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ABSTRACT: Prototheca species are achlorophyllic algae that are a rare cause of infection in humans. It most commonly causes localized cutaneous disease and rarely disseminated infection. Immunocompromised patients have the highest risk of disseminated protothecosis, with a higher mortality rate than localized cutaneous infections. At the species level, infections caused by Prototheca zopfii are reported less frequently than those caused by Prototheca wickerhamii. The diagnosis can be made using histopathology, culture, and molecular testing. There is no definitive evidence for an effective treatment, which currently consists of antifungals (primarily amphotericin B). With only a handful of cases of disseminated protothecosis reported worldwide that are caused by P. zopfii , we herein present an additional case of a postbone marrow transplant patient in the Midwest of the United States.
Assuntos
Infecções , Prototheca , Dermatopatias Infecciosas , Humanos , Infecções/diagnóstico , Infecções/etiologia , Infecções/patologia , Dermatopatias Infecciosas/complicações , Antifúngicos/uso terapêuticoRESUMO
Introducción: Las infecciones de artroplastia total de cadera tienen una incidencia baja, pero cuando suceden generan un problema sanitario no solo para el paciente, sino también para el sistema de salud. Las mismas pueden generar dolor, disminución de la capacidad funcional, pobre calidad de vida, múltiples cirugías, y en ocasiones, la muerte. Objetivos: Evaluar la incidencia nacional de infecciones en las artroplastias primarias de cadera operadas por artrosis en el 2014 en Uruguay, y los factores de riesgo vinculados al paciente, medio ambiente y acto quirúrgico, incluido el abordaje quirúrgico. Métodos: Estudio observacional analítico de todos los pacientes operados por artrosis. Se selecciona una muestra aleatoria de 633 pacientes, representativa de las 1738 artroplastias realizadas en Uruguay durante el año 2014. Mediante entrevista telefónica y revisión de historias clínicas se identificaron los pacientes con infección profunda del sitio quirúrgico. Se estimó la incidencia de infección y se realizó un análisis uni- multivariado mediante regresión logística para identificar factores asociados a la infección periprotésica profunda. Resultados: Se presentaron 8 infecciones, con una incidencia de 1,21 por ciento (IC 95 por ciento 0,59 2,20) en la población general. Los factores asociados a la infección protésica con significancia estadística fueron: a) IMC ≥ 35, p= 0,006; b) procedencia de Montevideo 2,07 por ciento (1,03 4,11) p= 0,031; c) procedencia del subsector privado 1,47 por ciento (0,77 2,78) p= 0,009; d) centro quirúrgico donde se realizó la cirugía 4,3 % (1,6 10,9) p= 0,03, e) uso de cemento con antibiótico 1,59 por ciento (0,65 3,25) p= 0,034. Se presentó sospecha de infección en 6 de 8 pacientes, en los primeros 30 días postoperatorios; a 7 de 8 pacientes se les realizó limpieza quirúrgica y solo a 1 de 8 pacientes se le realizó la revisión protésica definitiva. Conclusiones: La incidencia de infección en cirugía protésica electiva de cadera por artrosis en el Registro Nacional de Uruguay, fue similar a lo publicado en la bibliografía. De las variables frecuentemente citadas como incidentales en esta complicación, solo el índice de masa corporal fue asociado en esta serie. Llaman la atención las asociaciones dependientes de la procedencia, nivel socioeconómico y centro quirúrgico. Los resultados respecto al uso de cemento con antibiótico deben ser evaluados en estudios futuros(AU)
Introduction: Total hip arthroplasty infections have a low incidence, but when they occur they generate health problems for the patient, and for the health system. They can cause pain, decreased functional capacity, poor quality of life, multiple surgeries, and sometimes death. Objectives: To evaluate the national incidence of infections in primary hip arthroplasties operated for osteoarthritis in 2014, and the risk factors related to the patient, the environment and the surgical act, including the surgical approach. Methods: Analytical observational study of all patients operated on for osteoarthritis. A random sample of 633 patients was selected, representative of 1738 arthroplasties performed in Uruguay in 2014. Through a telephone interview and review of medical records, patients with deep infection of the surgical site were identified. The incidence of infection was estimated and univariate and multivariate analysis was performed using logistic regression to identify factors associated with deep periprosthetic infection. Results: There were 8 infections, with an incidence of 1.21 percent (95 percent CI 0.59 - 2.20) in the general population. The statistically significant factors associated with prosthetic infection were: a) BMI ≥ 35, p = 0.006; b) origin of Montevideo 2.07 percent(1.03 - 4.11) p = 0.031; c) origin of the private subsector 1.47 percent (0.77 - 2.78) p = 0.009; d) surgical center where the surgery was performed 4.3 percent(1.6 - 10.9) p = 0.03, e) use of cement with antibiotic 1.59 percent(0.65 - 3.25) p = 0.034. Suspicion of infection was presented in 6 of 8 patients, in the first 30 postoperative days; 7 of 8 patients underwent surgical cleaning and only 1 of 8 patients underwent final prosthetic revision. Conclusions: The incidence of infection in elective prosthetic hip surgery for osteoarthritis in the Uruguayan National Registry was similar to that published in the literature. Body mass index was the only variable associated as incidental to this complication in this series, out of those frequently cited. The associations depending on the origin, socioeconomic level and surgical center are striking. The results regarding the use of cement with antibiotics should be evaluated in future studies(AU)
Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Osteoartrite/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Artroplastia de Quadril/efeitos adversos , Infecções/etiologia , Uruguai/epidemiologia , Incidência , Estudos RetrospectivosRESUMO
La terapia con fármacos antagonistas del factor de necrosis tumoral alfa ha sido beneficiosa en el tratamiento de varias enfermedades como las del tejido conectivo e inflamatorias del intestino, pero no está exenta de riesgos. Las principales complicaciones de estas drogas inmunosupresoras son las infecciones, y la tuberculosis pulmonar es una de las principales afecciones, que se pueden observar en los pacientes con este tipo de tratamiento.Se presentó una mujer de 31 años, atendida en el Hospital Clínico Quirúrgico Hermanos Ameijeiras, La Habana, Cuba, con antecedentes de colitis ulcerativa, que hace 3 meses recibe terapia con Infliximab. Acude al hospital por referir 4 días previos al ingreso, fiebre de 390 C dos veces al día, acompañándose de cefalea, pérdida del apetito y dolor en la región perineal. Se le realizó radiografía de tórax, donde se describe radiopacidad heterogénea que va desde el cuerno superior del hilio derecho hasta planos axilares, en la tomografía axial de tórax reportan consolidación en segmento anterior del lóbulo superior derecho con presencia de broncograma aéreo y en el lavado bronquial microbiológico para bacilos ácido-alcohol resistentes se informó codificación 8, positivo a Mycobacterium tuberculosis. El diagnóstico preciso de tuberculosis relacionada con el uso de fármacos antagonistas del factor de necrosis tumoral alfa requiere un alto índice de sospecha y una investigación detallada. Existe un alto grado de complejidad diagnóstica, por la existencia de un amplio espectro clínico y la necesidad de excluir otras enfermedades.
Tumor necrosis factor alpha antagonist drug therapy has been beneficial in the treatment of several diseases such as connective tissue and inflammatory bowel diseases, but it is not without risks. The main complications of these immunosuppressive drugs are infections, and pulmonary tuberculosis is one of the main conditions, which can be observed in patients with this type of treatment. A 31-year-old woman, treated at the Hermanos Ameijeiras Clinical Surgical Hospital, Havana, Cuba, with a history of ulcerative colitis, who has been receiving Infliximab therapy for 3 months, presented. He went to the hospital for referring 4 days prior to admission, a fever of 390 C twice a day, accompanied by headache, loss of appetite and pain in the perineal region. A chest X-ray was performed, which described heterogeneous radiopacity that goes from the upper horn of the right hilum to axillary planes, in the chest axial tomography they report consolidation in the anterior segment of the right upper lobe with the presence of air bronchogram and in the bronchial lavage microbiological for acid-fast bacilli coding 8, positive for mycobacterium tuberculosis was reported. Accurate diagnosis of tuberculosis related to the use of tumor necrosis factor alpha antagonist drugs requires a high index of suspicion and detailed investigation. There is a high degree of diagnostic complexity, due to the existence of a wide clinical spectrum and the need to exclude other diseases.
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Humanos , Feminino , Adulto , Tuberculose Pulmonar/diagnóstico por imagem , Infliximab/efeitos adversos , Imunossupressores/efeitos adversos , Tuberculose Pulmonar/etiologia , Tomografia Computadorizada por Raios X , Infecções/etiologiaRESUMO
RESUMEN Introducción: el cáncer de la vejiga es la segunda neoplasia urológica. En Cuba constituye la séptima causa de cáncer en el sexo masculino y entre las primeras quince, cuando se combinan ambos sexos. Objetivo: evaluar el comportamiento del cáncer de vejiga en pacientes del Hospital Universitario Comandante "Faustino Pérez Hernández". Materiales y Métodos: se realizó un estudio observacional, descriptivo y transversal en el período comprendido desde diciembre de 2014 hasta enero de 2020. Los pacientes se dividieron en tres grupos tratados con cirugía de mínimo acceso, cirugía abierta y no operados, se describieron los grupos histológicos y estadiaje tumoral y se les aplicó tratamiento según protocolo del servicio, sus complicaciones y la presencia de recidivas tumorales también fueron descritas. En el universo se incluyeron en el estudio 222 pacientes diagnosticados de cáncer de vejiga. Resultados: se comprobó que el mayor número de pacientes diagnosticados con cáncer de vejiga son del sexo masculino, el tipo histológico es el carcinoma de células uroteliales de bajo grado y el estadio T1. Las recidivas se presentaron antes de los 5 años en el 10,8% de los casos. 196 pacientes presentaron complicaciones. Conclusiones: el cáncer de vejiga es más frecuente en las edades comprendidas entre 60 a 69 años, las recidivas aparecieron mayormente entre 1 y 3 años. Se presentó complicaciones en 196 pacientes, siendo la cirugía la modalidad terapéutica que mayor por ciento tuvo con un 32.22% y las infecciones son las complicaciones más frecuentes (AU).
SUMMARY Introduction: Cancer of the bladder (CV) is the second urological neoplasm. In Cuba it constitutes the seventh cause of cancer in males and among the first fifteen, when both sexes are combined. Objective: To evaluate the behavior of bladder cancer (CV) in patients of the Faustino Pérez Hernández Hospital. Materials and methods: An observational, descriptive and cross-sectional study was carried out in the period from December 2014 to January 2020. The patients were divided into 3 groups treated with Minimum Access Surgery (CMA), Open Surgery (CA) and No Operated (NO), the histological groups and tumor staging were described and treatment was applied according to the service protocol, their complications and the presence of tumor recurrences were also described.Universe: 222 patients diagnosed with bladder cancer were included in the study. Results: It was found that the greatest number of patients diagnosed with CV are male, the histological type is low-grade urothelial cell carcinoma and stage T1. Recurrences occurred before 5 years in 10.8% of cases. 196 patients presented complications. Conclusions: The CV is more frequent in the ages between 60 to 69 years, the recurrences appeared mainly between 1 and three years. Complications occurred in 196 patients, with Surgery being the therapeutic modality with the highest percentage with 32.22% and infections being the most frequent complications (AU).
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Humanos , Neoplasias da Bexiga Urinária/epidemiologia , Carcinoma/epidemiologia , Infecções/etiologia , Neoplasias da Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/diagnóstico , Carcinoma/cirurgia , Carcinoma/complicações , Carcinoma/diagnóstico , Epidemiologia Descritiva , Estudos Transversais , Estudo ObservacionalRESUMO
INTRODUCTION: Having reliable predictive models of prognosis/the risk of infection in systemic lupus erythematosus (SLE) patients would allow this problem to be addressed on an individual basis to study and implement possible preventive or therapeutic interventions. OBJECTIVE: To identify and analyze all predictive models of prognosis/the risk of infection in patients with SLE that exist in medical literature. METHODS: A structured search in PubMed, Embase, and LILACS databases was carried out until May 9, 2020. In addition, a search for abstracts in the American Congress of Rheumatology (ACR) and European League Against Rheumatism (EULAR) annual meetings' archives published over the past eight years was also conducted. Studies on developing, validating or updating predictive prognostic models carried out in patients with SLE, in which the outcome to be predicted is some type of infection, that were generated in any clinical context and with any time horizon were included. There were no restrictions on language, date, or status of the publication. To carry out the systematic review, the CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) guideline recommendations were followed. The PROBAST tool (A Tool to Assess the Risk of Bias and Applicability of Prediction Model Studies) was used to assess the risk of bias and the applicability of each model. RESULTS: We identified four models of infection prognosis in patients with SLE. Mostly, there were very few events per candidate predictor. In addition, to construct the models, an initial selection was made based on univariate analyses with no contraction of the estimated coefficients being carried out. This suggests that the proposed models have a high probability of overfitting and being optimistic. CONCLUSIONS: To date, very few prognostic models have been published on the infection of SLE patients. These models are very heterogeneous and are rated as having a high risk of bias and methodological weaknesses. Despite the widespread recognition of the frequency and severity of infections in SLE patients, there is no reliable predictive prognostic model that facilitates the study and implementation of personalized preventive or therapeutic measures.Protocol registration number: PROSPERO CRD42020171638.
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Infecções/etiologia , Lúpus Eritematoso Sistêmico/complicações , Progressão da Doença , Feminino , Humanos , Masculino , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
INTRODUCTION: HSCT has grown in number in recent years. This treatment in children has its particularities and has been characterized in previous studies only on a limited basis. There are important causes of morbidity and mortality in this group of patients, including evolution of primary disease, graft failure, infectious diseases, and GVHD. The aim of this study was to report case series of TRM within 100 days after transplantation and associated factors. METHODS: Retrospective cohort. All children transplanted between January 1, 2010 and December 31, 2017 were included and those who underwent the first HSCT in another center were excluded. RESULTS: Data from 292 children were analyzed. TRM in 100 days was 5.8%, being significantly higher in patients with umbilical cord blood as the cell source. Infectious complications were frequent in this sample (bacterial infections in 27%, viral infections in 75.3%, and fungal infections in 12%) and both the presence of fungal disease and more than one infection during the follow-up (viral and bacterial, viral and fungal or bacterial and fungal) had statistically significant association with the outcome. CONCLUSIONS: The prognosis in allogeneic HSCT is influenced by the origin of the stem cells, the presence of acute GVHD and the occurrence of infectious diseases. Studies that evaluate pediatric individuals undergoing HSCT and analyze their mortality profile, can improve the management of these patients, possibly leading to a reduction in TRM.
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Transplante de Células-Tronco Hematopoéticas/mortalidade , Adolescente , Brasil , Criança , Pré-Escolar , Feminino , Seguimentos , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/mortalidade , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Lactente , Recém-Nascido , Infecções/etiologia , Infecções/mortalidade , Masculino , Prognóstico , Estudos RetrospectivosRESUMO
OBJECTIVES: To examine the association between prenatal stress and infant physical health in the first year of life within an understudied, racially and ethnically diverse, highly stressed community sample. We expected that greater stress exposure would predict higher rates of infant illness. STUDY DESIGN: Low-income, racially/ethnically diverse, overweight women with low medical risk pregnancies were recruited (2011-2014) during pregnancy. Pregnancy Stressful Life Events were assessed retrospectively (mean, 11.88 months postpartum). Perceived stress was assessed twice during pregnancy (at a mean of 17.4 weeks and again at a mean of 25.6 weeks) and at 6 months postpartum. Women with live births (n = 202) were invited; 162 consented to the offspring study. Medical records from pediatric clinics and emergency departments for 148 infants were abstracted for counts of total infectious illnesses, total noninfectious illness, and diversity of illnesses over the first year of life. RESULTS: The final analytic sample included 109 women (mean age, 28.08 years) and their infants. In covariate-adjusted negative binomial models, maternal perceptions of stress across pregnancy were positively associated with infant illness. Each 1-point increase in average stress was associated with a 38% increase in incidence of infant infections (Incidence rate ratio, 1.38; 95% CI, 1.01-1.88; P < .05), a 73% increase in noninfectious illness (IRR, 1.73; 95% CI, 1.34-2.23; P < .05), and a 53% increase in illness diversity (IRR, 1.53; 95% CI, 1.25, 1.88; P < .01); effect sizes were larger for perceived stress later in pregnancy. Stressful life events count and postnatal stress were not uniquely associated with illness. CONCLUSIONS: In line with recommendations from the American Academy of Pediatrics to screen for maternal perinatal depression, screening and support for stress reduction during pregnancy may benefit both maternal and child health.
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Doenças do Recém-Nascido/etiologia , Infecções/etiologia , Período Pós-Parto , Complicações na Gravidez/psicologia , Estresse Psicológico/complicações , Adolescente , Adulto , Feminino , Humanos , Incidência , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Infecções/epidemiologia , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Estresse Psicológico/psicologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Diabetes is a chronic disease characterized by marked alterations in the metabolism of glucose and by high concentrations of glucose in the blood due to a decreased insulin production or resistance to the action of this hormone in peripheral tissues. The International Diabetes Federation estimates a global incidence of diabetes of about 10% in the adult population (20 - 79 years old), some 430 million cases reported worldwide in 2018. It is well documented that people with diabetes have a higher susceptibility to infectious diseases and therefore show higher morbidity and mortality compared to the non-diabetic population. Given that the innate immune response plays a fundamental role in protecting against invading pathogens through a myriad of humoral and cellular mechanisms, the present work makes a comprehensive review of the innate immune alterations in patients with type 2 diabetes mellitus (T2D) as well as a brief description of the molecular events leading or associated to such conditions. We show that in these patients a compromised innate immune response increases susceptibility to infections.
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Diabetes Mellitus Tipo 2/complicações , Imunidade Inata , Infecções/patologia , Animais , Diabetes Mellitus Tipo 2/imunologia , Humanos , Infecções/etiologiaRESUMO
Innate immune cells can develop exacerbated immunologic response and long-term inflammatory phenotype following brief exposure to endogenous or exogenous insults, which leads to an altered response towards a second challenge after the return to a nonactivated state. This phenomenon is known as trained immunity (TI). TI is not only important for host defense and vaccine response but also for chronic inflammations such as cardiovascular and metabolic diseases such as atherosclerosis. TI can occur in innate immune cells such as monocytes/macrophages, natural killer cells, endothelial cells (ECs), and nonimmune cells, such as fibroblast. In this brief review, we analyze the significance of TI in ECs, which are also considered as innate immune cells in addition to macrophages. TI can be induced by a variety of stimuli, including lipopolysaccharides, BCG (bacillus Calmette-Guerin), and oxLDL (oxidized low-density lipoprotein), which are defined as risk factors for cardiovascular and metabolic diseases. Furthermore, TI in ECs is functional for inflammation effectiveness and transition to chronic inflammation. Rewiring of cellular metabolism of the trained cells takes place during induction of TI, including increased glycolysis, glutaminolysis, increased accumulation of tricarboxylic acid cycle metabolites and acetyl-coenzyme A production, as well as increased mevalonate synthesis. Subsequently, this leads to epigenetic remodeling, resulting in important changes in chromatin architecture that enables increased gene transcription and enhanced proinflammatory immune response. However, TI pathways and inflammatory pathways are separated to ensure memory stays when inflammation undergoes resolution. Additionally, reactive oxygen species play context-dependent roles in TI. Therefore, TI plays significant roles in EC and macrophage pathology and chronic inflammation. However, further characterization of TI in ECs and macrophages would provide novel insights into cardiovascular disease pathogenesis and new therapeutic targets. Graphic Abstract: A graphic abstract is available for this article.