RESUMO
Eczema herpeticum (EH), or Kaposi's varicelliform eruption, is a skin infection with herpes simplex type I virus (HSV-1) that occurs in patients with compromised skin integrity, such as atopic dermatitis (AD). Unrecognized, it may be fatal and viremia in pregnancy may lead to fetal demise and miscarriage. We describe a rare case of EH in pregnancy, eczema herpeticum gravidarum (EHG), which is the third published report in the literature to date.
RESUMO
Liver biopsy is currently the gold standard for determining the stage of liver fibrosis. There are risks associated with liver biopsy; therefore, surrogate markers to predict the severity of disease would be useful. We studied 50 patients with HIV/hepatitis C co-infection who had liver biopsies and determined that no patient with an aspartate aminotransferase/platelet ratio index (APRI) of 0.6 or less had stage F3 or F4 disease. The APRI is useful for excluding advanced disease in this patient population.
Assuntos
Aspartato Aminotransferases/sangue , Infecções por HIV/complicações , Hepatite C Crônica/complicações , Adulto , Biomarcadores/sangue , Biópsia , Ensaios Enzimáticos Clínicos/métodos , Feminino , Hepatite C Crônica/diagnóstico , Humanos , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Índice de Gravidade de DoençaRESUMO
Reported rates of nephrotoxicity associated with the systemic use of polymyxins have varied widely. The emergence of infections due to multiresistant gram-negative bacteria has necessitated the use of systemic polymyxin B once again for the treatment of such infections. We retrospectively investigated the rate of nephrotoxicity in patients receiving polymyxin B parenterally for the treatment of infections caused by multiresistant gram-negative bacteria from October 1999 to September 2000. Demographic and clinical information was obtained for 60 patients. Outcome measures of interest were renal toxicity and clinical and microbiologic efficacy. Renal failure developed in 14% of the patients, all of whom had normal baseline renal function. Development of renal failure was independent of the daily and cumulative doses of polymyxin B and the length of treatment but was significantly associated with older age (76 versus 59 years, P = 0.02). The overall mortality was 20%, but it increased to 57% in those who developed renal failure. The organism was cleared in 88% of the patients from whom repeat specimens were obtained. The use of polymyxin B to treat multiresistant gram-negative infections was highly effective and associated with a lower rate of nephrotoxicity than previously described.
Assuntos
Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Nefropatias/induzido quimicamente , Polimixina B/efeitos adversos , Polimixina B/uso terapêutico , Acinetobacter baumannii/efeitos dos fármacos , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Creatinina/sangue , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Feminino , Seguimentos , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Pseudomonas aeruginosa/efeitos dos fármacos , Respiração Artificial , Estudos Retrospectivos , Análise de SobrevidaRESUMO
To our knowledge, pseudotumor cerebri as a complication of Lyme disease has been described only in children. We report the first case of an adult with pseudotumor cerebri due to Lyme disease and the use of serial lumbar punctures as the sole therapy.
