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1.
J Infect Chemother ; 30(8): 780-784, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38182008

RESUMO

Patients with Mycobacterium avium complex pulmonary disease (MAC-PD) often suffer from chronic symptoms such as sputum production, which reduces quality of life. Oscillatory positive expiratory pressure (OPEP) devices are used in physiotherapy to promote the clearance of respiratory secretions. We report two cases of improved lung function and improved scores on the Leicester Cough Questionnaire (LCQ) and the Breathlessness, Cough and Sputum Scale (BCSS) after the use of OPEP in patients with MAC-PD where treatment with guideline-based therapy, including amikacin liposome inhalation suspension, had proved ineffective for symptoms. Use of OPEP might maximize the efficacy of therapy and thereby improves outcomes in patients with MAC-PD. It is important to use both guideline-based therapy and OPEP, especially in patients whose health-related quality of life is affected by sputum symptoms. Further prospective studies are warranted to assess the benefit of adding OPEP to guidelines concerning therapy for patients with MAC-PD and sputum symptoms.


Assuntos
Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare , Qualidade de Vida , Humanos , Infecção por Mycobacterium avium-intracellulare/terapia , Infecção por Mycobacterium avium-intracellulare/microbiologia , Masculino , Idoso , Escarro/microbiologia , Feminino , Respiração com Pressão Positiva/instrumentação , Respiração com Pressão Positiva/métodos , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Resultado do Tratamento , Pneumopatias/microbiologia , Pneumopatias/terapia , Pneumopatias/fisiopatologia
2.
J Orthop Surg (Hong Kong) ; 31(3): 10225536231199392, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37878458

RESUMO

BACKGROUND: Mycobacterium avium complex (MAC) prosthetic joint infection (PJI) has been rarely reported. METHODS: This study aimed to investigate the epidemiology and outcomes of MAC PJI. A systematic review of the literature regarding the MAC infection following total joint arthroplasty including hip and knee joint was performed. Multiple databases were searched for published English-written articles up to May 2023. Studies that reported cases of PJI by MAC were reviewed. RESULTS: A total of 17 patients were identified and analyzed from 11 published studies. All patients presented with joint symptom of pain or swelling prior to the diagnosis and MAC was confirmed by culture. The most of the patients (16/17 patients, 94.1%) were noted to have underlying medical condition(s) that might have affected immunity. Treatment consisted of anti-MAC medication therapy only in two patients and anti-MAC medication therapy plus surgery in 15 patients. Among the patients who underwent surgery, 14 patients (82.3%) had removal of the prosthesis including seven patients who had two-stage surgery to have reimplantation of the prosthesis. No relapse of MAC infection was reported despite of one case of relapse of infection caused by different pyogenic bacteria. The rate of overall mortality was 29.4%, however, identified attributable mortality due to MAC infection was low (5.9%). CONCLUSION: PJI by MAC is a rare disease. However, MAC needs to be considered in the differential diagnosis in immunocompromised patients presenting with symptoms of PJI. Two-stage exchange arthroplasty may result in successful treatment outcomes without higher risks of relapse of infection if undertaken in association with appropriate active anti-MAC antibiotic therapy.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Artroplastia do Joelho , Infecção por Mycobacterium avium-intracellulare , Infecções Relacionadas à Prótese , Humanos , Complexo Mycobacterium avium , Artroplastia do Joelho/efeitos adversos , Artroplastia de Quadril/efeitos adversos , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Infecção por Mycobacterium avium-intracellulare/epidemiologia , Infecção por Mycobacterium avium-intracellulare/terapia , Próteses e Implantes/efeitos adversos , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/epidemiologia , Artrite Infecciosa/terapia , Recidiva , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/terapia , Estudos Retrospectivos
3.
Epidemiol Infect ; 149: e117, 2021 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-33902774

RESUMO

No previous studies have examined Mycobacterium avium complex pulmonary disease (MAC-PD) in only elderly patients ⩾75 years old. Here, we investigated the exacerbating factors of MAC-PD in elderly patients and clarified cases that can be followed up without MAC medication. From April 2011 to March 2019, 126 advanced aged patients at our institute were newly diagnosed with MAC-PD, and could be observed based on radiological findings for over a year. Their medical records were retrospectively examined for clinical and radiological findings at the time of diagnosis and 1 year later. To identify the predictors of exacerbation, clinical characteristics of 109 treatment-naïve patients were compared between exacerbated and unchanged groups. Additionally, the unchanged group was followed for one more year. In the current study, positive acid-fast bacilli smears from the sputum test, the presence of cavitary lesions and extensive radiological findings, particularly abnormal shadows in ⩾3 lobes, were predictive of exacerbation among treatment-naïve elderly MAC-PD patients. In the unchanged group, <10% showed exacerbation of radiological findings within the subsequent year. In conclusion, if the sputum smear is negative, no cavitary lesions are present, and abnormal shadows are restricted to ⩽2 lobes, elderly patients with MAC-PD may remain untreated for a few years.


Assuntos
Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Tuberculose Pulmonar/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Infecção por Mycobacterium avium-intracellulare/microbiologia , Infecção por Mycobacterium avium-intracellulare/patologia , Infecção por Mycobacterium avium-intracellulare/terapia , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Escarro/microbiologia , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/patologia , Tuberculose Pulmonar/terapia
5.
J Cyst Fibros ; 19(2): 232-235, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31399327

RESUMO

BACKGROUND: The majority of nontuberculous mycobacterial (NTM) pulmonary infections in people with cystic fibrosis (CF) are caused by Mycobacterium avium complex (MAC) species. Data on MAC species distribution and outcomes of infection in CF are lacking. METHODS: This was a single center, retrospective study. MAC isolates had species identification with MLSA of rpoB and the 16S23S ITS region. Clinical data were compared between species. RESULTS: Twenty-three people with CF and 57 MAC isolates were included. Infection with M. avium was the most common (65.2%). M. intracellulare was associated with higher rates of NTM disease, younger age, and steeper decline in lung function prior to infection. CONCLUSIONS: We observed worse clinical outcomes in people with M. intracellulare infection relative to other MAC species. Further investigation of clinical outcomes of MAC infection among CF patients is warranted to better define the utility of species-level identification of MAC isolates in CF.


Assuntos
Antibacterianos/uso terapêutico , Fibrose Cística , Infecções por Mycobacterium não Tuberculosas/classificação , Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare , Adulto , Fibrose Cística/diagnóstico , Fibrose Cística/microbiologia , Fibrose Cística/fisiopatologia , Feminino , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Infecções por Mycobacterium não Tuberculosas/terapia , Complexo Mycobacterium avium/classificação , Complexo Mycobacterium avium/efeitos dos fármacos , Complexo Mycobacterium avium/genética , Complexo Mycobacterium avium/patogenicidade , Infecção por Mycobacterium avium-intracellulare/epidemiologia , Infecção por Mycobacterium avium-intracellulare/fisiopatologia , Infecção por Mycobacterium avium-intracellulare/terapia , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Prognóstico , Testes de Função Respiratória/métodos , Estudos Retrospectivos , Estados Unidos/epidemiologia
6.
Vasc Endovascular Surg ; 54(2): 191-194, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31578128

RESUMO

Aortic graft infections are uncommon complications after endovascular aortic surgery. In the majority of cases, gram-positive and then gram-negative organisms are the causative agents leading to this condition. Atypical organisms are traditionally not responsible for graft infection unless the patient is immunocompromised. We are reporting a case of culture-confirmed mycobacterium avium complex infection of an aortic graft in a well-controlled patient with HIV who had an undetected viral load and a CD4 count of 324 while on highly active antiretroviral therapy.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Infecções por HIV/tratamento farmacológico , Complexo Mycobacterium avium/patogenicidade , Infecção por Mycobacterium avium-intracellulare/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/terapia , Adulto , Antibacterianos/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular/instrumentação , Remoção de Dispositivo , Infecções por HIV/diagnóstico , Infecções por HIV/imunologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Complexo Mycobacterium avium/imunologia , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Infecção por Mycobacterium avium-intracellulare/imunologia , Infecção por Mycobacterium avium-intracellulare/terapia , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/imunologia , Infecções Relacionadas à Prótese/terapia , Resultado do Tratamento
7.
Pneumologie ; 73(8): 474-481, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31075795

RESUMO

The recognition, correct diagnosis and adequate clinical management of infections caused by atypical mycobacteria are challenging tasks in clinical practice. Invasive infections caused by Mycobacterium chimaera, a member of the Mycobacterium avium-intracellulare complex, have been increasingly reported over the past few years. Most infections occurred in patients who had undergone open-chest cardiothoracic surgery. Epidemiological and molecular studies showed that transmission of M. chimaera occurred through intraoperative aerosols derived from contaminated heater-cooler units, i. e. devices that are used to enable the extracardiac circuit in cardiothoracic surgery. Thus far, approximately 120 patient cases have been reported worldwide. The latency between exposure and onset of clinical symptoms may comprise several years. Clinical manifestations of M. chimaera infections include not only endocarditis and implant-associated infections, but also non-cardiac entities such as sarcoidosis-like symptoms, vertebral osteomyelitis and chorioretinitis. The pathogen can be detected in blood culture vials and in surgically obtained specimens from affected tissues, if specific microbiological tests for detection of mycobacteria are employed. There are no simple-to-use screening tests and a high clinical index of suspicion is thus mandatory in patients with previous exposure and compatible signs and symptoms. The successful treatment of M. chimaera infections requires the removal of infected devices and prolonged combination therapy with antimycobacterial drugs. This review summarises the clinical relevance, epidemiology, symptomatology, diagnosis and treatment of infections caused by M. chimaera, with a specific focus on pneumological aspects.


Assuntos
Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Mycobacterium/isolamento & purificação , Humanos , Mycobacterium/classificação , Infecções por Mycobacterium não Tuberculosas , Infecção por Mycobacterium avium-intracellulare/terapia , Micobactérias não Tuberculosas
9.
Front Immunol ; 10: 621, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30984189

RESUMO

Mycobacterial Infections can be severe in patients with T-cell deficiency or phagocyte disorders, and treatment is frequently complicated by antimicrobial resistance. Restoration of T-cell immunity via stem cell transplantation facilitates control of mycobacterial infections, but presence of active infections during transplantation is associated with a higher risk of mortality. Adoptive T cell immunotherapy has been successful in targeting viruses, but has not been attempted to treat mycobacterial infections. We sought to expand and characterize mycobacterial-specific T-cells derived from healthy donors in order to determine suitability for adoptive immunotherapy. Mycobacteria-specific T-cells (MSTs) were generated from 10 healthy donors using a rapid ex vivo expansion protocol targeting five known mycobacterial target proteins (AG85B, PPE68, ESXA, ESXB, and ADK). MSTs were compared to T-cells expanded from the same donors using lysate from M. tuberculosis or purified protein derivative from M. avium (sensitin). MST expansion from seven patients with primary immunodeficiency disorders (PID) and two patients with IFN-γ autoantibodies and invasive M. avium infections. MSTs expanded from healthy donors recognized a median of 3 of 5 antigens, with production of IFN-γ, TNF, and GM-CSF in CD4+ T cells. Comparison of donors who received BCG vaccine (n = 6) to those who did not (n = 4) showed differential responses to PPE68 (p = 0.028) and ADK (p = 0.015) by IFN-γ ELISpot. MSTs expanded from lysate or sensitin also recognized multiple mycobacterial antigens, with a statistically significant differences noted only in the response to PPE68 (p = 0.016). MSTs expanded from patients with primary immunodeficiency (PID) and invasive mycobacterial infections showed activity against mycobacterial antigens in only two of seven subjects, whereas both patients with IFN-γ autoantibodies recognized mycobacterial antigens. Thus, MSTs can be generated from donors using a rapid expansion protocol regardless of history of BCG immunization. Most tested PID patients had no detectable T-cell immunity to mycobacteria despite history of infection. MSTs may have clinical utility for adoptive immunotherapy in T-cell deficient patients with invasive mycobacterial infections.


Assuntos
Proteínas de Bactérias/imunologia , Linfócitos T CD4-Positivos/imunologia , Complexo Mycobacterium avium/imunologia , Infecção por Mycobacterium avium-intracellulare/imunologia , Mycobacterium tuberculosis/imunologia , Doenças da Imunodeficiência Primária/imunologia , Transferência Adotiva , Linfócitos T CD4-Positivos/patologia , Feminino , Humanos , Masculino , Infecção por Mycobacterium avium-intracellulare/patologia , Infecção por Mycobacterium avium-intracellulare/terapia , Mycobacterium bovis/imunologia , Doenças da Imunodeficiência Primária/microbiologia , Doenças da Imunodeficiência Primária/patologia , Doenças da Imunodeficiência Primária/terapia
10.
Indian J Dermatol Venereol Leprol ; 85(6): 605-608, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29974888

RESUMO

The incidence of primary cutaneous Mycobacterium intracellulare infection is very low. We report a case of primary cutaneous M. intracellulare infection which presented as painful erythematous swelling of the right upper limb without systemic involvement. A novel technique of vacuum sealing drainage was successfully implemented after antimycobacterial treatment proved ineffective at the end of 3 months. Our technique also revealed some additional practical advantages.


Assuntos
Desbridamento/métodos , Drenagem/métodos , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Infecção por Mycobacterium avium-intracellulare/terapia , Idoso , Agricultura , Feminino , Humanos , Vácuo
11.
Ann Otol Rhinol Laryngol ; 127(10): 726-730, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29962232

RESUMO

OBJECTIVES: To describe a safe and effective treatment for endobronchial Mycobacterium avium complex. METHODS: Case report and literature review. RESULTS: We present a case of endobronchial M. avium complex in a healthy child treated with serial carbon-dioxide laser excisions and antibiotic triple therapy using azithromycin, rifampin, and ethambutol. No current guideline for the treatment of these lesions in the pediatric population exists. CONCLUSIONS: In patients with airway impingement, serial endoscopic surgical resection combined with antibiotics can provide safe and effective management.


Assuntos
Antituberculosos/uso terapêutico , Bronquite/microbiologia , Líquido da Lavagem Broncoalveolar/microbiologia , Terapia a Laser/métodos , Microcirurgia/métodos , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/microbiologia , Bronquite/diagnóstico , Bronquite/terapia , Broncoscopia , Pré-Escolar , Diagnóstico Diferencial , Humanos , Masculino , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Infecção por Mycobacterium avium-intracellulare/terapia , Tomografia Computadorizada por Raios X
12.
J Avian Med Surg ; 32(4): 322-327, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31112646

RESUMO

A 3-year-old female Bruce's green pigeon (Treron waalia) was presented with granulomatous inflammation of the cere and underlying tissues with osteomyelitis and bone proliferation of the dorsal premaxilla. Biopsy and culture revealed the presence of Mycobacterium avium-intracellulare complex, and multi-antimicrobial treatment was initiated with clarithromycin, ethambutol, rifabutin, and enrofloxacin. The cere lesion improved and no evidence of systemic granulomas was observed over 4 months of treatment, although leukocytosis and monocytosis persisted. Five months after discontinuation of antibiotic therapy, the white blood cell count had normalized, but distal beak irregularities and partial recurrence of the mass were present. The bird died 15 months after discontinuation of antibiotic therapy and necropsy revealed no evidence of active mycobacteriosis of the beak or cere. This report documents an unusual clinical presentation of mycobacteriosis, in addition to its successful resolution.


Assuntos
Doenças das Aves/microbiologia , Columbidae , Granuloma/veterinária , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/veterinária , Animais , Antibacterianos/uso terapêutico , Doenças das Aves/patologia , Quimioterapia Combinada , Feminino , Granuloma/microbiologia , Granuloma/patologia , Granuloma/terapia , Infecção por Mycobacterium avium-intracellulare/microbiologia , Infecção por Mycobacterium avium-intracellulare/patologia , Infecção por Mycobacterium avium-intracellulare/terapia
14.
Intern Med ; 55(20): 3053-3058, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27746449

RESUMO

We herein report a case of disseminated Mycobacterium avium infection that involved both optic nerves, the conjunctiva, the right lower lung, and multiple skin lesions, including a thoracic nodule. The patient was a 65-year-old man without any significant medical history. The pathogen was detected in the patient's eye discharge, sputum, bronchial lavage fluid, and thoracic nodule. Anti-mycobacterial chemotherapy, including clarithromycin, rifampicin, and ethambutol, was administered, and the thoracic nodule was resected. An autoantibody to interferon-γ was detected in the patient's serum. Bilateral swelling of his optic nerves and facial dermatitis improved after initiating anti-mycobacterial chemotherapy.


Assuntos
Autoanticorpos/sangue , Interferon gama/imunologia , Infecção por Mycobacterium avium-intracellulare/etiologia , Idoso , Antibacterianos/uso terapêutico , Claritromicina/uso terapêutico , Etambutol/uso terapêutico , Humanos , Masculino , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Infecção por Mycobacterium avium-intracellulare/terapia , Rifampina/uso terapêutico
15.
Biomed Res Int ; 2016: 4387461, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27556033

RESUMO

The nontuberculous mycobacteria are typically environmental organisms residing in soil and water. These microorganisms can cause a wide range of clinical diseases; pulmonary disease is most frequent, followed by lymphadenitis in children, skin and soft tissue disease, and rare extra pulmonary or disseminated infections. Mycobacterium avium complex is the second most common cause of pulmonary mycobacterioses after M. tuberculosis. This review covers the clinical and laboratory diagnosis of infection caused by the members of this complex and particularities for the treatment of different disease types and patient populations.


Assuntos
Infecção por Mycobacterium avium-intracellulare/diagnóstico , Animais , Reservatórios de Doenças/microbiologia , Microbiologia Ambiental , Humanos , Complexo Mycobacterium avium/classificação , Complexo Mycobacterium avium/efeitos dos fármacos , Complexo Mycobacterium avium/genética , Infecção por Mycobacterium avium-intracellulare/etiologia , Infecção por Mycobacterium avium-intracellulare/terapia , Fatores de Risco
16.
World Neurosurg ; 90: 703.e1-703.e3, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26926796

RESUMO

BACKGROUND: Spindle cell pseudotumors are formed by histiocytes in response to infection by Mycobacterium avium-intracellulare complex (MAC) and are rare in patients without AIDS. CASE DESCRIPTION: A 66-year-old man presented with neck pain, ataxia, and a history of sarcoidosis. A cerebellar lesion was identified on magnetic resonance imaging and surgically excised. Histopathology revealed this to be a spindle cell pseudotumor and MAC was isolated by bacterial culture of cerebrospinal fluid. Hematology revealed cluster of differentiation 4 lymphocytopenia but human immunodeficiency virus serology was negative. The patient was commenced on antimicrobial treatment that included a macrolide and remained well at 1 year follow-up. CONCLUSIONS: This rare presentation of isolated intracranial MAC was treated with surgical excision and antimicrobials with a good outcome.


Assuntos
Doenças Cerebelares/patologia , Doenças Cerebelares/terapia , Infecção por Mycobacterium avium-intracellulare/patologia , Infecção por Mycobacterium avium-intracellulare/terapia , Síndrome da Imunodeficiência Adquirida , Idoso , Antibacterianos/administração & dosagem , Terapia Combinada/métodos , Diagnóstico Diferencial , Humanos , Masculino , Procedimentos Neurocirúrgicos/métodos , Resultado do Tratamento
17.
BMC Pulm Med ; 15: 126, 2015 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-26496968

RESUMO

BACKGROUND: Biological agents inhibiting TNF-α and other molecules involved in inflammatory cascade have been increasingly used to treat rheumatoid arthritis (RA). However, it remains controversial whether biological agents can be used safely in a patient with an underlying chronic infectious disease. CASE PRESENTATION: A 63-year-old woman who had been treated with tocilizumab (TCZ), anti-interleukin-6 receptor antibody, for RA presented to our outpatient clinic due to hemoptysis. She was diagnosed with pulmonary Mycobacterium avium complex (MAC) infection, and high-resolution computed tomography (HRCT) showed a single cavitary lesion in the right upper lobe. After diagnosis of pulmonary MAC disease, TCZ was discontinued and combination chemotherapy with clarithromycin, rifampicin, ethambutol and amikacin was started for MAC pulmonary disease. Since the lesion was limited in the right upper lobe as a single cavity formation, she underwent right upper lobectomy. As her RA symptoms were deteriorated around the operation, TCZ was resumed. After resumption of TCZ, her RA symptoms improved and a recurrence of pulmonary MAC infection has not been observed for more than 1 year. CONCLUSION: This case suggested that TCZ could be safely reintroduced after the resection of a pulmonary MAC lesion. Although the use of biological agents is generally contraindicated in patients with pulmonary MAC disease, especially in those with a fibrocavitary lesion, a multimodality intervention for MAC including both medical and surgical approaches may enable introduction or resumption of biological agents.


Assuntos
Antibacterianos/uso terapêutico , Anticorpos Monoclonais Humanizados/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Hospedeiro Imunocomprometido , Pulmão/cirurgia , Infecção por Mycobacterium avium-intracellulare/terapia , Pneumonectomia , Amicacina/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Claritromicina/uso terapêutico , Etambutol/uso terapêutico , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Infecção por Mycobacterium avium-intracellulare/diagnóstico por imagem , Infecção por Mycobacterium avium-intracellulare/imunologia , Rifampina/uso terapêutico , Tomografia Computadorizada por Raios X
18.
J Clin Immunol ; 35(5): 459-62, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26054576

RESUMO

Mendelian susceptibility to mycobacterial disease (MSMD) is a rare condition characterized by clinical disease caused by weakly virulent mycobacteria. All genes mutated in MSMD patients are involved in IFN-γ immunity. Autosomal partial dominant (PD) interferon-γ receptor 1 (IFN-γR1) deficiency is the most frequent abnormality affecting the group of MSMD patients leading to impaired response of IFN-γ. We describe here a patient from India with disseminated infection due to Mycobacterium avium intracellulare (MAC) including multifocal osteomyelitis and BCG disease. A heterozygous mutation in exon 6 of IFNGR1 gene was identified, conferring an autosomal PD IFN-γR1 deficiency. Patient had recurrence of mycobacterial disease during antibiotic therapy for which subcutaneous IFN-γ was added as a modality of treatment for resistant MAC infection.


Assuntos
Complexo Mycobacterium avium/imunologia , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Osteomielite/imunologia , Receptores de Interferon/genética , Antibacterianos/uso terapêutico , Criança , Quimioterapia Combinada , Genes Dominantes/genética , Humanos , Índia , Interferon gama/uso terapêutico , Masculino , Mutação/genética , Infecção por Mycobacterium avium-intracellulare/genética , Infecção por Mycobacterium avium-intracellulare/terapia , Osteomielite/genética , Osteomielite/terapia , Receptor de Interferon gama
20.
Respirology ; 20(2): 348-51, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25430584

RESUMO

Data regarding many clinical aspects of pulmonary Mycobacterium avium complex (pMAC) are lacking. Guidelines rely substantially upon expert opinion, integrated through face-to-face meetings, variably weighting individual opinions. We surveyed North American non-tuberculous mycobacteria experts regarding clinical aspects of pMAC using Delphi methods. Nineteen of 26 invited experts (73%) responded, with extensive variability. Convergence could not be reached for most questions. Respondents described extensive uncertainty around specific issues. Findings underscore urgent need for more research.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pneumopatias/terapia , Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare/terapia , Técnica Delphi , Prova Pericial , Humanos , Pneumopatias/diagnóstico , Pneumopatias/microbiologia , Infecção por Mycobacterium avium-intracellulare/complicações , Infecção por Mycobacterium avium-intracellulare/diagnóstico , América do Norte , Guias de Prática Clínica como Assunto
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