RESUMO
In May 2013, Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection was diagnosed in an adult male in France with severe respiratory illness, who had travelled to the United Arab Emirates before symptom onset. Contact tracing identified a secondary case in a patient hospitalised in the same hospital room. No other cases of MERS-CoV infection were identified among the index case's 123 contacts, nor among 39 contacts of the secondary case, during the 10-day follow-up period.
Assuntos
Infecções por Coronavirus/epidemiologia , Infecções Respiratórias/epidemiologia , Viagem , Busca de Comunicante , Coronavirus/isolamento & purificação , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Evolução Fatal , França , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Respiratórias/prevenção & controle , Infecções Respiratórias/transmissão , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Emirados Árabes UnidosRESUMO
INTRODUCTION: Cryptococcosis is a serious invasive fungal infection mostly described in patients with cell-mediated immunosuppression. Cryptococcus neoformans osteomyelitis is a rare infection that occurs mainly during disseminated forms. OBSERVATION: A 72-year-old diabetic patient, treated with fludarabine-cyclophosphamide-rituximab (since 10 months) for lymphocytic leukemia presented with osteolysis of the fourth left hand metacarpien the histological examination of which revealed C. neoformans. This bone involvement was associated with costal osteolytis and pulmonary cryptococcosis but central nervous system (CNS) was spared. Fluconazole was administered intravenously for 15 days, then switched to oral route for 6 months with favorable clinical course. This case describes an unusual clinical presentation of disseminated cryptococcosis without CNS involvement with multiple osseous metastases. A review of cryptococcal osteomyelitis cases reported in adult from 2000 to 2011 is also discussed. CONCLUSION: Cryptococcosis is a rare infection that should be discussed in seriously immunocompromized patients presenting with osteomyelitis even in the absence of CNS involvement.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Criptococose/etiologia , Cryptococcus neoformans/isolamento & purificação , Fungemia/etiologia , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Infecções Oportunistas/microbiologia , Osteomielite/microbiologia , Idoso , Anticorpos Monoclonais Murinos/administração & dosagem , Anticorpos Monoclonais Murinos/efeitos adversos , Antifúngicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Fístula Cutânea/etiologia , Fístula Cutânea/microbiologia , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Diabetes Mellitus Tipo 2/complicações , Feminino , Fungemia/tratamento farmacológico , Fungemia/microbiologia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Leucemia Linfocítica Crônica de Células B/complicações , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/etiologia , Pneumopatias Fúngicas/microbiologia , Neutropenia/induzido quimicamente , Neutropenia/complicações , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/etiologia , Osteólise/etiologia , Osteomielite/tratamento farmacológico , Osteomielite/etiologia , Rituximab , Vidarabina/administração & dosagem , Vidarabina/efeitos adversos , Vidarabina/análogos & derivadosAssuntos
Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium/isolamento & purificação , Osteomielite/microbiologia , Punho/microbiologia , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Humanos , Imunocompetência , Masculino , Mycobacterium/classificação , Mycobacterium/efeitos dos fármacos , Mycobacterium/genética , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Osteomielite/diagnósticoRESUMO
Lymph node tuberculosis (LNTB) is the most frequent form of extra-pulmonary tuberculosis (TB). Randomised, controlled trials have convincingly demonstrated that 6 months of chemotherapy is sufficient for most drug-susceptible LNTB. We performed a retrospective, multicentric study from 1997 to 2010 to describe factors associated with prolonged anti-tuberculosis treatment in patients with LNTB. Of 126 patients diagnosed with LNTB, 22 (17.5%) were human immunodeficiency virus (HIV) infected. The median treatment duration was 9 months (interquartile range, 6-12). Treatment was significantly longer in patients with HIV (P < 0.01), additional sites of TB (P < 0.01) or weight loss (P = 0.04). Factors independently associated with excessively lengthy treatment were HIV co-infection and the presence of other TB foci.