Posts filed under ‘HIC no SIDA’

Review – Vibrio vulnificus, an important cause of severe sepsis and skin and soft-tissue infection.

International Journal of Infectious Diseases 2011 V.15 e157-e166

Michael A. Horseman a,b,c,*, Salim Surani c,d,e

aDepartment of Pharmacy Practice, College of Pharmacy, Texas A&M Health Sciences Center, Kingsville, Texas, USA

bDepartment of Family Medicine & Community Medicine, School of Medicine, University of Texas Health Sciences Center, San Antonio, Texas, USA

c Christus Spohn Hospital Corpus Christi – Memorial, 2606 Hospital Blvd, Corpus Christi, Texas 78405, USA

dDepartment of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA

eDepartment of Internal Medicine, Texas A&M Health Science Center – College of Medicine, Scott and White Hospital, Temple, Texas, USA

Vibrio vulnificus is a halophilic Gram-negative bacillus found worldwide in warm coastal waters.

The pathogen has the ability to cause primary sepsis in certain high-risk populations, including patients with chronic liver disease, immunodeficiency, iron storage disorders, end-stage renal disease, and diabetes mellitus.

Most reported cases of primary sepsis in the USA are associated with the ingestion of raw or undercooked oysters harvested from the Gulf Coast.

The mortality rate for patients with severe sepsis is high, exceeding 50% in most reported series.

Other clinical presentations include wound infection and gastroenteritis.

Mild to moderate wound infection and gastroenteritis may occur in patients without obvious risk factors.

Severe wound infection is often characterized by necrotizing skin and soft-tissue infection, including fasciitis and gangrene.

V. vulnificus possesses several virulence factors, including the ability to evade destruction by stomach acid, capsular polysaccharide, lipopolysaccharide, cytotoxins, pili, and flagellum.

The preferred antimicrobial therapy is doxycycline in combination with ceftazidime and surgery for necrotizing soft-tissue infection.

PDF

https://www.ijidonline.com/article/S1201-9712(10)02538-5/pdf

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January 10, 2019 at 8:32 am

Vibrio vulnificus, una bacteria al acecho en las playas.

Highlights en investigación December 2014

Iván Renato Zúñiga Carrasco*, Janett Caro Lozano**.

*Jefe del Departamento de Epidemiología. Miembro del Comité Local de

Investigación y Ética en Salud (CLIES). H.G.Z. # 18 IMSS Playa del Carmen, Quintana

Roo.

**Jefa del Departamento de Epidemiología. Miembro del Comité Local de

Investigación y Ética en Salud (CLIES) H.G.Z. C/M.F. 1 IMSS Chetumal, Quintana Roo.

Un patógeno que puede ser transmitido por los ostiones es Vibrio vulnificus.

Descrito en 1976, se le denominó “Vibrio lactosa positivo”, posteriormente se le llamó Beneckea vulnificus y finalmente V. vulnificus. Pertenece a la familia Vibrionaceae, son bacilos Gramnegativos, rectos y curvos, móviles por la presencia de un flagelo polar, oxidasa positivos, no esporulados.

Son termolábiles y se comportan como anaerobios facultativos.

Entre las más de 30 especies del género Vibrio, se han reportado 12 como patógenas para el hombre, entre las que sobresalen V. cholerae, V. parahaemolyticus y V vulnificus . . .

PDF

http://www.medigraphic.com/pdfs/revenfinfped/eip-2014/eip144e.pdf

January 10, 2019 at 8:30 am

CASO CLINICO – Shock séptico por Vibrio vulnificus – un caso pediátrico

Revista de Enfermedades Infecciosas en Pediatría Diciembre 2013 Vol. XXVII Núm. 106

Dra. Marisol Fonseca Flores*, Dra. Sandra Luz Lizárraga López**, Dr. Agustín De Colsa Ranero***

* Médico Residente de Pediatría. Instituto Nacional de Pediatría.

** Médico Adscrito a la Unidad de Terapia Intensiva. Instituto Nacional de Pediatría.

*** Médico Adscrito al Departamento de Infectología Pediátrica. Instituto Nacional de Pediatría.

Los reportes de infección por V. vulnificus en pediatría son limitados en la literatura, y característicamente se describen 3 cuadros clínicos: Sepsis Primaria, Infección de piel y tejidos blandos e Infección gastrointestinal.

Se reporta el caso de un paciente masculino de 15 años de edad con diagnóstico de aplasia pura de serie roja y hemosiderosis, quien ingresa con cuadro febril, lesiones dérmicas, diarrea y datos de choque.

A los 4 días de su ingreso se identifica Vibrio vulnificus en hemocultivo, sin embargo, el paciente fallece a pesar del tratamiento establecido.

Con la presentación de este caso, se describen las características clínicas, epidemiológicas, factores de riesgos y evolución de la infección sistémica por V. vulnificus . . .

PDF

http://www.medigraphic.com/pdfs/revenfinfped/eip-2013/eip134g.pdf

 

January 10, 2019 at 8:28 am

PATÓGENO OPORTUNISTA VIBRIO VULNIFICUS

Revista Digital Universitaria 10 de abril 2005 • Volumen 6 Número 4 • ISSN: 1067-6079

Vibrio vulnificus es un bacteria halofílica. Tiene como reservorios ostiones, pescado, sedimento, agua y plankton.

Causa tres cuadros clínicos en humanos: septicemia, gastroenteritis e infección en heridas, de estos cuadros clínicos la septicemia tiene una mortalidad menos del 50%.

En general este tipo de enfermedades se presenta en personas inmunocomprometidas o con problemas hepáticos, por lo que se considera un patógeno oportunista, aunque se han reportado casos de infección en heridas en personas sanas.

Los moluscos en general poseen una alimentación por filtración, este sistema de nutrición permite que se acumule una gran cantidad de microorganismos y otros elementos presentes en el ambiente en donde se desarrollan. . .

PDF

http://www.revista.unam.mx/vol.6/num4/art32/abr_art32.pdf

January 10, 2019 at 8:26 am

Infections in patients affected by rheumatologic diseases associated to glucocorticoid use or tumor necrosis factor-alpha inhibitors.

Rev Chilena Infectol. April 2014 V.31 N.2 P.181-95.

[Article in Spanish]

Fica A.

Abstract

A great diversity of infectious agents can affect patients that use steroids at immunosuppressive doses or tumor necrosis factor alpha (TNF-alpha) antagonists.

The list of participating microorganisms is more restricted in the case of anti TNF-alpha blockers.

Overlapping agents include intracellular bacteria, Mycobacterium tuberculosis, geographic fungal agents that have the ability to establish granulamotous infections, herpes zoster, and reactivation of chronic hepatitis B virus infection.

An important conceptual issue for these infections is the existence of a threshold prednisone daily dose for the emergence of opportunistic infections but higher levels of immunosuppression and cofactors are required in the case of Pneumocystis jiroveci and cytomegalovirus infections.

In order to prevent these threats, a detailed medical evaluation is needed before prescription to detect potential risks and manage them properly.

Prevention rules must be prescribed in every case, that include common sense behaviors, vaccines, and in selected cases, chemoprophylaxis for latent tuberculosis (TB) infection, P. jiroveci pneumonia (PCP) or other specific requirements.

Latent TB infection is probable and requires chemoprophylaxis in the case of remote or recent exposure to a patient with lung TB, a positive tuberculin or interferon-gamma release assay result or residual lung scars in a chest x-ray exam.

PCP prevention is suggested when the patient reaches a daily dose of prednisone of 30 mg but might be needed at lower doses in case of other concomitant immunosuppressive drugs or when lymphopenia arises shortly after prednisone initiation.

PDF

https://scielo.conicyt.cl/pdf/rci/v31n2/art09.pdf

 

November 19, 2018 at 11:12 am

Antimicrobial Prophylaxis for Adult Patients With Cancer-Related Immunosuppression – ASCO and IDSA Clinical Practice Guideline Update.

Journal of Clinical Oncology  September 2018

Purpose

To provide an updated joint ASCO/Infectious Diseases Society of America (IDSA) guideline on antimicrobial prophylaxis for adult patients with immunosuppression associated with cancer and its treatment.

Methods

ASCO and IDSA convened an update Expert Panel and conducted a systematic review of relevant studies from May 2011 to November 2016. The guideline recommendations were based on the review of evidence by the Expert Panel.

Results

Six new or updated meta-analyses and six new primary studies were added to the updated systematic review.

Recommendations

Antibacterial and antifungal prophylaxis is recommended for patients who are at high risk of infection, including patients who are expected to have profound, protracted neutropenia, which is defined as < 100 neutrophils/µL for > 7 days or other risk factors. Herpes simplex virus–seropositive patients undergoing allogeneic hematopoietic stem-cell transplantation or leukemia induction therapy should receive nucleoside analog-based antiviral prophylaxis, such as acyclovir. Pneumocystis jirovecii prophylaxis is recommended for patients receiving chemotherapy regimens that are associated with a > 3.5% risk for pneumonia as a result of this organism (eg, those with ≥ 20 mg prednisone equivalents daily for ≥ 1 month or on the basis of purine analog usage). Treatment with a nucleoside reverse transcription inhibitor (eg, entecavir or tenofovir) is recommended for patients at high risk of hepatitis B virus reactivation. Recommendations for vaccination and avoidance of prolonged contact with environments that have high concentrations of airborne fungal spores are also provided within the updated guideline. Additional information is available at http://www.asco.org/supportive-care-guidelines.

abstract

http://ascopubs.org/doi/pdf/10.1200/JCO.18.00374

PDF (CLIC en DOWNLOAD)

September 22, 2018 at 4:11 pm

Pharmacokinetics of anidulafungin in critically ill patients with candidemia/invasive candidiasis.

Antimicrob Agents Chemother. 2013 Apr;57(4):1672-6.

Liu P1, Ruhnke M, Meersseman W, Paiva JA, Kantecki M, Damle B.

Author information

1 Clinical Pharmacology, Specialty Care, Pfizer Inc, Groton, Connecticut, USA.

Abstract

The pharmacokinetics of intravenous anidulafungin in adult intensive care unit (ICU) patients were assessed in this study and compared with historical data from a general patient population and healthy subjects. Intensive plasma sampling was performed over a dosing interval at steady state from 21 ICU patients with candidemia/invasive candidiasis. All patients received the recommended dosing regimen (a 200-mg loading dose on day 1, followed by a daily 100-mg maintenance dose), except for a 54-year-old 240-kg female patient (who received a daily 150-mg maintenance dose instead). Plasma samples were assayed for anidulafungin using a validated liquid chromatography-tandem mass spectrometry method. Pharmacokinetic parameters in ICU patients were calculated by a noncompartmental method. With the exclusion of the 240-kg patient, the median (minimum, maximum) age, weight, and body mass index (BMI) of 20 ICU patients were 57 (39, 78) years, 65 (48, 106) kg, and 23.3 (16.2, 33.8) kg/m(2), respectively. The average anidulafungin area under the curve over the 24-hour dosing interval (AUC(0-24)), maximum concentration (C(max)), and clearance (CL) in 20 ICU patients were 92.7 mg · h/liter, 7.7 mg/liter, and 1.3 liters/h, respectively. The exposure in the 240-kg patient at a daily 150-mg dose was within the range observed in ICU patients overall. The average AUC(0-24) and Cmax in the general patient population and healthy subjects were 110.3 and 105.9 mg · h/liter and 7.2 and 7.0 mg/liter, respectively. The pharmacokinetics of anidulafungin in ICU patients appeared to be comparable to those in the general patient population and healthy subjects at the same dosing regimen.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623353/pdf/zac1672.pdf

July 7, 2018 at 3:36 pm

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