RESUMO
The therapeutic regimens used to treat patients with HIV disease involve a considerable pill burden. Patient adherence to dosing schedules and other factors have been implicated in the therapeutic failure of antiretroviral agents. Alternative medical approaches to HIV disease are problematic for clinicians and scientists because many of these herbal compounds have not been assessed in well-designed research trials. A thorough investigation of alternative therapies by the medical and pharmacological sciences are needed for evaluation against existing therapies.
Assuntos
Terapia Antirretroviral de Alta Atividade/métodos , Resistência a Múltiplos Medicamentos , Infecções por HIV/tratamento farmacológico , Dose Máxima Tolerável , Fármacos Anti-HIV/uso terapêutico , Terapias Complementares/métodos , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Infecções por HIV/diagnóstico , Humanos , Masculino , Prognóstico , Medição de Risco , Resultado do TratamentoRESUMO
Disseminated Neisseria gonorrhoeae gonococcal infections are the leading cause of acute arthritis in young adults. Recent published information indicates that a small proportion of gonococcal arthritis is caused by penicillinase-producing Neisseria gonorrhoeae (PPNG). This article reports three cases of PPNG over a 12-month period and recommends that all suspected cases of gonococcal arthritis be treated as if they were PPNG until proven otherwise.
Assuntos
Artrite Infecciosa/enzimologia , Gonorreia/enzimologia , Penicilinase/biossíntese , Adulto , Feminino , Hospitais Comunitários , Humanos , MasculinoRESUMO
Ceftazidime-resistant Klebsiella pneumoniae strains began to appear when ceftazidime usage was increased in two unrelated Chicago hospitals. These strains produced a beta-lactamase with an isoelectric point of 5.6 (RP-5.6) and strong hydrolyzing activity against ceftazidime. Two different restriction digest profiles were associated with the ceftazidime resistance plasmids. A second beta-lactamase with a pI of 5.2 (RP-5.2) was coproduced in two representative strains. The second beta-lactamase hydrolyzed ceftazidime, cefotaxime, and aztreonam with relative hydrolysis rates of < 8% of that observed for benzylpenicillin. Both enzymes were inhibited by clavulanic acid and tazobactam. Nucleotide sequencing of the genes coding for RP-5.2 and RP-5.6 revealed sequences identical to those of the TEM-12 and TEM-10 beta-lactamase genes, respectively. Both genes were derived from a TEM-1 sequence related to that of the gene encoded on the Tn2 transposon. Single point mutations are required to progress from TEM-1 to TEM-12 and from TEM-12 to TEM-10. Extracts from broths grown from single cell isolates of the strain producing TEM-12 and TEM-10 were shown to contain both enzymes. Transconjugants producing either the TEM-12 or the TEM-10 beta-lactamase were obtained. A significant finding was that both enzymes were encoded by plasmids with identical restriction digest patterns. These studies show that mutations leading to extended-spectrum beta-lactamases can occur sequentially in the same organism, with the genes encoding both enzymes maintained stably.
Assuntos
Ceftazidima/metabolismo , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , beta-Lactamases/isolamento & purificação , Antibacterianos/farmacologia , Sequência de Bases , DNA Bacteriano/genética , Resistência Microbiana a Medicamentos , Escherichia coli/genética , Humanos , Klebsiella pneumoniae/genética , Testes de Sensibilidade Microbiana , Dados de Sequência Molecular , Plasmídeos , Análise de Sequência de DNA , Inibidores de beta-Lactamases , beta-Lactamases/análise , beta-Lactamases/genéticaRESUMO
OBJECTIVE: To report a case of retroperitoneal abscess caused by Mycobacterium chelonae and treatment. DESIGN: Case report. SETTING: Private community teaching hospital. PATIENTS: A patient was admitted to the hospital following a gunshot to the flank. The bullet passed through the iliac crest and lodged in the abdomen. INTERVENTION: The patient was treated with cefazolin, trimethoprim/sulfamethoxazole, and amikacin at different times. OUTCOME: The patient responded well to pharmacologic treatment and at 18-month follow-up, he is disease free. CONCLUSIONS: Antimicrobial agents with in vitro activity against M. chelonae, especially amikacin-containing regimens, are recommended for treating M. chelonae infection.
Assuntos
Abscesso/microbiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium chelonae/isolamento & purificação , Abscesso/tratamento farmacológico , Adulto , Amicacina/uso terapêutico , Cefazolina/uso terapêutico , Quimioterapia Combinada , Hospitais Comunitários , Hospitais de Ensino , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Espaço Retroperitoneal , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Ferimentos por Arma de Fogo/microbiologiaAssuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Tuberculose Pulmonar/epidemiologia , População Urbana/estatística & dados numéricos , Infecções Oportunistas Relacionadas com a AIDS/transmissão , Chicago/epidemiologia , Estudos Transversais , Humanos , Incidência , Tuberculose Pulmonar/transmissãoRESUMO
OBJECTIVE: To report a case of Nocardia asteroides pneumonia and subsequent brain abscess in an immunocompromised host. SETTING: Private, community, teaching hospital. PATIENT: A man readmitted to the hospital for a third time with a fatal brain abscess, after responding to (misdirected) therapy in previous admissions. INTERVENTIONS: Treatment with cefuroxime, erythromycin, trimethoprim/sulfamethoxazole at different times. RESULTS: Patient's condition deteriorated and he died after one month of intravenous trimethoprim/sulfamethoxazole therapy. CONCLUSIONS: Because it is an infection of the immunocompromised host, it may be considered an AIDS-defining illness. Several other similar cases have been reported in the literature.
