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1.
Medicina (Kaunas) ; 58(2)2022 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-35208515

RESUMO

Background and Objectives: Adult-onset Still's disease (AOSD) is a rheumatic disease characterized by systemic inflammatory symptoms, including intermittent spiking fever, polyarthritis and a distinctive salmon-colored rash. Corticosteroids are the first-line treatment for AOSD. However, corticosteroids are potentially hepatotoxic in certain cases and may complicate the course of the disease. Materials and Methods: A 29-year-old female suffering from fever of unknown origin for two weeks was diagnosed with AOSD according to Yamaguchi's criteria. She received corticosteroids as the first-line treatment for AOSD and developed acute severe hepatitis. A diagnostic protocol has been performed. Results: Corticosteroid-induced liver injury was confirmed by clinical observation and rechallenge of the drug in this case. The result of liver biopsy also supported the diagnosis. Mycophenolic acid, a disease-modifying antirheumatic drug (DMARD) was chosen as an alternative treatment. AOSD remission was achieved under this treatment after three months. Conclusions: Severe acute hepatitis induced by corticosteroids, although very rare, may be observed in patients with AOSD. Drug-induced liver injury needs to be kept in mind when unexpected acute hepatitis is found. Mycophenolic acid could be a proper substitute medication in these cases.


Assuntos
Artrite , Doença Hepática Crônica Induzida por Substâncias e Drogas , Doença de Still de Início Tardio , Corticosteroides/efeitos adversos , Adulto , Doença Hepática Crônica Induzida por Substâncias e Drogas/complicações , Doença Hepática Crônica Induzida por Substâncias e Drogas/tratamento farmacológico , Feminino , Humanos , Doença de Still de Início Tardio/complicações , Doença de Still de Início Tardio/diagnóstico , Doença de Still de Início Tardio/tratamento farmacológico
2.
J Med Microbiol ; 61(Pt 5): 712-719, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22322339

RESUMO

The objectives of the study were to investigate the distribution of cphA-related genes (cphA) encoding a CphA metallo-ß-lactamase (MBL) among 51 consecutive Aeromonas blood isolates and to compare different phenotypic methods for detecting CphA. The presence of cphA was detected by PCR. Four phenotypic methods, the imipenem-EDTA combined disc test, imipenem-EDTA MBL Etest, agar dilution test and modified Hodge test (MHT), were used to detect imipenem susceptibility and MBL production. The results showed that 35 (69%) blood isolates had cphA. All (100%) of 16 Aeromonas aquariorum isolates and 12 Aeromonas veronii isolates, and 4 (80%) of 5 Aeromonas hydrophila isolates, carried cphA, but none of 15 Aeromonas caviae isolates did. With the standard inocula, irrespective of the presence or absence of cphA, all but one (50, 98%) isolates were susceptible to imipenem tested by disc diffusion, Etest and agar dilution (10(4) c.f.u. spot inocula), and did not exhibit MBL production by the imipenem-EDTA combined disc test and MBL Etest. By the agar dilution test using large inocula (10(7) c.f.u.), 34 (97%) of 35 cphA(+) isolates had imipenem MICs of ≥16 µg ml(-1), higher than the susceptible breakpoint (4 µg ml(-1)), and demonstrated positive results for the MHT, while one cphA(+) and all 17 cphA(-) isolates had imipenem MICs of ≤4 µg ml(-1). In conclusion, the distribution of cphA among aeromonads is species-specific, found in A. aquariorum, A. veronii and A. hydrophila, and the MHT may be a phenotypic screening test for CphA production.


Assuntos
Aeromonas/enzimologia , Aeromonas/isolamento & purificação , Bacteriemia/microbiologia , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Infecções por Bactérias Gram-Negativas/microbiologia , beta-Lactamases/genética , beta-Lactamases/metabolismo , Aeromonas/classificação , Aeromonas/genética , Antibacterianos/farmacologia , DNA Bacteriano/genética , Humanos , Testes de Sensibilidade Microbiana/métodos , Reação em Cadeia da Polimerase , beta-Lactamas/farmacologia
3.
Antimicrob Agents Chemother ; 55(12): 5813-8, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21968366

RESUMO

Although extended-spectrum-ß-lactamase (ESBL)-producing aeromonads have been increasingly reported in recent years, most of them were isolates from case reports or environmental isolates. To investigate the prevalence of ESBL producers among Aeromonas blood isolates and the genes encoding ESBLs, consecutive nonduplicate Aeromonas blood isolates collected at a medical center in southern Taiwan from March 2004 to December 2008 were studied. The ESBL phenotypes were examined by clavulanate combination disk test and the cefepime-clavulanate ESBL Etest. The presence of ESBL-encoding genes, including bla(TEM), bla(PER), bla(CTX-M), and bla(SHV) genes, was evaluated by PCR and sequence analysis. The results showed that 4 (2.6%) of 156 Aeromonas blood isolates, 1 Aeromonas hydrophila isolate and 3 Aeromonas caviae isolates, expressed an ESBL-producing phenotype. The ESBL gene in two A. caviae isolates was bla(PER-3), which was located in both chromosomes and plasmids, as demonstrated by Southern hybridization. Of four patients with ESBL-producing Aeromonas bacteremia, two presented with catheter-related phlebitis and the other two with primary bacteremia. Three patients had been treated with initial noncarbapenem ß-lactams for 5 to 10 days, and all survived. In conclusion, ESBL producers exist among Aeromonas blood isolates, and clinical suspicion of ESBL production should be raised in treating infections due to cefotaxime-resistant Aeromonas isolates.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Aeromonas caviae/isolamento & purificação , Aeromonas hydrophila/isolamento & purificação , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , beta-Lactamases/biossíntese , Aeromonas caviae/efeitos dos fármacos , Aeromonas caviae/enzimologia , Aeromonas caviae/genética , Aeromonas hydrophila/efeitos dos fármacos , Aeromonas hydrophila/enzimologia , Aeromonas hydrophila/genética , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Cefotaxima/farmacologia , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Prevalência , Taiwan/epidemiologia , beta-Lactamases/genética
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