: A female black patient 75 year-old patient with a history of malaria comes to consultation due to loss of sensitivity and motility, and headache. She had diagnoses of AIDS and cryptococcal meningitis through the study of cerebrospinal fluid and various tests to detect HIV. Treatment with antifungal and antiretroviral drugs was prescribed. Conclusions: An accurate diagnosis and the combination of antifungal and antiretroviral drugs were effective in saving the patients life and regressing most of her neurological symptoms(AU)
