RESUMO
A multinational outbreak of nosocomial fusarium meningitis occurred among immunocompetent patients who had undergone surgery with epidural anesthesia in Mexico. The pathogen involved had a high predilection for the brain stem and vertebrobasilar arterial system and was associated with high mortality from vessel injury. Effective treatment options remain limited; in vitro susceptibility testing of the organism suggested that it is resistant to all currently approved antifungal medications in the United States. To highlight the severe complications associated with fusarium infection acquired in this manner, we report data, clinical courses, and outcomes from 13 patients in the outbreak who presented with symptoms after a median delay of 39 days.
Assuntos
Surtos de Doenças , Fusariose , Fusarium , Doença Iatrogênica , Meningite Fúngica , Humanos , Antifúngicos/uso terapêutico , Fusariose/epidemiologia , Fusariose/etiologia , Fusarium/isolamento & purificação , Doença Iatrogênica/epidemiologia , Meningite Fúngica/epidemiologia , Meningite Fúngica/etiologia , México/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Internacionalidade , Imunocompetência , Farmacorresistência Fúngica , Analgesia Epidural/efeitos adversosRESUMO
BACKGROUND: The current fungal meningitis outbreak caused by contaminated epidural anesthesia with Fusarium solani among patients who underwent surgical procedures in Matamoros, Mexico remains a cause of concern. Its association with an increased susceptibility for cerebrovascular complications (CVC) has not been reported. This single-center study describes 3 patients with a unique pattern of CVC attributed to fungal meningitis. METHODS: A retrospective case series of patients diagnosed with fungal meningitis following surgical procedures under contaminated epidural anesthesia who developed a unique pattern of CVC during their hospitalization. RESULTS: Three female patients (mean age, 35 years) with CVC due to iatrogenic fungal meningitis were included. Positive Fungitell ß-D-glucan assay in cerebrospinal fluid was documented in all cases, and F. solani was confirmed by polymerase chain reaction in case 3. All cases were complicated by severe vertebrobasilar circulation vasculopathy and arterial dissections with resultant subarachnoid hemorrhage and intraventricular hemorrhage, ultimately leading to patients' death. CONCLUSIONS: The death toll from the ongoing fungal meningitis outbreak keeps rising, underscoring the need for early recognition and aggressive treatment. We highlight the risk for vertebrobasilar circulation CVC among these patients. The angioinvasive nature of F. solani is yet to be clarified; however, a clear pattern has been observed. Public health awareness should be raised and a strong response should be pursued.
Assuntos
Meningite Fúngica , Metilprednisolona , Humanos , Feminino , Adulto , Estudos Retrospectivos , México/epidemiologia , Meningite Fúngica/epidemiologia , Meningite Fúngica/etiologia , Meningite Fúngica/diagnóstico , Doença Iatrogênica/epidemiologiaRESUMO
INTRODUCTION: Cryptococcus neoformans is an opportunistic pathogen that causes â¼15% mortality in AIDS patients. Rio Grande City, Rio Grande do Sul (RS), Brazil, has the highest national rate of HIV/AIDS, considering cities with population more than 100,000 habitants. OBJECTIVE: We aimed to evaluate the clinical and epidemiological profile of cryptococcosis in a reference service for HIV-AIDS patients in the South region of Brazil, over seven years. Material and methods A retrospective study was performed including all cryptococcosis cases diagnosed at the University Hospital, Federal University of Rio Grande (UH-FURG) between January 2010 and December 2016. RESULTS: Seventy cases of cryptococcosis were diagnosis from 2010 to 2016 in the UH-FURG in the seven years of the study. These numbers were responsible for 2.1% to 8.1% of the hospitalizations/year for HIV patients. All were caused by C. neoformans infection (95% C. neoformans var. grubii VNI and 5% C. neoformans var. grubii VNII). Neurocryptococcosis was the major clinical manifestation and cryptococcosis was the HIV- defining condition in 40% of patients. The period of hospitalization was an average of 39.3 days (SD=31.3), and more than half of patients (53%; 37/70) died after a mean of 82 days. DISCUSSION: The present study showed the importance of cryptococcosis as an AIDS-defining disease in HIV-AIDS patients in a tertiary hospital from Southern Brazil. More investment is necessary to reduce the impact of this opportunistic mycosis in HIV-AIDS patients from southern Brazil.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Criptococose/epidemiologia , Infecções por HIV/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/microbiologia , Adulto , Idoso , Brasil/epidemiologia , Criptococose/complicações , Criptococose/microbiologia , Cryptococcus neoformans/isolamento & purificação , Feminino , HIV , Infecções por HIV/complicações , Infecções por HIV/microbiologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Meningite Fúngica/epidemiologia , Meningite Fúngica/etiologia , Meningite Fúngica/microbiologia , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Análise de Sobrevida , Adulto JovemRESUMO
AIMS: To report the case of a 26 year old white man, who developed chronic meningitis and intracerebral granulomata 15 days after an episode of near drowning in a swamp. METHODS: Aspergillus fumigatus was isolated from cerebrospinal fluid cultures. RESULTS: The patient died 70 days after the symptoms were first noticed, and seven days after a subarachnoid haemorrhage. Aspergillus has never been reported before as a cause of intracranial infection after near drowning. CONCLUSIONS: Physicians must be aware of this possibility when confronted with such a situation, because there are now effective therapeutic options for systemic aspergillosis.
Assuntos
Aspergilose/diagnóstico , Aspergillus fumigatus/isolamento & purificação , Meningite Fúngica/diagnóstico , Afogamento Iminente/complicações , Adulto , Aspergilose/etiologia , Evolução Fatal , Humanos , Masculino , Meningite Fúngica/etiologiaAssuntos
Artrite Infecciosa/etiologia , Coccidioidomicose/diagnóstico , Articulação do Joelho/microbiologia , Meningite Fúngica/etiologia , Osteólise/etiologia , Idoso , Artrite Infecciosa/microbiologia , Broncopneumonia/etiologia , Doença Crônica , Coccidioidomicose/complicações , Epilepsia Tônico-Clônica/etiologia , Granuloma/complicações , Granuloma/microbiologia , Dermatoses da Mão/complicações , Dermatoses da Mão/microbiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningite Fúngica/patologia , Recidiva , Esplenomegalia/etiologia , Líquido Sinovial/microbiologiaRESUMO
Aspergillosis of the central nervous system is an uncommon infection, mainly occurring in immunocompromised patients. It may be presented in several forms: meningitis, mycotic aneurysms, infarcts and the tumoral form (aspergilloma). The authors report a case of a diabetic patient with cerebral aspergilloma.
Assuntos
Aspergilose/diagnóstico , Encefalopatias/diagnóstico , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Adulto , Aspergilose/complicações , Encefalopatias/complicações , Infecções Fúngicas do Sistema Nervoso Central/complicações , Feminino , Humanos , Imageamento por Ressonância Magnética , Meningite Fúngica/tratamento farmacológico , Meningite Fúngica/etiologia , Lobo TemporalRESUMO
Aspergilose do sistema nervoso central é uma infecção rara, acometendo principalmente pacientes imunossuprimidos. Clinicamente pode se apresentar sob várias formas: meningite, aneurisma micótico, infartos cerebrais e como lesão tumoral (aspergiloma). Os autores apresentam o caso de um paciente diabético com aspergiloma cerebral.
Assuntos
Humanos , Feminino , Adulto , Aspergilose/diagnóstico , Encefalopatias/diagnóstico , Aspergilose/complicações , Aspergilose/cirurgia , Encefalopatias/complicações , Encefalopatias/cirurgia , Imageamento por Ressonância Magnética , Meningite Fúngica/tratamento farmacológico , Meningite Fúngica/etiologia , Complicações Pós-Operatórias/tratamento farmacológico , Lobo TemporalRESUMO
Se presenta un caso de meningitis primaria (sin afección pulmonar, ósea o dérmica) por el hongo Coccidioides immitis en un hombre de 27 años de edad que acudió por un síndrome de cráneo hipertensivo de un mes de evolución atendido en nuestra institución. El paciente provenía del norte de California y era previamente sano, sin antecedentes para sospechar inmunodeficiencia. La punción lumbar mostró glucosa 22 mg/dL, proteínas totales 62 mg/dL, leucocitos 110 células/mm3 97 por ciento polimorfonucleares, 3 por ciento mononucleares. La tomografía axial computada de cráneo evidenció dilatación ventricular bilateral. Se hizo el diagnóstico de meningitis por coccidioides immitis mediante la detección de anticuerpos (IgM 6.8 mg/dL e IgG 4.9 mg/dL; normal < 2 mg/dL) y cultivo de líquido cerebroespinal. La radiografía de tórax no mostró alteración alguna. La detección de anticuerpos contra el virus de la inmunodeficiencia humana fue negativa. Se colocó una válvula de derivación ventrículo-peritoneal y se manejó con anfotericina B intravenosa e intratecal a través de un reservorio de Ommaya. A pesar de este tratamiento, el paciente se deterioró neurológicamente y falleció dos semanas después de su egreso en su lugar de origen
Assuntos
Humanos , Masculino , Adulto , Anfotericina B/uso terapêutico , Coccidioides/isolamento & purificação , Coccidioidomicose/líquido cefalorraquidiano , Coccidioidomicose/diagnóstico , Coccidioidomicose/tratamento farmacológico , Meningite Fúngica/etiologia , Meningite Fúngica/fisiopatologia , Meningite Fúngica/tratamento farmacológico , Antifúngicos/administração & dosagem , Coccidioidomicose/mortalidade , Evolução FatalRESUMO
Se analiza la experiencia en 10 vírgenes (5 niños y 5 adultos) con coccidioidomicosis meníngea tratados con fluconazol oral. En todos el diagnóstico fue confirmado por la presencia del hongo en líquido cefalorraquídeo. Los pacientes recibieron tratamiento inicial a dosis de 6 mg/kg/día en niños y 400 mg/día en adultos. Todos respondieron favorablemente y en cinco casos el tratamiento fue retirado al obtener mejoría, pero se reactivó la enfermedad en cuatro de ellos. Todos mejoraron al reinstaurar con fluconazol. Se corroboró la utilidad del fluconazol en el tratamiento de la coccidioidomicosisi meníngea
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Coccidioidomicose/tratamento farmacológico , Fluconazol/uso terapêutico , Meningite Fúngica/etiologia , Meningite Fúngica/tratamento farmacológicoRESUMO
The objective of the present work was to carry out a survey of soil samples taken from different areas of a hospital of infectious disease located in the city of Córdoba, where three AIDS patients were hospitalized during different periods in the same ward. The three of them returned with meningeal cryptococcosis between three or five months after having been discharged. Cryptococcus neoformans was isolated in 8/10 samples collected outside the hospital, near the pigeon house. The samples collected from the AIDS patients ward and its surroundings were negative. These findings suggest that the patients may have been infected by the fungus during their first stay in hospital