RESUMO
INTRODUCTION: Nocardia brasiliensis is a very rarely reported cause of chronic phagedenic ulcerations. We report the case of an elderly woman who developed such an infection after falling on her right leg on the road in the Bresse country (an essentially agricultural and bovine-cattle breading region) and developed a chronic phagedenic ulcer secondarily complicated by nodular lymphangitis of the thigh. CASE REPORT: A 75 year-old woman fell on her right leg on the side of the main road outside her hamlet in the Bresse country and secondarily developed a chronique phagedenic ulceration. We first considered her as suffering from pyoderma gangrenosum. A complete scanning only revealed an autoimmune thyroiditis and a rapidly healing gastric ulceration, and none of the treatments, either local or systemic, helped the skin condition to heal. After 3 weeks of application of a local corticoid ointment, the patient developed fever, general malaise, an exacerbation of her wound and an infiltration of the skin round her knee, together with nodular lymphangitic dissemination. A supplementary bacterial swab disclosed massive proliferation of a slow-growing Gram-positive bacillus, which proved to be Nocardia brasiliensis, together with a methicillino-sensitive Staphylococcus aureus. The treatment with sulfamethoxazole-trimetoprim gave a rash after 12 hours and was changed to amoxicillin and clavulanic acid, which rapidly proved to be permanently effective. DISCUSSION: The revelation of this particular slow-growing bacteria is difficult and requires bacterial swabs. Nocardia brasiliensis is relatively rare in primary skin ulcerations and we discuss the reasons why an elderly women should find this bacteria on the road outside her hamlet in the French countryside. This particular infectious condition requires general scanning, to make sure that the primary skin condition does not extend to other organs. We review the therapeutical options for patients who exhibit allergic reactions to the classically effective antibiotic drugs.
Assuntos
Úlcera da Perna/etiologia , Úlcera da Perna/microbiologia , Nocardiose/complicações , Acidentes por Quedas , Idoso , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Doença Crônica , Quimioterapia Combinada/uso terapêutico , Feminino , Humanos , Linfangite/etiologia , Nocardia/patogenicidade , Nocardiose/tratamento farmacológicoRESUMO
We describe clinical and pathological features of kidney and skin involvement in a patient with hypersensitivity vasculitis associated with dapsone. Although visceral damage occurs rarely, similar skin and kidney histopathologic and immunohistochemical findings indicate that this organ is a target for type IV cell-mediated dapsone reaction. To our knowledge, this is the first reported case of renal hypersensitivity vasculitis associated with dapsone.
Assuntos
Dapsona/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Nefropatias/induzido quimicamente , Hansenostáticos/efeitos adversos , Vasculite Leucocitoclástica Cutânea/induzido quimicamente , Adulto , Antibacterianos , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Clofazimina/administração & dosagem , Clofazimina/uso terapêutico , Ciclofosfamida/administração & dosagem , Ciclofosfamida/uso terapêutico , Dapsona/administração & dosagem , Dapsona/uso terapêutico , Hipersensibilidade a Drogas/tratamento farmacológico , Quimioterapia Combinada/administração & dosagem , Quimioterapia Combinada/uso terapêutico , Feminino , Humanos , Imunossupressores/uso terapêutico , Nefropatias/tratamento farmacológico , Hansenostáticos/administração & dosagem , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Vasculite Leucocitoclástica Cutânea/tratamento farmacológicoRESUMO
The clinical and microbiological efficacy, as well as the tolerability of the amoxicillin/sulbactam combination as empiric treatment for complicated community-acquired pneumonia (CCAP) were evaluated in children from 3 months to 15 years with CCAP who were randomized 1:1 to receive either amoxicillin/sulbactam or cefuroxime. Of 234 patients hospitalized with CCAP in the study period (June, 1999-April, 2002), 62 patients qualified for the study: 32 received amoxicillin/sulbactam and 30 cefuroxime. Two were excluded. Demographic and clinical data showed that both groups were comparable at entry. One etiologic agent was identified in 55% of the patients, with Streptococcus pneumoniae being the most frequent. After treatment, the days of fever, duration of intravenous treatment, and hospitalization stay were similar in both groups. Overall favorable clinical responses were comparable: 97% for amoxicillin/sulbactam vs 100% for the comparative therapy. There was good tolerance to both drugs. Amoxicillin/sulbactam produced a satisfactory therapeutic outcome similar to that of cefuroxime for treatment of CCAP, and may be an appropriate choice for the treatment of this serious pediatric infection.
Assuntos
Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Quimioterapia Combinada/uso terapêutico , Pneumonia/tratamento farmacológico , Sulbactam/uso terapêutico , Adolescente , Amoxicilina/administração & dosagem , Amoxicilina/efeitos adversos , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Cefuroxima/uso terapêutico , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/tratamento farmacológico , Feminino , Humanos , Pacientes Internados , Masculino , Pneumonia Pneumocócica/tratamento farmacológico , Streptococcus pneumoniae/isolamento & purificação , Streptococcus pneumoniae/patogenicidade , Sulbactam/administração & dosagem , Sulbactam/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: The protective role of Helicobacter pylori in gastro-oesophageal reflux disease has been widely discussed. AIM: To assess the risk of reflux oesophagitis in patients with functional dyspepsia after treatment for H. pylori infection. METHODS: A randomized, placebo-controlled, investigator-blinded trial was carried out on 157 functional dyspeptic patients. Patients were randomized to receive lansoprazole, amoxicillin and clarithromycin (antibiotic group) or lansoprazole and identical antibiotic placebos (control group). Upper gastrointestinal endoscopy was performed at baseline, 3 and 12 months after randomization. The primary aim was to detect the presence of reflux oesophagitis. Analyses were performed on an intention-to-treat basis. RESULTS: A total of 147 patients (94%) and 133 (85%) completed 3 months and 12 months follow-up, respectively. The eradication rate of H. pylori was 90% in the antibiotic group (74 of 82) and 1% (one of 75) in the control group. At 3 months, reflux oesophagitis was diagnosed in 3.7% (three of 82) in the antibiotic group and 4% (three of 75) in the control group (P > 0.2). At 12 months, diagnosis was established in five new cases within the first group and in four within the second (P > 0.2). No difference was found in heartburn symptoms. CONCLUSIONS: H. pylori eradication does not cause reflux oesophagitis in this western population of functional dyspeptic patients.
Assuntos
Dispepsia/microbiologia , Esofagite Péptica/etiologia , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Omeprazol/análogos & derivados , 2-Piridinilmetilsulfinilbenzimidazóis , Adolescente , Adulto , Idoso , Amoxicilina/uso terapêutico , Claritromicina/uso terapêutico , Quimioterapia Combinada/uso terapêutico , Dispepsia/complicações , Dispepsia/tratamento farmacológico , Esofagite Péptica/microbiologia , Seguimentos , Azia/complicações , Infecções por Helicobacter/complicações , Humanos , Lansoprazol , Pessoa de Meia-Idade , Omeprazol/uso terapêutico , Medição de Risco , Método Simples-CegoAssuntos
Imunocompetência/fisiologia , Nocardiose/diagnóstico , Nocardia/classificação , Dermatopatias Bacterianas/microbiologia , Adulto , Antibacterianos , Quimioterapia Combinada/uso terapêutico , Seguimentos , Humanos , Masculino , Nocardia/efeitos dos fármacos , Nocardiose/tratamento farmacológico , Medição de Risco , Dermatopatias Bacterianas/tratamento farmacológico , Resultado do TratamentoRESUMO
OBJECTIVE: To determine whether treatment with amoxicillin-sulbactam in women with threatened idiopathic preterm labour will prolong the gestation and reduce preterm birth rates in a Latin-American population. METHODS: A double-blind, placebo-controlled, randomized trial was conducted in 96 women who were hospitalized for preterm labour between 24 and 34 weeks of gestation at the Pereira Rossell Hospital, in Montevideo, Uruguay. The primary outcome measure was prematurity. The sample size was calculated a priori based on the hospital database. Statistical analyses were performed using the t-test, chi square, weighted mean difference (WMD) and relative risk (RR) with their confidence intervals (95% CI). Analysis by intention-to-treat. RESULTS: Out of 47 patients assigned for antibiotics, 43 completed the treatment. There were no significant statistical differences between antibiotics and placebo group in prematurity (RR:1.04, 95% CI: 0.59, 1.84), prolongation of pregnancy (WMD:0.23, 95% CI: -0.96, 1.42) and other perinatal outcomes. CONCLUSION: Antibiotics did not prove to have benefits in improving perinatal outcomes in this Latin American population.
Assuntos
Amoxicilina/uso terapêutico , Quimioterapia Combinada/uso terapêutico , Trabalho de Parto Prematuro/prevenção & controle , Complicações Infecciosas na Gravidez , Sulbactam/uso terapêutico , Adolescente , Adulto , Método Duplo-Cego , Membranas Extraembrionárias , Feminino , Ruptura Prematura de Membranas Fetais , Humanos , Trabalho de Parto Prematuro/etiologia , Gravidez , Resultado da Gravidez , UruguaiRESUMO
PURPOSE: To report a rare case of lymphocutaneous Nocardia brasiliensis originating in the eyelid. DESIGN: Observational case report. METHODS: The clinical presentation, workup, and treatment of a case of lymphocutaneous Nocardia brasiliensis originating in the eyelid are presented. RESULTS: The patient presented with a preseptal cellulitis from an abrasion of the eyelid that progressed to submandibular lymph node suppuration. Culture was performed, and a diagnosis of lymphocutaneous Nocardia brasiliensis was made. CONCLUSION: Nocardia brasiliensis may cause a lymphocutaneous infection of the face and must be considered in the differential diagnosis of preseptal cellulitis.
Assuntos
Infecções Oculares Bacterianas/microbiologia , Doenças Palpebrais/microbiologia , Doenças Linfáticas/microbiologia , Nocardiose/microbiologia , Nocardia/isolamento & purificação , Dermatopatias Bacterianas/microbiologia , Idoso , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Quimioterapia Combinada/uso terapêutico , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/tratamento farmacológico , Humanos , Linfonodos/microbiologia , Linfonodos/patologia , Doenças Linfáticas/diagnóstico , Doenças Linfáticas/tratamento farmacológico , Masculino , Nocardiose/diagnóstico , Nocardiose/tratamento farmacológico , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
The antibiotic treatment currently recommended by the International Society for Peritoneal Dialysis (ISPD) for peritonitis consists of a combination of a first- and a third-generation cephalosporin. The schedule formerly recommended combined a first-generation cephalosporin and an aminoglycoside. No comparison between the treatment schedules has been performed until now. We compared the effectiveness of these two regimens in peritoneal dialysis-related peritonitis at our center. From January 1999 to April 2000, we followed 107 patients in our PD clinic (period 1: 47% men; 32% with diabetes; mean age: 52 +/- 13 years). We followed a similar number of patients from January 2002 to July 2003 (period 2: 109 patients; 54% men; 51% with diabetes; mean age: 56 +/- 18 years). In each period, diagnosis and treatment of peritonitis were based on the recommendations of the ISPD as earlier described. Negative culture rates were similar in period 1 and period 2 (32% vs. 30%). In both study groups, the bacteria that most commonly caused peritonitis were Staphylococcus epidermidis (period 1: 41%; period 2: 39%) and S. aureus (period 1: 27%; period 2: 18%). Gram-positive infections occurred in 59% of patients during period 1 and in 57% during period 2. Gram-negative infections occurred in 16% of patients during period 1 and in 18% during period 2. We observed no significant difference in the peritonitis cure rate from period 1 to period 2 (78% vs. 83%; chi-square: 0.98; p = 0.3), but changes in the primary antibiotic schedule were necessary in 4 patients in period 1 as compared with 1 patient in period 2. The rates of catheter removal were not significantly different during the two periods (period 1: 14%; period 2: 5%; chi-square: 2.5; p = 0.11). Mortality was also not significantly different during the two periods (period 1: 7%; period 2: 5%; chi-square: 0.23; p = 0.62). The two antibiotic schedules were equally effective in the treatment of peritonitis. Cost-effectiveness, impact on residual renal function, and potential development of bacterial resistance must be considered when selecting the antibiotic schedule for peritonitis treatment.
Assuntos
Quimioterapia Combinada/uso terapêutico , Diálise Peritoneal/efeitos adversos , Peritonite/tratamento farmacológico , Ceftazidima/administração & dosagem , Cefalotina/administração & dosagem , Esquema de Medicação , Feminino , Gentamicinas/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite/etiologia , Peritonite/microbiologia , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Resultado do TratamentoRESUMO
We designed a 4-way crossover, ex-vivo pharmacodynamic study to compare the bactericidal rate of amoxicillin/sulbactam (AMX-SUL), azithromycin (AZM), doxycycline (DOX) and levofloxacin (LVX) against Streptococcus pneumoniae ATCC 49619. Six volunteers were randomized to receive alternatively a single tablet of the above drugs. Venous blood samples were obtained immediately before and at 2, 4 and 6 h after dose to perform time-kill studies and to determine antibiotic levels in serum. AMX-SUL was the only drug showing bactericidal activity with the sera obtained at every time after dose, as defined by a > or = 3-log10 cfu/ml decrease in the viable cell counts compared to the original inoculum after a 24-h incubation. AZM was only inhibitory at 2h after dose (i.e. a 1.3-log10 cfu/ml decrease in the viable cell counts) and proved bactericidal at 4 and 6 h post-dose. LVX proved bactericidal with the 2-h serum, was only inhibitory with the 4-h serum (e.g. a 1.5-log10 cfu/ml decrease) and was unable to avoid bacterial growth at 6 h post-dose. Bacterial growth was observed with DOX at every time after dose. This study may shed light on the understanding of breakthrough pneumococcal bacteremia during the course of oral therapy with AZM in patients with community-acquired nia (CAP), as well as the increasing treatment failures observed with LVX, and the selection of bacterial resistance during therapy reported with both drugs. It also provides the basis for a "warning signal" on the use of oral DOX and confirms the efficacy of AMX-SUL.
Assuntos
Amoxicilina/farmacologia , Azitromicina/farmacologia , Doxiciclina/farmacologia , Levofloxacino , Ofloxacino/farmacologia , Streptococcus pneumoniae/efeitos dos fármacos , Sulbactam/farmacologia , Adulto , Amoxicilina/sangue , Análise de Variância , Azitromicina/sangue , Atividade Bactericida do Sangue , Contagem de Colônia Microbiana , Estudos Cross-Over , Doxiciclina/sangue , Farmacorresistência Bacteriana , Quimioterapia Combinada/uso terapêutico , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Ofloxacino/sangue , Probabilidade , Sensibilidade e Especificidade , Teste Bactericida do Soro , Método Simples-Cego , Estatísticas não Paramétricas , Streptococcus pneumoniae/isolamento & purificação , Sulbactam/sangueRESUMO
The aim of this study was to describe the epidemiology and microbiology of bloodstream infections (BSIs) among adult surgical cancer patients and to determine independent factors that influence in-hospital mortality. The study enrolled 112 consecutive episodes of BSIs in adult surgical cancer patients during a 26-month period. The median age of the patients was 64.5 years, and crude in-hospital mortality was 19.6%. The median time from surgery to the index blood culture was 11 days and from index blood culture to death was 4.5 days. Seventy-five percent of the patients had an advanced tumor disease, 36.6% were under intensive care, and 68.7% had a central venous catheter in place at the time the bloodstream infection was diagnosed. Associated infected sites were present in 57.1% of the episodes. There were 328 noninfectious co-morbid conditions. Poor performance status, weight loss, hypoalbuminemia, and ventilatory support accounted for 67.4% of them. There was a predominance of aerobic gram-negative bacilli (62%), followed by gram-positive cocci (26.6%) and fungi (9.3%). The observed mortality rates associated with these organism groups were similar (23.6% vs 15% vs 28.6%, respectively; P=0.44). The most frequent organisms were Enterobacter spp., coagulase-negative staphylococci, Klebsiella spp., Acinetobacter spp., and fungi. Nonfermentative strains predominated in patients with catheters. Thirty-five (30.2%) pathogens were considered resistant. There was no significant difference in the mortality rate between patients with resistant and those with nonresistant organisms (20% vs 26%, respectively; P=0.49). Logistic regression analysis showed > or = 4 co-morbid conditions, advanced tumor, thoracic surgery, catheter retention, and pulmonary infiltrates as independent predictors of mortality. Medical and infection control measures addressing certain variables amenable to intervention might reduce the negative impact of postoperative infectious morbidity and mortality of BSIs in adult surgical cancer patients.