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1.
Artigo em Inglês | MEDLINE | ID: mdl-38807931

RESUMO

Levofloxacin prophylaxis reduces bloodstream infections in neutropenic patients with acute myeloid leukemia or relapsed acute lymphoblastic leukemia. A retrospective, longitudinal cohort study compares incidence of bacteremia, multidrug-resistant organisms (MDRO), and Clostridioides difficile (CDI) between time periods of levofloxacin prophylaxis implementation. Benefits were sustained without increasing MDRO or CDI.

2.
Clin Pediatr (Phila) ; : 99228231189132, 2023 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-37491834

RESUMO

We aimed to describe the frequency of treatment failure and associated risk factors for treatment failure amongst neonates with skin and soft tissue infections (SSTIs). We conducted a retrospective cohort study of neonates 0 to 28 days old with uncomplicated SSTIs presenting to the emergency department of a quaternary care children's hospital from 2009 to 2017. Data were collected via chart review. Skin and soft tissue infections included the following: cellulitis, abscess, mastitis, perirectal SSTI, carbuncle, and furuncle. Of the 202 neonates in the study, most were term, afebrile with mastitis, or perirectal SSTI. Treatment failure occurred in 8% (17/202) of neonates receiving oral antibiotics; 10 of these neonates had perirectal SSTIs and 2 had clindamycin and methicillin-resistant Staphylococcus aureus. Neonates with treatment failure had increased odds of having perirectal SSTIs (odds ratio [OR] = 4.08, 95% confidence interval [CI] = 1.46-11.31). Further studies are needed to identify strategies to prevent treatment failure in neonates with perirectal SSTIs.

4.
Pediatr Blood Cancer ; 69(7): e29525, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35029328

RESUMO

BACKGROUND: Bloodstream infections (BSIs) cause morbidity and mortality in pediatric patients with leukemia. Antibiotic prophylaxis during periods of chemotherapy-induced neutropenia may reduce the incidence of BSIs. PROCEDURE: A levofloxacin prophylaxis guideline was implemented for pediatric patients with acute myeloid leukemia and relapsed acute lymphoblastic leukemia. We conducted a retrospective cohort study over 4 years (2 years pre and 2 years post implementation) of the practice guideline to assess the impact on central line-associated bloodstream infections (CLABSI) and BSI events. Secondary outcomes included incidence of Clostridioides difficile-associated diarrhea, bacteremia due to multidrug-resistant organisms (MDRO), and bacteremia due to levofloxacin nonsusceptible organisms. STATA was used for data analysis. RESULTS: Sixty-three and 72 patients met inclusion criteria for the pre- and postimplementation cohorts, respectively. Demographics were similar between the groups. We observed 60 BSI events in the pre-group versus 49 events in the post-group (p = .1). Bacteremia due to Gram-negative rods (risk ratio [RR] 0.37 [0.21, 0.66], p < .001) and National Healthcare Safety Network (NHSN) CLABSIs (RR 0.62 [0.44, 0.89], p = .01) were significantly reduced in the postimplementation group. The incidences of C. difficile-associated diarrhea and MDRO bacteremia were similar between groups. However, we observed an increase in the incidence of BSI due to Gram-negative rods that were nonsusceptible to levofloxacin (RR 3.38 [0.72, 6.65], p < .001). CONCLUSION: Following implementation of a levofloxacin prophylaxis guideline, we observed a significant decrease in BSIs due to Gram-negative rods and NHSN CLABSIs. Vigilant monitoring of outcomes post guideline implementation is critical to track emergence of resistant organisms.


Assuntos
Bacteriemia , Clostridioides difficile , Infecção Hospitalar , Leucemia Mieloide Aguda , Sepse , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Bacteriemia/prevenção & controle , Criança , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Atenção à Saúde , Diarreia/induzido quimicamente , Diarreia/epidemiologia , Seguimentos , Humanos , Leucemia Mieloide Aguda/tratamento farmacológico , Levofloxacino/uso terapêutico , Estudos Retrospectivos , Sepse/complicações
7.
Pediatr Infect Dis J ; 40(8): 746-748, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-33941743

RESUMO

Cutaneous mucormycosis in children is an opportunistic fungal infection associated with significant morbidity and mortality. We describe characteristics of 12 patients with healthcare-associated cutaneous mucormycosis at Texas Children's Hospital and results of an outbreak investigation. A definitive source was not identified. Skin lesions near medical device securement sites should raise concern for mucormycosis in patients with underlying medical conditions.


Assuntos
Infecção Hospitalar/complicações , Infecção Hospitalar/microbiologia , Dermatomicoses/etiologia , Dermatomicoses/microbiologia , Mucormicose/etiologia , Mucormicose/microbiologia , Adolescente , Criança , Pré-Escolar , Infecção Hospitalar/terapia , Dermatomicoses/terapia , Surtos de Doenças , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Controle de Infecções , Masculino , Mucormicose/terapia , Estudos Retrospectivos , Rhizopus/isolamento & purificação , Texas/epidemiologia
8.
Pediatr Infect Dis J ; 40(9): e346-e348, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33990519

RESUMO

We report 2 infants hospitalized with Cronobacter sakazakii meningitis. Each infant had exposure to powdered infant formula at home. Both infants survived, but 1 infant had a subdural empyema drained and developed left sensorineural hearing loss. Early advanced brain imaging is recommended in infants with C. sakazakii meningitis. Reporting to state and federal public health officials may help identify outbreaks.


Assuntos
Encéfalo/diagnóstico por imagem , Cronobacter sakazakii/patogenicidade , Infecções por Enterobacteriaceae/diagnóstico por imagem , Fórmulas Infantis/microbiologia , Meningites Bacterianas/diagnóstico por imagem , Saúde Pública , Antibacterianos/uso terapêutico , Encéfalo/microbiologia , Cronobacter sakazakii/genética , Surtos de Doenças/prevenção & controle , Infecções por Enterobacteriaceae/líquido cefalorraquidiano , Infecções por Enterobacteriaceae/tratamento farmacológico , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Masculino , Resultado do Tratamento
9.
J Pediatric Infect Dis Soc ; 10(5): 593-598, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-33301595

RESUMO

BACKGROUND: An understanding of the clinical characteristics of children with coronavirus disease 2019 in diverse communities is needed to optimize the response of healthcare providers during this pandemic. METHODS: We performed a retrospective review of all children presenting to the Texas Children's Hospital system with testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from March 10, 2020, through June 28, 2020. Demographics were recorded for all patients undergoing testing and clinical characteristics and outcomes were recorded for children with positive tests. RESULTS: Of 16 554 unique patients ≤ 21 years of age who were tested for SARS-CoV-2, 1215 (7.3%) patients tested positive. Infants under 1 year of age and patients aged 18-21 years had the highest percent of positive tests at 9.9% (230/2329) and 10.7% (79/739), respectively. Hispanic children accounted for 66% (802/1215) of positive tests, though they only represented 42.1% (6972/16 554) of all children tested for SARS-CoV-2. Of the 1215 children with a positive test, 55.7% had fever, 40.9% had cough, 39.8% had congestion or rhinorrhea, 21.9% had gastrointestinal complaints, and 15.9% were asymptomatic. Only 97 (8%) patients were hospitalized (of which 68% were Hispanic). Most of the hospitalized patients had underlying medical conditions (62/97, 63.9%), including obesity. Thirty-one hospitalized patients (31/97, 32%) required respiratory support and 9 patients (9/97, 9.3%) received SARS-CoV-2 antiviral therapy. Two patients died. CONCLUSIONS: A relatively high percentage of Hispanic children tested positive for SARS-CoV-2 and were hospitalized. Most of the children with detection of SARS-CoV-2 had uncomplicated illness courses; some children were critically ill; and 2 patients died.


Assuntos
COVID-19/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , COVID-19/etnologia , COVID-19/mortalidade , Criança , Pré-Escolar , Estado Terminal , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Masculino , Pandemias , Pneumonia Viral/etnologia , Pneumonia Viral/mortalidade , Estudos Retrospectivos , SARS-CoV-2 , Texas/epidemiologia , Adulto Jovem
10.
J Pediatric Infect Dis Soc ; 9(3): 373-377, 2020 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-32504532

RESUMO

We describe the clinical course of 57 children with coronavirus disease 2019 (COVID-19) cared for through a single hospital system. Most children were mildly symptomatic, and only a few patients with underlying medical conditions required hospitalization. Systemwide patient evaluation processes allowed for prompt identification and management of patients with COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Adolescente , COVID-19 , Criança , Pré-Escolar , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/patologia , Feminino , Hospitalização , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Masculino , Pandemias , Pneumonia Viral/patologia , SARS-CoV-2 , Texas , Resultado do Tratamento , Adulto Jovem , Tratamento Farmacológico da COVID-19
11.
PLoS One ; 15(6): e0235115, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32569268

RESUMO

BACKGROUND: Microbial surface component recognizing adhesive matrix molecules (MSCRAMMs) facilitate Staphylococcus aureus adherence to host tissue. We hypothesized that S. aureus isolates from implant-associated infections (IAIs) would differ in MSCRAMM profile and biofilm formation in vitro compared to skin and soft tissue infection (SSTI) isolates. METHODS: Pediatric patients and their isolates were identified retrospectively. IAI and SSTI isolates were matched (1:4). Pulsed field gel electrophoresis was performed to group isolates as USA300 vs. non-USA300. Whole genome sequencing was performed and raw sequence data were interrogated for presence of MSCRAMMs (clfA, clfB, cna, ebh, efb, fnbpA, fnbpB, isdA, isdB, sdrC, sdrD, sdrE), biofilm-associated (icaA,D,B,C), and Panton-Valentine leukocidin (lukSF-PV) genes, accessory gene regulator group, and multilocus sequence types. In vitro biofilm formation was assessed for 47 IAI and 47 SSTI isolates using a microtiter plate assay. Conditional logistic regression was performed for analysis of matched data (STATA11, College Station, TX). RESULTS: Forty-seven IAI and 188 SSTI isolates were studied. IAI isolates were more often methicillin susceptible S. aureus and non-USA300 vs. SSTI isolates [34 (72%) vs. 79 (42%), p = 0.001 and 38 (81%) vs. 57 (30%) p <0.001, respectively]. Greater than 98% of isolates carried clfA, clfB, efb, isdA, isdB, and icaA,D,B,C while cna was more frequently found among IAI vs. SSTI isolates (p = 0.003). Most isolates were strong biofilm producers. CONCLUSIONS: S. aureus IAI isolates were significantly more likely to be MSSA and non-USA300 than SSTI isolates. Carriage of MSCRAMMs and biofilm formation did not differ significantly between isolates. Evaluation of genetic polymorphisms and gene expression profiles are needed to further delineate the role of adhesins in the pathogenesis of IAIs.


Assuntos
Adesinas Bacterianas/genética , Biofilmes/crescimento & desenvolvimento , Genes Bacterianos , Infecções Relacionadas à Prótese/genética , Infecções Relacionadas à Prótese/microbiologia , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Criança , Humanos , Pele/patologia , Infecções dos Tecidos Moles/genética , Infecções dos Tecidos Moles/microbiologia
12.
MedEdPORTAL ; 15: 10804, 2019 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-30931383

RESUMO

Introduction: Resident physicians may have difficulty with identifying and managing pediatric septic shock due to limited patient encounters. Simulation-based interventions can enhance competency. We developed a low-fidelity tabletop simulation game to teach pediatric septic shock and compared residents' knowledge of and comfort with recognition and management of septic shock. Methods: Pediatric and emergency medicine residents participated in an education session involving a low-fidelity, tabletop simulation in which they managed two simulated pediatric patients with septic shock. The two patients were a 12-year-old healthy male with cold shock due to a urinary tract infection and a 5-year-old female with a history of leukemia who developed warm shock due to pneumonia. Because this session was presented as a board game rather than high-fidelity simulation, learners focused on decision making rather than the mechanics of procedures. Residents completed a survey and a knowledge-based test before and after this session. Results: Twenty-three pediatric and nine emergency medicine residents participated. Correct responses for the preintervention test were 71%, compared with 83% postintervention. The difference in rates was 12% (95% confidence interval, -0.17 to -0.07; p < .0001). Residents rated this modality as being more useful than lectures or reading and as equivalent to bedside teaching and high-fidelity simulation. Discussion: Our pilot low-fidelity simulation improved resident knowledge and comfort with pediatric septic shock care. Further studies are needed to address the impact of low-fidelity simulations on patient outcomes.


Assuntos
Medicina de Emergência/educação , Internato e Residência/métodos , Pediatria/educação , Choque Séptico/etiologia , Criança , Pré-Escolar , Competência Clínica , Feminino , Jogos Recreativos , Humanos , Conhecimento , Aprendizagem/fisiologia , Leucemia/complicações , Masculino , Pneumonia/complicações , Choque Séptico/diagnóstico , Choque Séptico/terapia , Treinamento por Simulação/métodos , Infecções Urinárias/complicações
13.
Pediatr Infect Dis J ; 38(8): 808-811, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31033905

RESUMO

BACKGROUND: Staphylococcus aureus is a significant cause of implant-associated infections (IAIs). Data detailing the optimal treatment of IAIs are lacking in children. We describe the clinical features and outcomes of pediatric patients with S. aureus IAIs seen at Texas Children's Hospital. METHODS: Patients and their isolates were identified from a S. aureus surveillance database from 2008 to 2016 in Houston, TX. Demographic and clinical data were collected retrospectively. Fisher's exact was used for statistical analysis. RESULTS: Forty-five patients with 47 IAIs were identified. Most patients had an infected orthopedic implant: 22 (47%) spinal rods and 19 (40%) with other orthopedic hardware. Thirty (64%) IAIs developed within 90 days of implant placement. Six patients had polymicrobial infections and 3 patients were bacteremic. Of the 47 IAI isolates, 34 (72%) were methicillin-susceptible S. aureus (MSSA) and 13 (28%) were methicillin-resistant S. aureus. All children underwent surgical irrigation, debridement and antibiotic therapy. Of the 47 IAI episodes, 22 of the implants were removed at time of initial presentation, 7 implants had delayed removal, and 18 implants remained in place. Successful treatment was achieved in all patients with immediate implant removal (22/22) and in 83% of patients with implant retention (15/18), including 10 patients with early postoperative infections (<3 months) and 5 patients with late postoperative infections (>3 months). Four patients had recurrence of infection. CONCLUSIONS: The majority of S. aureus IAIs were methicillin-susceptible S. aureus. All children with immediate implant removal and most children with retained implants were treated successfully with surgery and antibiotic therapy.


Assuntos
Próteses e Implantes/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus , Fatores Etários , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Pesquisas sobre Atenção à Saúde , Hospitais Pediátricos , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Infecções Relacionadas à Prótese/prevenção & controle , Infecções Estafilocócicas/prevenção & controle , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Texas/epidemiologia , Resultado do Tratamento
14.
Pediatr Infect Dis J ; 38(9): e226-e228, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30747830

RESUMO

Seasonal influenza infection is associated with secondary bacterial complications involving the upper and lower respiratory tract. However, the association of influenza infection with secondary severe or complicated head and neck infections is not appreciated. We report 6 cases of head and neck infections following influenza infection in pediatric patients.


Assuntos
Coinfecção/diagnóstico , Cabeça/microbiologia , Influenza Humana/complicações , Pescoço/microbiologia , Adolescente , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Criança , Pré-Escolar , Coinfecção/microbiologia , Coinfecção/virologia , Registros Eletrônicos de Saúde , Feminino , Cabeça/patologia , Humanos , Lactente , Influenza Humana/microbiologia , Masculino , Pescoço/patologia , Estudos Retrospectivos
15.
Pediatr Infect Dis J ; 38(2): e32-e34, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29620720

RESUMO

Brodie abscess is a subacute hematogenous osteomyelitis characterized by intraosseous abscess formation. Treatment recommendations and clinical outcomes for this unusual infection are not well established. We report 15 cases of Brodie abscess in a 10-year retrospective review of pediatric patients at Texas Children's Hospital and describe their clinical presentation and outcomes.


Assuntos
Abscesso/diagnóstico , Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Gerenciamento Clínico , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Abscesso/epidemiologia , Abscesso/patologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Osteomielite/epidemiologia , Osteomielite/patologia , Estudos Retrospectivos , Texas , Resultado do Tratamento
16.
J Pediatric Infect Dis Soc ; 7(3): 205-209, 2018 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-28575438

RESUMO

BACKGROUND: Periorbital and orbital cellulitis cause significant pediatric morbidity. Here, we define the clinical features of and characterize isolates from children with periorbital or orbital cellulitis caused by Staphylococcus aureus at Texas Children's Hospital in Houston. METHODS: Patients were identified from a prospective S aureus study database from January 2002 to July 2015. Demographic and clinical data were collected retrospectively. Isolates were genotyped by pulsed-field gel electrophoresis, and Panton-Valentine leukocidin (lukSF-PV [pvl]) genes were detected by quantitative polymerase chain reaction. Data were analyzed with the Fisher exact or Wilcoxon rank-sum test. RESULTS: Eighty-five patients with periorbital (n = 58) or orbital (n = 27) cellulitis were identified. We found 57 (67%) methicillin-resistant S aureus (MRSA) isolates, 72 (85%) pvl-positive (pvl+) isolates, and 66 (78%) USA300 isolates. No differences in clinical characteristics were found when we compared MRSA to methicillin-susceptible (MSSA) infections or USA300 to non-USA300 infections. Patients with orbital cellulitis were hospitalized a median of 12 days (range, 2-28 days) and received antibiotics for 21 days (range, 10-32 days). Twelve (44%) patients with orbital cellulitis received steroids. Steroid treatment did not affect the length of hospitalization or duration of antibiotic treatment. Six (7%) patients with orbital cellulitis were bacteremic. Patients with periorbital cellulitis were hospitalized for a median of 3 days (range, 0-17 days) and received antibiotics for 11 days (range, 7-32 days). According to computed tomography (CT), 19 (70%) patients with orbital cellulitis and 11 (41%) with periorbital cellulitis had sinusitis. CONCLUSIONS: The majority of periorbital and orbital S aureus infections at Texas Children's Hospital were caused by MRSA, and no change was observed over time. Empirical antibiotic treatment should include coverage for MRSA. PVL might be an important virulence factor in these presentations. S aureus is associated with sinusitis and its complications.


Assuntos
Celulite Orbitária/microbiologia , Staphylococcus aureus/genética , Adolescente , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Toxinas Bacterianas/genética , Criança , Pré-Escolar , Exotoxinas/genética , Feminino , Genótipo , Humanos , Lactente , Tempo de Internação , Leucocidinas/genética , Masculino , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Testes de Sensibilidade Microbiana , Celulite Orbitária/tratamento farmacológico , Estudos Retrospectivos , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/patogenicidade , Resultado do Tratamento , Fatores de Virulência
17.
J Pediatric Infect Dis Soc ; 7(3): 199-204, 2018 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-28510690

RESUMO

BACKGROUND: Trichosporonosis is an emerging and often fatal opportunistic fungal infection in immunocompromised patients, particularly those with hematologic malignancy, but data in children are lacking. METHODS: We report here 3 cases of invasive infection caused by Trichosporon asahii in pediatric patients with acute lymphoblastic leukemia at Texas Children's Hospital in Houston, Texas. We also conducted a literature review and identified 16 additional reports of pediatric patients with invasive T asahii infection and an underlying malignant or nonmalignant hematologic disorder. RESULTS: Of the 19 cases of invasive T asahii infection, the most commonly reported underlying hematologic disorder was acute lymphoblastic leukenia (47%), followed by acute myelogenous leukemia (21%). Most of the patients (94%) had neutropenia, defined as an absolute neutrophil count of <500 cells/mm3. Antifungal prophylaxis information was available in 6 of the 19 cases, and micafungin use was reported in 5 cases. Treatment regimens frequently included voriconazole monotherapy (47%) or the combination of an azole antifungal with amphotericin B (35%). The mortality rate was 58%. CONCLUSIONS: Recognizing that echinocandins, which are increasingly used for prophylaxis in patients with a hematologic malignancy, are not active against Trichosporon species is of critical importance. The recommended first-line therapy for trichosporonosis is voriconazole, but successful outcome depends largely on the underlying immune status of the host.


Assuntos
Hospedeiro Imunocomprometido , Infecções Fúngicas Invasivas/diagnóstico , Infecções Oportunistas/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/imunologia , Tricosporonose/diagnóstico , Adolescente , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Criança , Quimioterapia Combinada , Equinocandinas/uso terapêutico , Feminino , Humanos , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/microbiologia , Leucemia Mieloide Aguda/imunologia , Lipopeptídeos/uso terapêutico , Masculino , Micafungina , Neutropenia/complicações , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Tricosporonose/tratamento farmacológico , Tricosporonose/microbiologia , Voriconazol/uso terapêutico
18.
Pediatr Infect Dis J ; 36(4): 426-427, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27977556

RESUMO

Prostatic abscesses are infrequently encountered in adults and are exceedingly rare in the pediatric population. We present the case of an 11-year-old boy with a methicillin-susceptible Staphylococcus aureus prostatic abscess and bacteremia.


Assuntos
Abscesso , Staphylococcus aureus Resistente à Meticilina , Próstata , Doenças Prostáticas , Infecções Estafilocócicas , Antibacterianos/uso terapêutico , Criança , Humanos , Masculino , Próstata/diagnóstico por imagem , Próstata/patologia
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