Posts filed under ‘Infecciones en esplenectomizados’

Aspergilosis. Formas clínicas y tratamiento

Enf Infecciosas & Microbiologia Clínica Abril 2012 V.30 N.4

Jesús Fortún, Yolanda Meije, Gema Fresco, Santiago Moreno.

Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España

Resumen

La aspergilosis invasiva junto con la aspergilosis crónica pulmonar y la aspergilosis broncopulmonar alérgica, constituyen las formas clínicas de aspergilosis.

Aunque el número de especies de Aspergillus spp. es muy numeroso, Aspergillus fumigatus-complex es el agente etiológico más frecuente, independientemente de la forma clínica y la afección de base del paciente.

El incremento de los diferentes tratamientos inmunosupresores y el mayor uso de corticoides en pacientes con enfermedad obstructiva crónica han condicionado un mayor protagonismo de la aspergilosis en los últimos años.

El uso de galactomanano y las pruebas de imagen complementan las limitaciones microbiológicas en el diagnóstico de estos pacientes. Voriconazol y anfotericina liposomal constituyen la base del tratamiento en todas las formas de aspergilosis, y posaconazol, itraconazol, caspofungina y otras equinocandinas son alternativas eficaces.

El pronóstico depende de la forma clínica y las características del huésped, pero es sombrío fundamentalmente en las formas invasivas diseminadas.

abstract

http://www.elsevier.es/es-revista-enfermedades-infecciosas-microbiologia-clinica-28-articulo-aspergilosis-formas-clinicas-tratamiento-S0213005X12000316

PDF (hacer CLIC en “DESCARGAR PDF”)

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July 17, 2017 at 8:11 am

Pre-existing medical conditions associated with Vibrio vulnificus septicaemia.

Epidemiol Infect. 2014 Apr;142(4):878-81.

Menon MP1, Yu PA1, Iwamoto M1, Painter J1.

Author information

1Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Abstract

Vibrio vulnificus (Vv) can result in severe disease. Although pre-existing liver disease is a recognized risk factor for serious infection, the relative importance of other comorbidities has not been fully assessed.

We analysed reports of Vv infections submitted to CDC from January 1988 to September 2006 in order to assess the role of pre-existing conditions contributing to severe outcomes.

A total of 1212 patients with Vv infection were reported. Only patients with liver disease [adjusted odds ratio (aOR) 5.1)] were more likely to become septic when exposure was due to contaminated food.

Patients with liver disease (aOR 4.1), a haematological disease (aOR 3.2), or malignancy (aOR 3.2) were more likely to become septic when infection was acquired via a non-foodborne exposure.

As such, patients with these pre-existing medical conditions should be advised of the risk of life-threatening illness after eating undercooked contaminated seafood or exposing broken skin to warm seawater

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4598054/pdf/nihms727972.pdf

February 17, 2017 at 4:39 pm

Patients After Splenectomy: Old Risks and New Perspectives.

Chirurgia (Bucur). 2016 Sept-Oct;111(5):393-399. doi: 10.21614/chirurgia.111.5.393.

Dragomir M, Petrescu DGE, Manga GE, Călin GA, Vasilescu C; -.

Abstract

The risks that arise after splenectomy can be divided in infectious and non-infectious. The link between splenectomy and these hazards remains partially unknown.

Host defense against infection is altered after splenectomy and such individuals develop sepsis more easily and the infection has a fulminant course.

Splenectomy is also a potential risk factor for several vascular complications that result from partial or total obstruction of an arterial or venous blood vessel. Furthermore, pulmonary hypertensioncan be a severe and sometimes fatal complication following splenectomy.

Some authors also consider that malignancies, diabetes mellitus and acute pancreatitis are non-infectious complications after splenectomy.

The most feared complication for splenectomized patients remains sepsis. The pathophysiology of sepsis is still controversial.

Death in sepsis can occur due to either hyper-inflammation or immune paralysis. Multiple experimental evidences link cellular and viral microRNAs with sepsis.

We presume that miRNAs are also associated with the immunosuppression of the asplenic patients which leads to the high risk of deadly sepsis.

Studying the expression level of circulating miRNAs in asplenic patients could help us better understand the postsplenectomy immunosuppression and develop new diagnostic and therapeutic tools.

PDF

http://revistachirurgia.ro/pdfs/2016-5-393.pdf

February 10, 2017 at 8:56 am

Community-acquired Listeria monocytogenes meningitis in adults.

Clin Infect Dis. 2006 Nov 15;43(10):1233-8.                         

Brouwer MC1, van de Beek D, Heckenberg SG, Spanjaard L, de Gans J.

Author information

1Department of Neurology, Center of Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.c.brouwer@amc.uva.nl

Abstract

BACKGROUND:

Listeria monocytogenes is the third most common cause of bacterial meningitis.

METHODS:

We prospectively evaluated 30 episodes of community-acquired L. monocytogenes meningitis, confirmed by culture of cerebrospinal fluid specimens, in a nationwide study in The Netherlands. Outcome was graded using the Glasgow outcome score; an unfavorable outcome was defined as a score of 1-4.

RESULTS:

We found 30 episodes of L. monocytogenes meningitis. All patients were immunocompromised or > 50 years old. In 19 (63%) of 30 patients, symptoms were present for > 24 h; in 8 patients (27%), symptoms were present for > or = 4 days. The classic triad of fever, neck stiffness, and change in mental status was present in 13 (43%) of 30 patients. An individual cerebrospinal fluid indicator of bacterial meningitis was present in 23 (77%) of 30 cases. Gram staining of cerebrospinal fluid samples revealed the causative organism in 7 (28%) of 25 cases. The initial antimicrobial therapy was amoxicillin based for 21 (70%) of 30 patients. The coverage of initial antimicrobial therapy was microbiologically inadequate for 9 (30%) of the patients. The mortality rate was 17% (5 of 30), and 8 (27%) of 30 patients experienced an unfavorable outcome. Inadequate initial antimicrobial therapy was not related to outcome.

CONCLUSIONS:

In contrast with previous reports, we found that patients with meningitis due to L. monocytogenes do not present with atypical clinical features; however, typical cerebrospinal fluid findings predictive for bacterial meningitis might be absent. A high proportion of patients received initial antimicrobial therapy that did not cover L. monocytogenes.

PDF

http://cid.oxfordjournals.org/content/43/10/1233.full.pdf+html

December 16, 2016 at 6:27 pm

Three-year multicenter surveillance of community-acquired Listeria monocytogenes meningitis in adults.

BMC Infect Dis. 2010 Nov 11;10:324.

Amaya-Villar R1, García-Cabrera E, Sulleiro-Igual E, Fernández-Viladrich P, Fontanals-Aymerich D, Catalán-Alonso P, Rodrigo-Gonzalo de Liria C, Coloma-Conde A, Grill-Díaz F, Guerrero-Espejo A, Pachón J, Prats-Pastor G.

Author information

1Intensive Care Unit, Hospital Universitario Virgen del Rocío, Av Manuel Siurot s/n, 41013 Sevilla, Spain.   ramayav@wanadoo.es      

Abstract

BACKGROUND:

Listeria monocytogenes is the third most frequent cause of bacterial meningitis. The aim of this study is to know the incidence and risk factors associated with development of acute community-acquired Lm meningitis in adult patients and to evaluate the clinical features, management, and outcome in this prospective case series.

METHODS:

A descriptive, prospective, and multicentric study carried out in 9 hospitals in the Spanish Network for Research in Infectious Diseases (REIPI) over a 39-month period. All adults patients admitted to the participating hospitals with the diagnosis of acute community-acquired bacterial meningitis (Ac-ABM) were included in this study. All these cases were diagnosed on the basis of a compatible clinical picture and a positive cerebrospinal fluid (CSF) culture or blood culture. The patients were followed up until death or discharge from hospital.

RESULTS:

Two hundred and seventy-eight patients with Ac-ABM were included. Forty-six episodes of Lm meningitis were identified in 46 adult patients. In the multivariate analysis only age (OR 1.026; 95% CI 1.00-1.05; p = 0.042), immunosuppression (OR 2.520; 95% CI 1.05-6.00; p = 0.037), and CSF/blood glucose ratio (OR 39.42; 95% CI 4.01-387.50; p = 0.002) were independently associated with a Lm meningitis. The classic triad of fever, neck stiffness and altered mental status was present in 21 (49%) patients, 32% had focal neurological findings at presentation, 12% presented cerebellum dysfunction, and 9% had seizures. Twenty-nine (68%) patients were immunocompromised. Empirical antimicrobial therapy was intravenous ampicillin for 34 (79%) of 43 patients, in 11 (32%) of them associated to aminoglycosides. Definitive ampicillin plus gentamicin therapy was significantly associated with unfavourable outcome (67% vs 28%; p = 0.024) and a higher mortality (67% vs 32%; p = 0.040).The mortality rate was 28% (12 of 43 patients) and 5 of 31 (16.1%) surviving patients developed adverse clinical outcome.

CONCLUSIONS:

Elderly or immunocompromised patients, and a higher CSF/blood glucose ratio in patients with Ac-ABM must alert clinicians about Lm aetiology. Furthermore, we observed a high incidence of acute community-acquired Lm meningitis in adults and the addition of aminoglycosides to treatment should be avoid in order to improve the patients’ outcome. Nevertheless, despite developments in intensive care and antimicrobial therapy, this entity is still a serious disease that carries high morbidity and mortality rates.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995464/pdf/1471-2334-10-324.pdf

December 16, 2016 at 6:15 pm

Care of the Asplenic Patient

N Engl J Med  July 24, 2014 V.371 P.349-356

CLINICAL PRACTICE

  1. G. Rubin and W. Schaffner

From the Division of Infectious Diseases, Department of Pediatrics, Steven and Alexandra Cohen Children’s Medical Center of New York, New Hyde Park, and Hofstra North Shore–LIJ School of Medicine, Hempstead — both in New York (L.G.R.); and the Departments of Health Policy and Medicine, Vanderbilt University School of Medicine, Nashville (W.S.).

Address reprint requests to Dr. Rubin at Cohen Children’s Medical Center of New York, 269-01 76th Ave., New Hyde Park, NY 11040, or at lrubin4@nshs.edu

A 23-year-old man sustained abdominal trauma in a motorcycle accident that required a surgical splenectomy.

He received the 23-valent pneumococcal polysaccharide vaccine (PPSV23) after surgery.

Six months after his surgery, he calls his primary care provider because he has fever.

What is the appropriate management?

Are other prophylactic measures available and indicated?….

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMcp1314291

August 9, 2014 at 6:48 pm

Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses.

Lancet Infect Dis. 2009 Aug;9(8):493-504.

Kunisaki KM1, Janoff EN.

1Pulmonary Section, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417, USA. kunis001@umn.edu

Abstract

Patients that are immunosuppressed might be at risk of serious influenza-associated complications.

As a result, multiple guidelines recommend influenza vaccination for patients infected with HIV, who have received solid-organ transplants, who have received haemopoietic stem-cell transplants, and patients on haemodialysis.

However, immunosuppression might also limit vaccine responses. To better inform policy, we reviewed the published work relevant to incidence, outcomes, and prevention of influenza infection in these patients, and in patients being treated chemotherapy and with systemic corticosteroids.

Available data suggest that most immunosuppressed populations are indeed at higher risk of influenza-associated complications, have a general trend toward impaired humoral vaccine responses (although these data are mixed), and can be safely vaccinated–although longitudinal data are largely lacking.

Randomised clinical trial data were limited to one study of HIV-infected patients with high vaccine efficacy. Better trial data would inform vaccination recommendations on the basis of efficacy and cost in these at-risk populations.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775097/pdf/nihms-133861.pdf

 

May 30, 2014 at 6:47 pm

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