RESUMO
In this report we describe a case of cerebral phaeohyphomycosis involving a 56-year-old Egyptian male who worked as a mason in Kuwait for 6 years. Computerized tomography scan of the brain revealed presence of a large abscess in the left occipital lobe. Aspirated pus from the abscess showed branched, septate, hyphae with light brown pigmentation. Cultured pus grew the fungus Ramichloridium mackenziei. Despite amphotericin B (1 mg kg(-1) per day) therapy for 2 weeks, the patient expired. The isolate was later found to be resistant to amphotericin B ( > 32 microg ml(-1)). Antifungal susceptibility testing to other agents was also performed.
Assuntos
Anfotericina B/uso terapêutico , Ascomicetos/isolamento & purificação , Encefalopatias/microbiologia , Micoses/microbiologia , Antifúngicos/uso terapêutico , Encefalopatias/diagnóstico , Encefalopatias/tratamento farmacológico , Encefalopatias/cirurgia , Drenagem , Evolução Fatal , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Oriente Médio , Micoses/tratamento farmacológico , Micoses/cirurgiaRESUMO
Autoimmune hepatitis has a global distribution and affects all ages. Genetic factors strongly influence susceptibility, clinical expression, and treatment response. The diagnosis of autoimmune hepatitis has been codified by an international panel. An acute or fulminant presentation is recognized but not a cholestatic form. Subclassifications by predominant autoantibody profile have been proposed, but they lack etiologic and prognostic differences. Autoantibodies continue to be characterized to improve diagnostic specificity, predict outcome, and identify pertinent antigenic targets. Cytosolic enzymes are prime candidates as autoantigens. DRB1*0301 and DRB1*0401 are the susceptibility alleles in Caucasoid Northern Europeans and North Americans, and they also affect clinical expression and treatment outcome. Other autoimmune promoters affecting cytokine production and immunocyte activation may act in synergy with the susceptibility alleles to affect disease behavior. Cell-mediated and antibody-dependent forms of cytotoxicity are probably interactive pathogenic mechanisms, and novel site-specific therapies are feasible because these mechanisms are defined. Potent new immunosuppressive agents are emerging from the transplantation arena, but prednisone alone or in combination with azathioprine remains the mainstay of treatment. Corticosteroid therapy is effective but not ideal.
Assuntos
Hepatite Autoimune , Distribuição por Idade , Anti-Inflamatórios/uso terapêutico , Azatioprina/uso terapêutico , Causalidade , Quimioterapia Combinada , Europa (Continente)/epidemiologia , Predisposição Genética para Doença/genética , Saúde Global , Antígenos HLA-DR/genética , Cadeias HLA-DRB1 , Hepatite Autoimune/diagnóstico , Hepatite Autoimune/epidemiologia , Hepatite Autoimune/genética , Hepatite Autoimune/imunologia , Hepatite Autoimune/terapia , Humanos , Imunossupressores/uso terapêutico , Transplante de Fígado , América do Norte/epidemiologia , Valor Preditivo dos Testes , Prednisona/uso terapêutico , Prognóstico , Recidiva , Indução de Remissão/métodos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Healthcare workers (HCWs) have an occupational risk of infection with hepatitis C virus (HCV). However, data regarding the magnitude of this risk are limited. We conducted a prospective study on a cohort of 24 HCWs who were exposed to HCV by needlestick injuries involving 25 patients. All source patients were viremic with a mean HCV-RNA level of 1.65 megagenomic equivalents per milliliter. At least 64% of patients were infected with HCV serotype 4 (Simmond's classification). After a follow up period of at least 6 months, none of the exposed HCWs acquired HCV. Thus, HCV does not seem to be easily transmitted by needlestick injuries. However, further large-scale studies are needed for a more accurate estimation of the risk of transmission.
Assuntos
Acidentes de Trabalho , Hepatite C/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Adolescente , Adulto , Criança , Feminino , Seguimentos , Humanos , Kuweit , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Alfa-interferon is the standard treatment of chronic hepatitis B. However, the response rate varies widely in patients from different parts of the world, reflecting differences in the natural history of the disease and the immune reactivity of the population studied. The aim of this study is to assess the efficacy of alfa-interferon in the treatment of Kuwaiti patients with chronic replicative hepatitis B infection. Twenty-two adult Kuwaiti patients with biopsy-proven chronic hepatitis B were treated with alfa-interferon after an observation period of six months. All patients had abnormal transaminase levels and were HBeAg and HBV-DNA positive. Alfa-interferon-2b, 5 million units, was administered five days a week for 16 weeks. Patients were followed for at least 12 months after completing therapy. One of the 22 patients dropped out of the study after a single dose of interferon, because of side effects. Of the remaining 21 patients, three (14%) had a sustained loss of HBV-DNA and HBeAg. None of the patients lost HBsAg. There were no episodes of hepatic decompensation or deaths during the study. One patient developed hepatocellular carcinoma 28 months after completing treatment with interferon. Overall, Kuwaiti patients with chronic replicative hepatitis B responded poorly to interferon therapy.
