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1.
Mycoses ; 62(3): 252-260, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30565742

RESUMO

Invasive fungal infections (IFI) of the Central Nervous System (IFI-CNS) and Paranasal Sinuses (IFI-PS) are rare, life-threatening infections in haematologic patients, and their management remains a challenge despite the availability of new diagnostic techniques and novel antifungal agents. In addition, analyses of large cohorts of patients focusing on these rare IFI are still lacking. Between January 2010 and December 2016, 89 consecutive cases of Proven (53) or Probable (36) IFI-CNS (71/89) and IFI-PS (18/89) were collected in 34 haematological centres. The median age was 40 years (range 5-79); acute leukaemia was the most common underlying disease (69%) and 29% of cases received a previous allogeneic stem cell transplant. Aspergillus spp. were the most common pathogens (69%), followed by mucormycetes (22%), Cryptococcus spp. (4%) and Fusarium spp. (2%). The lung was the primary focus of fungal infection (48% of cases). The nervous system biopsy was performed in 10% of IFI-CNS, and a sinus biopsy was performed in 56% of IFI-PS (P = 0.03). The Galactomannan test on cerebrospinal fluid has been performed in 42% of IFI-CNS (30/71), and it was positive in 67%. Eighty-four pts received a first-line antifungal therapy with Amphotericine B in 58% of cases, Voriconazole in 31% and both in 11%. Moreover, 58% of patients received 2 or more lines of therapy and 38% were treated with a combination of 2 or more antifungal drugs. The median duration of antifungal therapy was 60 days (range 5-835). A surgical intervention was performed in 26% of cases but only 10% of IFI-CNS underwent neurosurgical intervention. The overall response rate to antifungal therapy (complete or partial response) was 57%, and 1-year overall survival was 32% without significant differences between IFI-CNS and IFI-PS. The overall mortality was 69% but the IFI attributable mortality was 33%. Mortality of IFI-CNS/PS remains high but, compared to previous historical data, it seems to be reduced probably due to the availability of newer antifungal drugs. The results arising from this large contemporary cohort of cases may allow a more effective diagnostic and therapeutic management of these very rare IFI complications in haematologic patients.


Assuntos
Antifúngicos/uso terapêutico , Infecções Fúngicas do Sistema Nervoso Central/epidemiologia , Desbridamento , Fungos/classificação , Fungos/isolamento & purificação , Neoplasias Hematológicas/complicações , Sinusite/epidemiologia , Adolescente , Adulto , Idoso , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Infecções Fúngicas do Sistema Nervoso Central/terapia , Líquido Cefalorraquidiano/microbiologia , Criança , Pré-Escolar , Estudos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seios Paranasais/microbiologia , Sinusite/microbiologia , Sinusite/terapia , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
2.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 33(2): 99-102, mar.-abr. 2014. ilus
Artigo em Inglês | IBECS | ID: ibc-120942

RESUMO

A young patient with undefined autoimmune lymphoproliferative syndrome (ALPS-U) and low back pain underwent a CT and MRI study that showed enhancing vertebral lesions, some pulmonary nodules and diffuse latero-cervical lymphadenopathy. A 18F-FDG-PET/CT scan showed many areas of intense 18F-FDG uptake in multiple vertebrae, in some ribs, in the sacrum, in the liver, in both lungs, in multiple lymph nodes spread in the cervical, thoracic and abdominal chains. A bone marrow biopsy showed a "lymphomatoid granulomatosis", a rare variant of B-cell non-Hodgkin lymphoma (NHL). After the treatment, the 18F-FDG-PET/CT scan showed a complete metabolic response (AU)


Un paciente joven con síndrome linfoproliferativo autoinmune indefinido (ALPS-U) y dolor lumbar se sometió a una tomografía computarizada y a una resonancia magnética, estudios que mostraron varias lesiones vertebrales, algunos nódulos pulmonares y adenopatías laterocervicales difusas. Una exploración 18F-FDG-PET/TC reveló áreas de captación intensa de 18F-FDG en múltiples vértebras, algunas costillas, sacro, hígado, ambos pulmones y en varios ganglios linfáticos repartidos en las cadenas cervicales, torácica y abdominal. La biopsia de médula ósea diagnosticó una “granulomatosis linfomatoide”, una variante poco frecuente de Linfoma no-Hodgkin de células B (LNH). Tras el tratamiento, la exploración 18F-FDG-PET/TC demostró una respuesta metabólica completa (AU)


Assuntos
Humanos , Masculino , Síndrome Linfoproliferativa Autoimune , Linfoma não Hodgkin , Tomografia por Emissão de Pósitrons , Fluordesoxiglucose F18 , Dor Lombar/etiologia
3.
Rev Esp Med Nucl Imagen Mol ; 33(2): 99-102, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23845452

RESUMO

A young patient with undefined autoimmune lymphoproliferative syndrome (ALPS-U) and low back pain underwent a CT and MRI study that showed enhancing vertebral lesions, some pulmonary nodules and diffuse latero-cervical lymphadenopathy. A (18)F-FDG-PET/CT scan showed many areas of intense (18)F-FDG uptake in multiple vertebrae, in some ribs, in the sacrum, in the liver, in both lungs, in multiple lymph nodes spread in the cervical, thoracic and abdominal chains. A bone marrow biopsy showed a "lymphomatoid granulomatosis", a rare variant of B-cell non-Hodgkin lymphoma (NHL). After the treatment, the (18)F-FDG-PET/CT scan showed a complete metabolic response.


Assuntos
Síndrome Linfoproliferativa Autoimune/diagnóstico , Síndrome Linfoproliferativa Autoimune/terapia , Fluordesoxiglucose F18 , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/terapia , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios X , Adulto , Humanos , Masculino
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