Posts filed under ‘HIC no SIDA’

Daptomicina: características farmacológicas y aporte en el tratamiento de infecciones por cocos gram positivos

Revista Chilena de Infectología Abril 2012 V.29 N.2

Daptomycin: pharmacological characteristics and its role in the treatment of gram positive infections

Rafael Araos, Patricia García, Leonardo Chanqueo y Jaime Labarca

Facultad de Medicina Clínica Alemana/Universidad del Desarrollo, Santiago, Chile. Departamento de Medicina Interna (RA).

Pontificia Universidad Católica de Chile. Departamento de Laboratorios Clínicos (PG).

Pontificia Universidad Católica de Chile. Departamento de Medicina Interna (JL).

Hospital San Juan de Dios de Santiago. Laboratorio de Microbiología (LCh).

Daptomicina es un anti-infeccioso de reciente introducción en Chile, miembro exclusivo de una nueva familia de antimicrobianos conocida como lipopéptidos cíclicos. Tiene un mecanismo de acción único que le confiere un potente efecto bactericida sobre los microorganismos susceptibles. Su especto antimicrobiano comprende cocáceas grampositivas de importancia clínica como Staphylococcus aureus y Enterococcus spp., incluyendo cepas resistentes a antimicrobianos habituales. Está aprobada para el uso clínico en infecciones de piel y tejidos blandos y bacteriemia complicada y no complicada por S. aureus, en adultos. Estudios en curso sugieren que será una alternativa útil en otras infecciones frecuentes como osteomielitis, infecciones asociadas a dispositivos ortopédicos, infecciones asociadas a biopelículas e infecciones en hospederos inmunosuprimidos, en particular en pacientes onco-hematológicos. El principal efecto adverso asociado al uso de daptomicina es la toxicidad muscular, observándose miopatía reversible, la mayoría de las veces asintomática, en aproximadamente 3% de los pacientes que utilizan el fármaco.

PDF

http://www.scielo.cl/pdf/rci/v29n2/art01.pdf

May 6, 2017 at 7:10 pm

Risk of serious infections associated with use of immunosuppressive agents in pregnant women with autoimmune inflammatory conditions: cohort study.

BMJ. 2017 Mar 6;356:j895.

Desai RJ1, Bateman BT2,3, Huybrechts KF2, Patorno E2, Hernandez-Diaz S4, Park Y4, Dejene SZ2, Cohen J4, Mogun H2, Kim SC2.

Author information

1 Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02120, USA rdesai@bwh.harvard.edu.

2 Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02120, USA.

3 Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

4 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.

Abstract

Objective To compare the risk of serious infections associated with use of systemic steroids, non-biologic agents, or tumor necrosis factor α (TNF) inhibitors in pregnancy.

Design Observational cohort study.Setting Public (Medicaid, 2001-10) or private (Optum Clinformatics, 2004-15) health insurance programs in the US.Participants 4961 pregnant women treated with immunosuppressive drugs for rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, psoriatic arthritis, or inflammatory bowel disease.Exposure for observational studies Exposure was classified into steroid, non-biologic, or TNF inhibitors on first filled prescription during pregnancy. Because TNF inhibitors are not used to treat systemic lupus erythematosus, patients with this condition were excluded from comparisons involving TNF inhibitors.Main outcome measure The main outcome was occurrence of serious infections during pregnancy, defined by hospital admission for bacterial or opportunistic infections. Hazard ratios were derived using Cox proportional hazard regression models after adjustment for confounding with propensity score fine stratification. A logistic regression model was used to conduct a dose-response analysis among women filling at least one steroid prescription.

Results 71 out of 4961 pregnant women (0.2%) treated with immunosuppressive agents experienced serious infections. The crude incidence rates of serious infections per 100 person years among 2598 steroid users, 1587 non-biologic users, and 776 TNF inhibitors users included in this study were 3.4 (95% confidence interval 2.5 to 4.7), 2.3 (1.5 to 3.5), and 1.5 (0.7 to 3.0), respectively. No statistically significant differences in the risk of serious infections during pregnancy were observed among users of the three immunosuppressive drug classes: non-biologics v steroids, hazard ratio 0.81 (95% confidence interval 0.48 to 1.37), TNF inhibitors v steroids 0.91 (0.36 to 2.26), and TNF inhibitors v non-biologics 1.36 (0.47 to 3.93). In the dose-response analysis, higher steroid dose was associated with an increased risk of serious infections during pregnancy (coefficient for each unit increase in average prednisone equivalent mg daily dose=0.019, P=0.02).

Conclusions Risk of serious infections is similar among pregnant women with systemic inflammatory conditions using steroids, non-biologics, and TNF inhibitors. However, high dose steroid use is an independent risk factor of serious infections in pregnancy.

PDF

http://www.bmj.com/content/bmj/356/bmj.j895.full.pdf

April 13, 2017 at 8:37 am

Vaccinations for rheumatoid arthritis.

Curr Rheumatol Rep. 2014 Aug;16(8):431.

Perry LM1, Winthrop KL, Curtis JR.

Author information

1Division of Arthritis & Rheumatic Diseases, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.

Abstract

Patients with rheumatoid arthritis (RA) suffer an increased burden of infectious disease-related morbidity and mortality and have twice the risk of acquiring a severe infection compared to the general population.

This increased risk is not only a result of the autoimmune disease but is also attributed to the immunosuppressive therapies that are commonly used in this patient population. Given the increase in infection-related risks in RA, there is great interest in mitigating such risk.

A number of vaccines are available to the rheumatologist, with a handful that are of importance for RA patients in the United States.

The goal of this paper is to highlight the most recent literature on the key vaccines and the specific considerations for the rheumatologist and their RA patients, with a particular focus on influenza, pneumococcal, and herpes zoster vaccines.

It is important for rheumatologist to understand and be aware of which vaccines are live and what potential contraindications exist for giving vaccines to RA patients.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080407/pdf/nihms-604880.pdf

April 9, 2017 at 7:32 pm

Pneumocystis jirovecii Pneumonia in Rheumatoid Arthritis Patients: Risks and Prophylaxis Recommendations.

Clin Med Insights Circ Respir Pulm Med. 2015 Sep 6;9(Suppl 1):29-40.                   

Mori S1, Sugimoto M2.

Author information

1Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, NHO Kumamoto Saishunsou National Hospital, Kumamoto, Japan.

2Division of Respiratory Medicine, Department of Medicine, Social Insurance Omuta Tenryo Hospital, Fukuoka, Japan.

Abstract

Pneumocystis jirovecii infection causes fulminant interstitial pneumonia (Pneumocystis pneumonia, PCP) in patients with rheumatoid arthritis (RA) who are receiving biological and/or nonbiological antirheumatic drugs. Recently, we encountered a PCP outbreak among RA outpatients at our institution. Hospital-acquired, person-to-person transmission appears to be the most likely mode of this cluster of P. jirovecii infection. Carriage of P. jirovecii seems a time-limited phenomenon in immunocompetent hosts, but in RA patients receiving antirheumatic therapy, clearance of this organism from the lungs is delayed. Carriers among RA patients can serve as sources and reservoirs of P. jirovecii infection for other susceptible patients in outpatient facilities. Development of PCP is a matter of time in such carriers. Considering the poor survival rates of PCP cases, prophylactic antibiotics should be considered for RA patients who are scheduled to receive antirheumatic therapy. Once a new case of PCP occurs, we should take prompt action not only to treat the PCP patient but also to prevent other patients from becoming new carriers of P. jirovecii. Short-term prophylaxis with trimethoprim-sulfamethoxazole is effective in controlling P. jirovecii infection and preventing future outbreaks of PCP among RA patients.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562607/pdf/ccrpm-suppl.1-2015-029.pdf

April 9, 2017 at 7:30 pm

Atypical Presentation of Disseminated Zoster in a Patient with Rheumatoid Arthritis.

Case Rep Med. 2015;2015:124840.     

Patel N1, Singh D1, Patel K1, Ahmed S1, Anand P1.

Author information

1Department of Medicine, Nassau University Medical Center, East Meadow, NY 11554, USA.

Abstract

Patients with rheumatoid arthritis (RA) have 2-fold increased risk of herpes zoster. In literature, limited information exists about disseminated cutaneous zoster in RA patients. An 83-year-old African-American female with RA presented with generalized and widespread vesicular rash covering her entire body. Comorbidities include hypertension, type II diabetes, and dyslipidemia. Patient was on methotrexate 12.5 mg and was not receiving any corticosteroids, anti-TNF therapy, or other biological agents. The patient was afebrile (98F) with no SIRS criteria. Multiple vesicular lesions were present covering patient’s entire body including face. Lesions were in different stages, some umbilicated with diameter of 2-7cm. Many lesions have a rim of erythema with no discharge. On admission, patient was also pancytopenic with leukocyte count of 1.70k/mm(3). Biopsies of lesions were performed, which were positive for Varicella antigen. Subsequently, patient was started on Acyclovir. The patient’s clinical status improved and rash resolved. Our patient presented with “atypical” clinical picture of disseminated cutaneous zoster with no obvious dermatome involvement. Disseminated zoster is a potentially serious infection that can have an atypical presentation in patients with immunocompromised status. High index of suspicion is needed to make the diagnosis promptly and to initiate therapy to decrease mortality and morbidity.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609790/pdf/CRIM2015-124840.pdf

April 9, 2017 at 7:29 pm

Prosthetic Joint Infection due to Mycobacterium avium-intracellulare in a Patient with Rheumatoid Arthritis: A Case Report and Review of the Literature.

Case Rep Infect Dis. 2017;2017:8682354. doi: 10.1155/2017/8682354. Epub 2017 Feb 9.

Ingraham NE1, Schneider B2, Alpern JD3.

Author information

1 Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA.

2 Department of Internal Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.

3 Department of Infectious Disease, University of Minnesota, Minneapolis, MN, USA.

Abstract

Nontuberculous mycobacteria (NTM) are a rare cause of prosthetic joint infections (PJI). However, the prevalence of NTM infections may be increasing with the rise of newer immunosuppressive medications such as biologics. In this case report, we describe a rare complication of immunosuppressive therapies and highlight the complexity of diagnosing and treating PJI due to NTM. The patient is a 79-year-old Caucasian male with a history of severe destructive rheumatoid arthritis on several immunosuppressive agents and right hip osteoarthritis s/p total hip arthroplasty 15 years previously with several complex revisions, presenting with several weeks of worsening right hip and abdominal pain. A right hip CT scan revealed periprosthetic fluid collections. Aspiration of three fluid pockets was AFB smear-positive and grew Mycobacterium avium-intracellulare. The patient was deemed a poor surgical candidate. He underwent a limited I&D and several months of antimycobacterial therapy but clinically deteriorated and opted for hospice care. PJI caused by NTM are rare and difficult to treat. The increased use of biologics and prosthetic joint replacements over the past several decades may increase the risk of PJI due to NTM. A high index of suspicion for NTM in immunosuppressed patients with PJI is needed.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322427/pdf/CRIID2017-8682354.pdf

March 18, 2017 at 10:42 am

Specific management of post-chikungunya rheumatic disorders: a retrospective study of 159 cases in Reunion Island from 2006-2012.

PLoS Negl Trop Dis. 2015 Mar 11;9(3):e0003603.

Javelle E1, Ribera A2, Degasne I3, Gaüzère BA4, Marimoutou C5, Simon F1.

Author information

1Department of Tropical and Infectious Diseases, Laveran Military Teaching Hospital, Marseille, France.

2Private Rheumatology Office, Saint Denis, La Réunion, France.

3Department of Rheumatology, Centre Hospitalier Universitaire de La Réunion, Hôpital Felix Guyon, Saint Denis, La Réunion, France.

4Intensive Care Unit, Centre Hospitalier Universitaire de La Réunion, Hôpital Felix Guyon, Saint Denis, La Réunion, France.

5French Army Centre for Epidemiology and Public Health (“IRBA”), Marseille, France.

Abstract

BACKGROUND:

Since 2003, the tropical arthritogenic chikungunya (CHIK) virus has become an increasingly medical and economic burden in affected areas as it can often result in long-term disabilities. The clinical spectrum of post-CHIK (pCHIK) rheumatic disorders is wide. Evidence-based recommendations are needed to help physicians manage the treatment of afflicted patients.

PATIENTS AND METHODS:

We conducted a 6-year case series retrospective study in Reunion Island of patients referred to a rheumatologist due to continuous rheumatic or musculoskeletal pains that persisted following CHIK infection. These various disorders were documented in terms of their clinical and therapeutic courses. Post-CHIK de novo chronic inflammatory rheumatisms (CIRs) were identified according to validated criteria.

RESULTS:

We reviewed 159 patient medical files. Ninety-four patients (59%) who were free of any articular disorder prior to CHIK met the CIR criteria: rheumatoid arthritis (n=40), spondyloarthritis (n=33), undifferentiated polyarthritis (n=21). Bone lesions detectable by radiography occurred in half of the patients (median time: 3.5 years pCHIK). A positive therapeutic response was achieved in 54 out of the 72 patients (75%) who were treated with methotrexate (MTX). Twelve out of the 92 patients (13%) received immunomodulatory biologic agents due to failure of contra-indication of MTX treatment. Other patients mainly presented with mechanical shoulder or knee disorders, bilateral distal polyarthralgia that was frequently associated with oedema at the extremities and tunnel syndromes. These pCHIK musculoskeletal disorders (MSDs) were managed with pain-killers, local and/or general anti-inflammatory drugs, and physiotherapy.

CONCLUSION:

Rheumatologists in Reunion Island managed CHIK rheumatic disorders in a pragmatic manner following the outbreak in 2006. This retrospective study describes the common mechanical and inflammatory pCHIK disorders. We provide a diagnostic and therapeutic algorithm to help physicians deal with chronic patients, and to limit both functional and economic impacts. The therapeutic indication of MTX in pCHIK CIR could be approved in future efficacy trials.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356515/pdf/pntd.0003603.pdf

February 28, 2017 at 9:06 am

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