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1.
63 samples of mycetomas were examined between 1981 and 1984. Most of them (53 cases) were actinomycotic mycetomas of which 20 were due to Streptomyces somaliensis, 17 to Actinomadura pelletieri, 11 to Nocardia sp., 4 to Actinomadura madurae. The 11 mycotic mycetomas were all due to Madurella mycetomi (= M. mycetomatis).  相似文献   

2.
The epidemiological data of 502 mycetomas studied in the Department of Mycology, "Centro Dermatológico Pascua", Mexico City, were analysed. Mycetomas prevail in males (79.7%), they are more frequent between 16 and 45 years of age (75%) and among rural workers (62.5%); they preferentially affect lower limbs (62.5%); these data are generally similar to the known publications on the matter. Actinomycetomas are the most frequent with 97.2% of the cases, distributed as follows: Nocardia: 85.6% among which 71.9% are N. brasiliensis, Actinomadura madurae: 9.6%, Streptomyces somaliensis: 1.6%, Actinomadura pelletieri: only one case: 0.2%. Eumycetomas, a total of 9, are due to Madurella mycetomi (2), Madurella grisea (2), an undetermined black grain (1), Acremonium sp. and Fusarium sp. (1), Fusarium, sp. (1), Pseudallescheria boydii (1), and an undetermined white grain (1).  相似文献   

3.
Mycetoma is still endemic in the northern areas of West-Africa. This infection is more common in males, rural inhabitants, between 20 and 40 years of age. Mycetoma is generally easy to identify on clinical presentation, it is a chronic subcutaneous inflammatory tumor with discharging sinuses. The commonest affected site is the foot (70%), leg, knee, thigh, hand and arm are the most frequent extrapodal localizations. Diagnosis must be confirmed by the presence of grains at direct and histological examinations. It is indispensable to distinguish actinomycetoma (caused by aerobic bacteria) and eumycetoma (caused by fungi) as their treatments are different. The main etiological agents in West-Africa: Streptomyces somaliensis, Actinomadura pelletieri, Actinomadura madurae (actinomycetes), Madurella mycetomatis and Leptosphaeria sp (fungi) can be identified in most cases by histological examination of the grain. In the West Sahelian belt actinomycetoma is more frequent than eumycetoma except in Mauritania. When a mycetoma is diagnosed it is fundamental to determine as precisely as possible the extent of the lesion. Bone involvement is the major complication and must be systematically investigated by radiology. Mycetoma has characteristic ultrasonographic features, ultrasonographic technique appears to be very useful in medical centers where no mycological tests can be done. Ultrasonography is also an accurate technique to delimit the extent of the process. Computed tomography is also sensitive to assess the extent of mycetoma in soft tissues and can detect early bone involvement but is more onerous than ultrasonography. Ketoconazole or itraconazole in combination with surgery is recommended for eumycetoma patients. Actinomycetoma responds to antibacterial agents, different therapeutic schemes can be proposed and depend on the etiological agent.  相似文献   

4.
An 18-year-old woman from rural West Bengal was affected with mycetoma involving her neck, back, and chest. After an interval of eight years, her younger brother developed mycetoma on his left arm. No history of trauma or immune deficiency was present in either case. By microscopic examination of sinus-discharged materials from both the cases, identical rusty red, hard grains were demonstrated. Soluble red pigment-producing colonies grew in Sabouraud dextrose-agar medium. Isolates were positive for casein hydrolysis and negative for hydrolysis test of xanthine, hypoxanthine, tyrosine, and nitrate reduction. Thus it differed from the only known red grain mycetoma agent, Actinomadura pelletieri and was provisionally identified as Actinomadura vinacea. Familial affection in mycetoma, that too caused by a new agent, is reported here for its uniqueness.  相似文献   

5.
A significant proportion of patients present with the immune reconstitution inflammatory syndrome (IRIS) after commencing antiretroviral therapy (ART). This syndrome is most frequently associated with infective causes. The lack of evidence-based treatment guidelines poses challenges in the management of these patients. Alternative causes for deterioration should be excluded, and optimization of treatment for the underlying opportunistic infection is essential. In addition, anti-inflammatory or immunomodulatory therapy may be considered, particularly in severe cases. Corticosteroids, the only treatment for which clinical trial data exist (for treating paradoxical tuberculosis-associated IRIS), are the treatment most frequently used in IRIS. Limited anecdotal reports of benefit exist for other agents, including NSAIDs, pentoxifylline, montelukast, thalidomide, and hydroxychloroquine. Therapeutic procedures (eg, aspiration of pus collections) play an important role in some patients. Interruption of ART may be considered in life-threatening forms of IRIS.  相似文献   

6.
《Autoimmunity reviews》2020,19(4):102490
BackgroundImmunoglobulin A vasculitis (IgAV) is a systemic small vessel vasculitis for which treatment of severe cases is usually based on glucocorticoids and other conventional immunosuppressive drugs. The role of rituximab for resistant or refractory cases has been explored in isolated case reports and small series.AimsTo perform a literature review of all pediatric and adult patients with IgAV treated with rituximab (RTX) and to assess disease characteristics, RTX efficacy and safety.Methods: We conducted a systematic literature review according to PRISMA guidelines by selecting articles with information on IgAV and RTX up to October 2019. We extracted data on patient characteristics, disease course, RTX efficacy and tolerance. The resulting database was analyzed with statistical software package SPSS v 22.0.ResultsAmong the initial 161 articles found, 20 studies including 35 well-characterized IgAV patients treated with RTX were finally analyzed. Distribution by sex was similar, and the median age at diagnosis was 26 (range: 2 months to 70 years). Patients included were equally diagnosed at pediatric age and in the adulthood. Almost 90% of patients had renal involvement before RTX treatment and resistant or refractory disease to glucocorticoids or other immunosuppressive agents, mainly with renal impairment, was the reason for RTX administration in 85.7% of patients. RTX was used because of contraindication to these previous agents in 8.6% of patients, and as first line therapy in 5.7% of them. With regard to RTX response, 94.3% of patients presented clinical improvement of any type and 74.3% achieved sustained remission at the end of follow-up. Among the 13 (37.1%) patients who experienced a disease relapse, 11 (31.4%) were treated with a new RTX dose, with good disease control in all cases. In terms of treatment requirements, glucocorticoids and additional immunosuppressants were significantly lower after RTX administration. No deaths were observed and the rate of minor RTX-associated adverse effects was of 8.6%.ConclusionRTX seems to be a safe and useful agent in inducing disease remission and reducing previous immunosuppressive treatment in IgAV pediatric and adult patients resistant or refractory to glucocorticoids or other immunosuppressive drugs, and in those patients in whom these agents are contraindicated. Nevertheless, controlled clinical trials in are still warranted to clarify the role of RTX in IgAV.  相似文献   

7.

Introduction

Mycetomas are inflammatory pseudotumours of subcutaneous and possibly osseous soft fabrics, generally polyfistulas with chronic mode of evolution.

Patients and methods

This study was carried out at the laboratory of parasitology and mycology of Le Dantec hospital in Dakar, Senegal, including 113 patients, from june 2008 to july 2010.

Results

Patients were from different regions in Senegal and in neighborhood countries, referred to the laboratory for mycetoma diagnosis. Among the 250 patients referred, 113 were positives after direct observation and culture corresponding to 45.2% index of infestation. The age range varies between 13 to 73 years with an average age of 33.9 years. The age bracket ranging between 20–39 years is more infected (27.34%), followed by 40–59 years (25.2%), 60 years and more (4.5%), 30–39 years (16.64%), 13–19 years (7.2%). The infection sex rate were, male: 79.6% and female: 20.4%. Infection prevalence profession dependant was found mainly in farmers and breeders with respectively: 48.7%, and 42.5%. The foot infestation is most represented with 72.5%, then leg (12.3%), knee (7.1%), scalp (2.7%), hand (1.8%). The other localizations are found with less than 1%: back, thigh, chest and ganglion inguinal. According to mycetoma agents, fungy are represented than mycetomas actinomycosic with respectively 70% and 30%. The species found were: Madurella mycetomatis (53.1%), Actinomadura pelletieri (23%), Leptosphaeria senegalensis (9.7%), Streptomyces somaliensis (2.6%), Actinomadura madurae (2,6%), Pseudallescheria boydii (1.8%), Nocardia spp. (1.8%), Scedosporium apiospermum (0.9%), Fusarium solani (0.9%). We found agents of dermatophytes: Microsporum langeronii (1.8%), and Trichophyton mentagrophytes (0.9%).

Conclusion

This study confirms that mycetomas are endemic affections in Senegal, where it still remain a real cause of disability among population leaving in rural area.  相似文献   

8.
目的 分析影响艾滋病患者口服抗病毒药物依从性的相关因素,并找出针对性护理干预对策进行干预.方法 针对性护理干预措施前后,对门诊治疗的389例艾滋病患者抗逆转录病毒高效治疗的服药的依从行为和抗病毒治疗疗效进行问卷调查.结果 389例患者中108例出现非依从性行为,依从性差的原因主要有对抗病毒治疗丧失信心或出现忧郁状态、医学知识缺乏或对药物的认知不清、药物的副作用、社会歧视、自我管理能力差等原因.通过健康教育和护理干预6个月后,与针对性护理干预前比较,患者的非依从性行为发生率(27.8%对5.6%,P<0.001)和抗病毒治疗疗效即病毒载量达到检测不到水平的比例(24.4%对74.0%,P<0.001)均得到显著改善.结论 针对性的对患者进行健康教育和护理干预,能显著提高患者的依从性和抗病毒治疗的疗效.  相似文献   

9.
Epidemiologic, clinical and paraclinical data of 126 children with tuberculosis whose HIV status was known, have been compared. Among them, 65% were HIV positive, the co-infection tuberculosis HIV/AIDS was observed in all social categories. The source of contamination was discovered for 72% of the patients. The mother was involved in 47.5% of cases. The main reasons of consultation were a long standing fever a chronic cough and a weight loss. Diarrhea was mainly observed in positive HIV patients (p = 0.00). The general condition was influenced by a weight loss which was more important in positive patients with a IMC lower than 10 in 12.8% of cases. There was no significant difference between all clinical forms. Digital hippocratism, chronic otitis and parotiditis were only observed in positive HIV patients with skin illness ten times more frequent (p = 0.00). Anergia to tuberculin tests (78.4%) and a sedimentation speed up to 100 mm at the first hour were observed in more than 60% of the positive HIV patients (p = 0.001). Evolution was favorable under treatment for 84% of positive HIV patients with an increasing weight becoming weaker after one month of treatment. All deaths happened among that population.  相似文献   

10.
Three hundred and twenty patients were enrolled in a prospective randomized trial comparing cefoperazone, ceftizoxime and ceftriaxone for initial therapy of infectious episodes in cancer patients. Patients with neutropenia were excluded. In 286 evaluable episodes, the response rates associated with the three agents were 77 % for cefoperazone, 70 % for ceftizoxime and 72 % for ceftriaxone, with no statistically significant differences between the three treatment groups. The overall response rate for all episodes of pneumonia (64 %) was significantly lower than the response rate for all other infections (81 %; p=0.002), and the mortality associated with pneumonia (9 %) was higher than that associated with all other episodes (2 %; p=0.01). Patients with infections due to gram-negative organisms responded well to all three agents, whereas patients with gram-positive infections responded more favorably to cefoperazone. Two different schedules of ceftriaxone were used. The clinical response did not differ significantly between patients receiving ceftriaxone once daily and those receiving it twice daily. The incidence of superinfection and relapse was extremely low and all three agents were well tolerated. It is concluded that extended spectrum cephalosporins are effective as single agents for the treatment of infections in cancer patients with adequate neutrophil counts.  相似文献   

11.
研究连续性血液净化(CBP)救治对比剂急性肾损伤(CI-AKI)的临床特点.选取2003年5月至2010年5月间救治的32例CI-AKI患者,分析发病规律,检测造影前、后及CBP救治前、后其血肌酐(Cr)、尿酸(UA)、高敏C反应蛋白(hs-CRP)等生化指标的动态变化,观察患者28 d的病死率.结果表明(1)发病规律...  相似文献   

12.
The microflora of clinical material (urine, urethral discharge and smear, vaginal discharge and smear, feces in colonic dysbacteriosis) from patients with urinary tract infections (UTI) in the Moscow Region was studied. Escherichia coli and Staphylococcus epidermidis have been found to be the most common agents isolated from the urine of UTI patients. Pseudomonas aeruginosa and other staphylococcal species and enterococci account for a smaller proportion of infections. High- (E. coli and S. epidermidis) and moderate-priority pathogens are translocated into the urinary tract from the colonic biotope in dysbacteriosis. The causative agents of non-gonococcal urethritis are staphylococci (more commonly epidermal ones) in 50% of cases, those of pyelonephritis are staphylococci (predominantly E. coli) in more than 50% of cases. The etiological agents of female genital infections are staphylococci (mainly epidermal ones) in 40% of cases.  相似文献   

13.
Metastatic sarcomas are commonly resistant to chemotherapy. The serine/threonine kinase, mammalian target of rapamycin (mTOR), is a protein kinase of the phosphatidylinositol 3-kinase (PI3K)/AKT signaling pathway thought to have a key role in controlling cancer growth and thus is an important target for cancer therapy. Several inhibitors of mTOR are in clinical trials, including AP23573, which is being tested on metastatic sarcomas and other tumors. We hypothesized that a marker for the activity of mTOR, phosphorylated S6 ribosomal protein, would be predictive of clinical response to the drug, that is, high tumor expression would signify better response than low expression. This was a blinded study. Of 26 patients treated, 20 remained on study, with available paraffin blocks. Fourteen patients received AP23573 alone and six patients received AP23573 in combination with adriamycin. An antibody to the phosphorylated S6 ribosomal protein was used to stain the tumors, all high-grade sarcomas. Pretreatment biopsy or resection material was tested: the original tumor (n=6) or tumor recurrence/metastasis (n=14); either of these may have been after treatment with other agents. Staining was scored for both quantity/percentage of tumor cells and intensity. Scoring was performed without knowledge of tumor response. Staining quantity could be categorized into two natural groups: high expressors (> or =20% of tumor cells, 11 cases) and low expressors (0-10% of tumor cells, 9 cases). The high-expression group had eight stable and three progressive cases (73% stable disease); the low-expression group had three stable and six progressive cases (67% progressive disease). Chi-square analysis showed statistical significance (P< or =0.05) at this initial cutoff (10%) selected blindly. The level of phosphorylated S6 ribosomal protein expression was predictive of early tumor response to the mTOR inhibitor, suggesting that this is a promising new predictive sarcoma marker for targeted mTOR inhibitor therapy.  相似文献   

14.
Autopsy-verified causes of death after stroke   总被引:5,自引:0,他引:5  
In a population-based sample of 409 stroke patients, autopsy was performed in 82 of the 95 patients who died during the first three months and in 61 of the 128 patients dying thereafter. The dominant causes of death, as verified by autopsy, were cerebrovascular disease in the first week (90%), pulmonary embolism in the second to fourth week (30%), bronchopneumonia during the second and third months (27%) and cardiac disease, mainly myocardial infarction, later than three months after the stroke (37%). Death was attributed to causes other than the brain lesion in 59% of the patients with ischemic and in 24% of the patients with hemorrhagic stroke (p less than 0.01). Age and sex had little influence on the distribution of causes of death. Fatal pulmonary embolism and bronchopneumonia surprisingly often occurred in ambulatory patients. An intracardiac thrombus was present in 20% of deceased patients with atrial fibrillation, and in 17% of cases with a history of myocardial infarction. When attempts are made to reduce mortality (and morbidity) after stroke, there would seem to be a considerable potential for prevention and early treatment of complications, such as pulmonary embolism, bronchopneumonia and cardiac disorders.  相似文献   

15.
A 5-year retrospective multicenter study was performed for microascaceous moulds (Microascaceae, Ascomycetes) in Finnish clinical specimens. The files from 1993-1997 of six clinical mycology laboratories in Finland were searched for reports of these fungi, mainly Scopulariopsis and Scedosporium anamorphs in keratinous specimens. From the 521 primary findings, 165 cases were selected for further study based on direct microscopy, colony numbers and accompanying fungi. The clinical records of 148 cases (141 Scopulariopsis, 7 Scedosporium) were studied. Of the nail infections from which Scopulariopsis was recovered, 39 cases were further separated which showed clinical or laboratory-based evidence of dermatophytosis. In the remaining 90 'non-dermatophyte' nail cases, Scopulariopsis spp. were the only documented fungal agents (c. 6 cases/million/year). The patients were mainly elderly, 66% of whom had problems involving their big toe nails. For 74% of them, the nail problem was mentioned as their reason for visiting the physician. However, only 18% had documented benefit from treatment. The Scopulariopsis nail infections seem to be treatment-resistant and the pathogenesis and etiological role of Scopulariopsis remain poorly understood.  相似文献   

16.
Summary In 223 patients suffering from Graves' disease, TSH receptor autoantibodies in serum were measured using the commercially available TRAK assay (Henning, Berlin). Of 53 patients examined before treatment, 50 (94%) were TRAK-positive. During drug therapy the number of positive titers decreased. Of 38 patients examined after a therapy course for the first time, only two (5.3%) were positive. Evaluation of antibody status after all three forms of treatment (drugs, surgery, radioiodine) in 146 patients showed that of 33 patients with persistently positive titers only nine relapsed. Of the 24 patients out of this group without relapse, 15 had operative or radioiodine treatment. The 113 patients becoming or remaining TRAK-negative after treatment showed 12 relapses, in all these cases relapse was accompanied or announced by conversion to positive TRAK values. The high sensitivity and specificity of the assay (in a control group of 40 patients with autonomous adenoma no positive TRAK was seen) allow to use the test for discrimination between Graves' disease and disseminated autonomy of the thyroid in patients presenting with diffuse hyperthyroidism. Thus, by helping to establish an exact diagnosis, TRAK could become important for therapy planning. Concerning relapse prediction, our data are less promising since only 39% of patients with persistently positive TRAK titers relapsed. TRAK is not a reliable indicator of relapse risk especially in patients operated or treated with radioiodine. On the other hand, 10% of patients showing negative titers after treatment also relapsed, all turning to positive TRAK values at the same time.

Abkürzungen TBIA Thyrotropin binding inhibiting antibodies - TSAb Thyreoidea-stimulierende Antikörper - TSH schilddrüsenstimulierendes Hormon  相似文献   

17.
Despite modern achievements in diagnostics and treatment, invasive and non-invasive pneumococcal infections remain a topical public health problem. To a large extent, it is connected with the absence or inconsistence of evidence-based information on this kind of infection. In this paper, retrospective analysis of the incidence of pneumococcal infections was performed on the basis of medical records available today in every health institution; the peculiarities of their nosologic structure were revealed. Among invasive forms, pneumococcal pneumonias prevailed (50.06%); apparent hypodiagnostics of pneumococcal meningitis was noted (only 4.02%). Among non-invasive forms, acute otitis with various complications prevailed (47.5%), acute sinusitis was registered in 37.5% of cases, and other ENT diseases (sphenoiditis, frontitis, ethmoiditis, etc.) were registered in 15% of cases. The study found that the main risk factors in these patients had been different ENT diseases which the patients had suffered from during the previous three months before the actual illness. Thus, the necessity for the development and perfection of techniques of microbiological diagnostics and the development of epidemiological control methods on their basis are obvious.  相似文献   

18.
Prognosis of several autoimmune diseases, especially rheumatoid arthritis (RA), ankylosing spondylitis, Crohn’s disease (CD), and psoriasis, usually refractory to conventional treatment improved considerably with the introduction of tumor necrosis factor alpha (TNF-α) antagonistic agents, which is now available (infliximab, etanercept, and adalimumab). However, a portion of patients persists with active disease, infusion reactions, and relapses even during current biological therapy. One of the reasons for this is the associated immunogenicity to these drugs. The incentive for induction of antibodies against anti-TNF-α agent depends mainly on its constitution. Chimerical drugs have a higher capacity of inducing immunogenicity compared to completely human drugs. Among the three anti-TNF-α agents, this phenomenon has been studied mainly in patients using infliximab, especially in RA and CD. The prevalence of anti-infliximab antibodies in RA varies from 12% to 44% and seems to be inversely proportional to the level of seric infliximab and therapeutic response. The use of etanercept was associated to the development of anti-etanercept antibodies in 0% to 18% of patients, without apparent effect on effectiveness or adverse events. Studies with RA and CD patients show prevalence of anti-adalimumab antibodies from 1% to 87%. Immunosuppressive drug addiction can reduce the induction of anti-TNF-α antibodies.  相似文献   

19.
A novel strategy for the molecular identification of fungal agents of onychomycosis (including Trichophyton rubrum) has been designed based on the use of species-specific and universal primers in conjunction with a commercial kit that allows the extraction of DNA directly from the nail specimens. The microsatellite marker T1, which is based on a (GT)n repeat, was applied for the species-specific identification of Trichophyton rubrum. To evaluate how often Scopulariopsis spp. are detected in nail specimens, a second primer pair was designed to amplify specifically a 336-bp DNA fragment of the 28S region of the nuclear rRNA gene of S. brevicaulis and closely related species. Other fungal species were identified using amplification of the internal transcribed spacer (ITS) region of the rRNA gene, followed by restriction fragment length polymorphism analysis or sequencing. In addition, polyacrylamide gel separation of the T1-PCR product allowed subtyping of T. rubrum strains. We studied 195 nail specimens (the "nail sample") and 66 previously collected etiologic strains (the "strain sample") from 261 onychomycosis patients from Bulgaria and Greece. Of the etiologic agents obtained from both samples, T. rubrum was the most common organism, confirmed to be present in 76% of all cases and serving as the sole or (rarely) mixed etiologic agent in 199 of 218 cases (91%) where the identity of the causal organism(s) was confirmed. Other agents seen included molds (6% of cases with identified etiologic agents; mainly S. brevicaulis) and other dermatophyte species (4%; most frequently Trichophyton interdigitale). Simultaneous infections with two fungal species were confirmed in a small percentage of cases (below 1%). The proportion of morphologically identified cultures revealed by molecular study to have been misidentified was 6%. Subtyping revealed that all but five T. rubrum isolates were of the common type B that is prevalent in Europe. In comparison to microscopy and culture, the molecular approach was superior. The PCR was more sensitive (84%) than culture (22%) in the nail sample and was more frequently correct in specifically identifying etiologic agents (100%) than microscopy plus routine culture in either the nail or the strain samples (correct culture identifications in 96% and 94% of cases, respectively). Using the molecular approach, the time for diagnosing the identity of fungi causing onychomycosis could be reduced to 48 h, whereas culture techniques generally require 2 to 4 weeks. The early detection and identification of the infecting species in nails will facilitate prompt and appropriate treatment and may be an aid for the development of new antifungal agents.  相似文献   

20.
Behçet''s disease (BD) involves multisystem vasculitis of unknown origin. Ocular manifestations of BD mostly include bilateral panuveitis and retinal vasculitis, which are very challenging to treat. Interferon alfa-2a (IFN) has been recently introduced for treating refractory Behçet uveitis, mainly in Germany and Turkey. Nonetheless, there is so far no consensus about the ideal treatment regimen of IFN for Behçet uveitis. We report our experience of IFN treatment in five Korean BD patients with refractory uveitis. All patients complained of oral ulcers; one patient had a positive pathergy test and 2 showed the presence of HLA-B51. Immunosuppressive agents used prior to IFN treatment included cyclosporine and methotrexate. The IFN treatment was commenced with a dose of 6-9 MIU/day for 7 days, adjusted according to individual ocular manifestations, tapered down to 3 MIU three times in a week, and then discontinued. All patients showed positive response to IFN treatment; 50% of them showed complete response without additional major ocular inflammation during the follow-up period. Other BD symptoms also improved after IFN treatment in most cases. After treatment, the relapse rate and the required dose of oral corticosteroid were decreased in most cases, showing a significant steroid-sparing effect. However, the visual acuity was not improved in most cases due to irreversible macular sequelae. Despite the small sample size of this study, we suggest that, in Korean patients, IFN is an effective treatment modality for BD uveitis as was observed in German and Turkish patients.  相似文献   

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