RESUMO
The effectiveness of splenic embolization (SE) in treating refractory immune thrombocytopenia (ITP) remains uncertain. A systematic literature review was undertaken to assess the effectiveness and safety of SE in treating both paediatric and adult patients with ITP. We conducted an extensive search employing predefined criteria. We extracted platelet counts at baseline and at multiple intervals following SE, along with details of the proportion of embolized spleen parenchyma and the proportion of patients exhibiting complete or partial platelet count responses. We identified nine eligible reports for the analysis of effectiveness (228 patients) and 15 reports for the safety analysis (151 patients). Pooled estimates of complete response (platelet count >100 × 109/L) and overall response (platelet count >30 × 109/L) were 50.1% (95% CI: 38-62.3) and 74.4% (95% CI: 64.9-83.9) respectively. Most studies applied an embolization of at least 60% of the spleen parenchyma. Nearly all the patients suffered from mild adverse events (AEs), 1.3% suffered from serious AEs and one patient died (0.7%). In conclusion, SE resulted in an overall response rate in 74.4% of patients with ITP. However, this finding derives from uncontrolled studies of low to moderate quality.
Assuntos
Embolização Terapêutica , Púrpura Trombocitopênica Idiopática , Baço , Humanos , Embolização Terapêutica/métodos , Púrpura Trombocitopênica Idiopática/terapia , Contagem de Plaquetas , Resultado do Tratamento , AdultoRESUMO
The epidemiology of West Nile virus (WNV) in Israel is different from other neighbouring countries in the Middle East where disease burden has been minimal. We analysed a cohort of Ashkenazi Jewish patients with symptomatic WNV infection (n = 39), and WNV-negative controls (n = 61), for nine genetic variants that has been suggested to be associated with susceptibility to WNV. Two single nucleotide polymorphisms were significantly more frequent in WNV-infected than non-infected individuals, rs7280422 (MX1) [odds ratio (OR) 4·05, 95% confidence interval (CI) 2·04-8·03, P < 0·001] and rs3213545 (OASL) (OR 1·85, 95% CI 1·03-3·3, P = 0·03). Genetic polymorphism may play a significant role in susceptibility to WNV infection in Ashkenazi Jews.
Assuntos
Predisposição Genética para Doença/genética , Judeus/genética , Febre do Nilo Ocidental/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Genótipo , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único/genética , Vírus do Nilo Ocidental , Adulto JovemRESUMO
In 1996 an outbreak of severe soft tissue infections caused by Vibrio vulnificus unexpectedly erupted in fish consumers in Israel with relatively little morbidity in fish farmers. To test the hypothesis that recurrent exposure of fishermen to the virulent strain may have provided protection against severe or symptomatic disease, we investigated the association between the immune response to V. vulnificus biotype 3 lipopolysaccharide (BT3 LPS) and disease susceptibility in fish farmers and fish consumers. Serum samples were tested for IgA and IgG of anti-BT3 LPS in fishermen and fish consumers who suffered from V. vulnificus BT3 infections and their matched controls. Pre-existing levels of IgG (IgG0) of anti-BT3 LPS were significantly lower in diseased fishermen who developed disease associated with the homologous biotype, compared to controls. In multivariate analysis, levels of IgG0 anti-BT3 LPS remained the only variable significantly associated with disease occurrence in fishermen. Higher levels of pre-existing IgG anti-BT 3 LPS antibodies may be associated with protection against severe or symptomatic disease with the homologous biotype in fishermen but not in subjects from the general public.
Assuntos
Anticorpos Antibacterianos/imunologia , Suscetibilidade a Doenças , Lipopolissacarídeos/imunologia , Vibrioses/imunologia , Vibrio vulnificus/imunologia , Estudos de Casos e Controles , Feminino , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Israel , Masculino , Pessoa de Meia-Idade , Soro/imunologia , Vibrioses/prevenção & controleRESUMO
In 1996, a major unexplained outbreak of systemic Vibrio vulnificus infection erupted among Israeli fish market workers. The origins of this emergent infectious disease have not been fully understood. A possible link between climate change and disease emergence is being investigated. Meteorological service data from 1981, the earliest detection and reporting of V. vulnificus for the time in Israel, to 1998 for two stations located within the main inland fish farm industry were analyzed. The 1996-1998 summers were identified as the hottest ever recorded in Israel in the previous 40 years. Time series of monthly minimum, maximum, and mean temperatures showed significant increase in the summer temperatures along the 18 years. The highest minimum temperature value was recorded in summer 1996. Lag correlation analysis revealed significant correlations between temperature values and hospital admission dates. The eruption appeared 25-30 days after the extreme heat conditions in summer 1996, at a lag of 3 weeks in summer 1997 while the results for 1998 were at a lag of less than a week. Higher significant results were detected for the daily minimum temperatures in summer 1996 compatible with the disease eruption. These findings suggest that high water temperature might have impacted the ecology of our study area and caused the emergence of the disease, as an effect of global climate change.
Assuntos
Clima , Surtos de Doenças , Vibrioses/epidemiologia , Vibrio vulnificus , Humanos , Israel/epidemiologia , Análise de Regressão , Estações do Ano , Temperatura , Fatores de Tempo , Vibrioses/etiologiaRESUMO
Encapsulated bacteria can cause severe infections following bone marrow transplantation, usually in patients with chronic graft-versus-host disease (GVHD). Presented here is the case of an allogenic bone marrow transplantation recipient with chronic GVHD who developed overwhelming pneumococcal sepsis 3 years following transplantation. One year earlier the male patient had developed non-meningococcal, non-gonococcal neisseria infection. The infection recurred repeatedly despite monthly replacement immunoglobulin prophylaxis. These infections were attributed to functional hyposplenism after a prominent number of Howell-Jolly bodies was noticed in a peripheral blood smear during the patient's most recent admission. The case report is followed by a discussion of the policy of administering antibiotic prophylaxis to patients with chronic GVHD.
Assuntos
Transplante de Medula Óssea/efeitos adversos , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/tratamento farmacológico , Choque Séptico/diagnóstico , Choque Séptico/tratamento farmacológico , Esplenopatias/diagnóstico , Adulto , Antibacterianos , Transplante de Medula Óssea/imunologia , Quimioterapia Combinada/administração & dosagem , Seguimentos , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/terapia , Humanos , Hidrocortisona/administração & dosagem , Leucemia Mielogênica Crônica BCR-ABL Positiva/diagnóstico , Leucemia Mielogênica Crônica BCR-ABL Positiva/cirurgia , Masculino , Infecções Pneumocócicas/complicações , Medição de Risco , Índice de Gravidade de Doença , Choque Séptico/complicações , Esplenopatias/complicações , Transplante Homólogo , Resultado do TratamentoRESUMO
The rarity of anaerobic gram-negative endocarditis limits the ability of physicians to define its prognosis. Two cases of endocarditis due to Bacteroidesfragilis are described, and a review of the English literature for all cases of anaerobic gram-negative endocarditis reported since 1940 is presented. The disease predominantly affects males. Clinical features are similar to those of endocarditis due to nonanaerobic organisms, but underlying heart disease is less common and the rate of thromboembolic complications is high. All deaths reported were due to Bacteroides spp.; no deaths due to Fusobacterium spp. have been reported. Treatment with metronidazole has dramatically improved the prognosis of patients with endocarditis due to anaerobic gram-negative bacilli.
Assuntos
Antibacterianos/administração & dosagem , Infecções por Bacteroides/diagnóstico , Bacteroides fragilis/isolamento & purificação , Endocardite Bacteriana/diagnóstico , Metronidazol/administração & dosagem , Idoso , Infecções por Bacteroides/tratamento farmacológico , Bacteroides fragilis/efeitos dos fármacos , Ecocardiografia Transesofagiana , Endocardite Bacteriana/tratamento farmacológico , Feminino , Seguimentos , Humanos , Infusões Intravenosas , Pessoa de Meia-Idade , Medição de Risco , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Hepatite/diagnóstico por imagem , Isquemia/diagnóstico por imagem , Fígado/diagnóstico por imagem , Fígado/metabolismo , Medronato de Tecnécio Tc 99m/farmacocinética , Doença Aguda , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Feminino , Hepatite/etiologia , Humanos , Isquemia/etiologia , Fígado/irrigação sanguínea , Cintilografia , Sensibilidade e EspecificidadeRESUMO
OBJECTIVES: The true incidence of post-splenectomy sepsis remains undetermined. METHODS: An English literature review on post-splenectomy sepsis was undertaken by means of databases of MEDLINE for the period 1966-96. The data registered included age at splenectomy, indication for splenectomy, incidence of infection and death, interval between splenectomy and infection, and microbial aetiology. RESULTS: The reports include 19 680 patients having undergone splenectomy with a median follow up of 6.9 years. The incidence of infection after splenectomy was 3.2% and the mortality rate was 1.4%. Only 6942 reports were sufficiently detailed to allow useful analysis. The incidence of infection among children and adults was similar, 3.3% and 3.2%, respectively. However, the death rates among children were higher than adults (1.7% vs. 1.3%). The incidence of infection was highest among patients with thalassemia major (8.2%), and sickle-cell anaemia (7.3%). The highest mortality rates were observed among patients with thalassaemia major (5.1%), and sickle-cell anaemia (4.8%). CONCLUSION: The incidence of sepsis among post-splenectomy patients is low, however, it carries a high mortality rate especially among children with hematological disorders.
Assuntos
Complicações Pós-Operatórias , Sepse/microbiologia , Esplenectomia , Adolescente , Adulto , Fatores Etários , Anemia Falciforme/cirurgia , Criança , Humanos , Incidência , Estudos Retrospectivos , Fatores de Risco , Sepse/mortalidade , Talassemia/cirurgiaRESUMO
BACKGROUND: Urinary tract infection is one of the most common bacterial infections. Since antibiotics are given empirically, it is necessary to assess the distribution and susceptibility of the microorganisms in each case. OBJECTIVES: To evaluate the demographic characteristics of ambulatory patients with UTI, the distribution and susceptibility of uropathogens, and the risk factors associated with trimethoprim-sulfamethoxazole resistant bacteria in women. METHODS: During 12 days in August 1997 all the urine cultures sent to the Tel-Hanan Laboratory (Haifa) were evaluated. Demographic characteristics of the patients, their underlying diseases and the previous use of antibiotics were obtained. RESULTS: During the 12 day survey 6,495 cultures were sent for evaluation. Of the 1,075 (17%) that were positive 950 were included in the study; 83.7% were from females, of whom 57% were > or = 50 years old. Escherichia coli was the most common pathogen, with 74.7% in the female and 55% in the male population; 86.2% of the E. coli were resistant to amoxicillin, 38.8% to cephalexin and 46.8% to TMP-SMX. Cefuroxime (4.2%), ofloxacin (4.8%), ciprofloxacin (4.8%) and nitrofurantoin (0.4%) showed the lowest rates of resistance. By a multivariant analysis, post-menopause and recurrent UTI were found to be independent factors related to TMP-SMX resistance in women. CONCLUSION: In northern Israel, ampicillin, cephalexin and TMP-SMX cannot be used empirically in the treatment of community-acquired UTI. Post-menopause and recurrent UTI are independent factors associated with TMP-SMX resistant pathogens in women.
Assuntos
Bacteriúria/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Adolescente , Adulto , Idoso , Amoxicilina/farmacologia , Bacteriúria/microbiologia , Cefalexina/farmacologia , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/microbiologia , Resistência Microbiana a Medicamentos , Escherichia coli/efeitos dos fármacos , Feminino , Humanos , Lactente , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Ofloxacino/farmacologia , Fatores de Risco , Combinação Trimetoprima e Sulfametoxazol/farmacologiaRESUMO
BACKGROUND: Vibrio vulnificus is a gram-negative bacterium that causes septicaemia and wound infection. Cases occur sporadically, and no previous outbreaks due to a common source or a clonal strain have been reported. In the summer and autumn of 1996 and 1997, an outbreak of invasive V. vulnificus infection occurred in Israel in people who had recently handled fresh, whole fish purchased from artificial fish-ponds. METHODS: We reviewed clinical and epidemiological information, and undertook an environmental investigation to assess disease characteristics, modes of transmission, phenotypic characteristics of the bacterium, and fish-marketing policy. The clonal nature of 19 isolates was studied by biotyping, pulsed-field gel electrophoresis, and restriction-fragment length polymorphism (RFLP) analysis of a PCR fragment. FINDINGS: During 1996-97, 62 cases of wound infection and bacteraemia occurred. 57 patients developed cellulitis, four had necrotising fasciitis, and one developed osteomyelitis. In all cases, the fish were cultivated in inland fish-ponds. In the summer of 1996, fish-pond managers initiated a new marketing policy, in which fish were sold alive instead of being packed in ice. Phenotypically, the isolates had five atypical biochemical test results. The isolates were non-typeable by pulsed-field gel electrophoresis, and all had the same PCR-RFLP pattern which had not been seen previously. INTERPRETATION: The cause of the outbreak was a new strain of V. vulnificus, classified as biogroup 3. A new fish-marketing policy that began in 1996 may have exposed susceptible people to the organism.
Assuntos
Bacteriemia/microbiologia , Surtos de Doenças , Peixes/microbiologia , Manipulação de Alimentos , Vibrioses/epidemiologia , Infecção dos Ferimentos/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Bacteriemia/epidemiologia , Bacteriemia/prevenção & controle , Surtos de Doenças/prevenção & controle , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Política Pública , Vibrio/classificação , Vibrioses/microbiologia , Vibrioses/prevenção & controle , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/prevenção & controleAssuntos
Surtos de Doenças , Esquistossomose/epidemiologia , Doença Aguda , Etiópia/epidemiologia , Humanos , IsraelAssuntos
Candidíase Mucocutânea Crônica/complicações , Enteropatias/complicações , Prototheca , Adulto , Anfotericina B/uso terapêutico , Biópsia , Candidíase Mucocutânea Crônica/patologia , Humanos , Interferon gama/uso terapêutico , Enteropatias/tratamento farmacológico , Enteropatias/patologia , Itraconazol/uso terapêutico , Masculino , Prototheca/efeitos dos fármacos , Prototheca/isolamento & purificação , Resultado do TratamentoRESUMO
Seventy-eight families (506 members) of recently immigrating Ethiopian Jews to Israel, were tested for the presence of HBV serological markers to evaluate the intrafamilial horizontal transmission of the virus. Eighty-four members (16.6%) were carriers and 20.2% were HBeAg positive, the overall infection rate was 67.8%. In 40 families (51.3%) at least one family member was HBsAG positive, and in 19 families (24.4%) two or more family members were HBsAg positive. Thirty-six carriers (42.8%) were children under the age of 10, by one year of age 30% have contracted the virus, and by the age of 5 and 10 years 43.5% and 57.1% have had serological markers for past HBV infection, respectively. Our data correlate with other studies regarding the importance of horizontal spread of HBV among Sub-Saharan Africans.