Herpes simplex virus (HSV) pneumonia in the non-ventilated immunocompromised host: Burden and predictors

Objectives: To evaluate burden and predictors of HSV pneumonia among immunocompromised patients not undergoing invasive mechanical ventilation according to a tailored diagnostic algorithm. Methods: This prospective, observational study included immunocompromised adults with pneumonia non-responding to empirical antibiotic therapy. Bronchoalveolar lavage (BAL) specimens were cultured for bacteria, mycobacteria and fungi. Real-time PCR for Herpesviruses and other microorganisms were performed on BAL and other specimens. Cytological examination of BAL samples was carried out for identification of intranuclear inclusion bodies and immunohistochemical staining for HSV. Results: We enrolled 45 patients (mean age 64.6 years) from January 2015 to June 2016. Nineteen (42.2%) cases tested positive for HSV-1 PCR on BAL. According to our definitions, 11 (24.4%) patients had HSV- 1 pneumonia with viral loads ranging between 10 3 copies/mL and 10 7 copies/mL. HSV-1 positive throat swab (OR 85.2, 95% CI 5.83\u20131245.1, P < 0.001) and solid organ transplant (SOT) (OR 53.3, 95% CI 1.37\u20132072.8, P < 0.03) as underlying condition were found to be independently associated with HSV pneumonia by multivariable analysis. Conclusions: HSV pneumonia turned out to be relatively common and should be investigated especially in individuals with HSV positive throat swab and SOT. Interventional studies are needed to assess the real clinical impact of HSV pneumonia in immunocompromised patients

Impact of Initial Antifungal Therapy on the Outcome of Patients With Candidemia and Septic Shock Admitted to Medical Wards: A Propensity Score-Adjusted Analysis

Echinocandins are recommended as firstline therapy in patients with candidemia. However, there is debate on their efficacy in survival outcomes. The aim of this study is to evaluate whether the choice of initial antifungal therapy improves mortality in patients with candidemia in relation to the presence of septic shock

Impact of Initial Antifungal Therapy on the Outcome of Patients With Candidemia and Septic Shock Admitted to Medical Wards: A Propensity Score-Adjusted Analysis

13noBACKGROUND: Echinocandins are recommended as firstline therapy in patients with candidemia. However, there is debate on their efficacy in survival outcomes. The aim of this study is to evaluate whether the choice of initial antifungal therapy improves mortality in patients with candidemia in relation to the presence of septic shock. METHODS: Patients with candidemia hospitalized in internal medicine wards of 5 tertiary care centers were included in the study (December 2012-December 2014). Patient characteristics, therapeutic interventions, and outcome were reviewed. Propensity score (PS) was used as a covariate of the multivariate analysis to perform a stratified analysis according to PS quartiles and to match patients receiving "echinocandins" or "azoles." RESULTS: Overall, 439 patients with candidemia were included in the study. A total of 172 (39.2%) patients had septic shock. Thirty-day mortality was significantly higher in patients with septic shock (45.3%) compared with those without septic shock (31.5%; P = .003). Among patients with septic shock, the use of echinocandins in the first 48 hours, compared with azoles, did not affect 30-day mortality in the PS-adjusted Cox regression analysis (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.37-1.59; P = .48), the PS-stratified analysis, or the logistic regression model in matched cohorts (adjusted HR, 0.92; 95% CI, 0.51-1.63; P = .77). CONCLUSIONS: Echinocandin therapy seems not to improve the outcome of non-intensive care unit patients with septic shock due to candidemia. These findings support the urgent need of further studies in this patient population.openopenFalcone, Marco; Giusy, Tiseo; Gutiérrez-Gutiérrez, Belen; Giammarco, Raponi; Paolo, Carfagna; Chiara, Rosin; Roberto, Luzzati; Diego, Delle Rose; Massimo, Andreoni; Alessio, Farcomeni; Mario, Venditti; Rodríguez-Baño, Jesus; Menichetti, FrancescoMarco, Falcone; Tiseo, Giusy; Belen, Gutiérrez-Gutiérrez; Raponi, Giammarco; Carfagna, Paolo; Rosin, Chiara; Luzzati, Roberto; Delle Rose, Diego; Andreoni, Massimo; Farcomeni, Alessio; Venditti, Mario; Jesus, Rodríguez-Baño; Francesco, Menichett

A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality

Abstract Purpose: Clinical data on patients with intra-abdominal candidiasis (IAC) is still scarce. Methods: We collected data from 13 hospitals in Italy, Spain, Brazil, and Greece over a 3-year period (2011\u20132013) including patients from ICU, medical, and surgical wards. Results: A total of 481 patients were included in the study. Of these, 27 % were hospitalized in ICU. Mean age was 63 years and 57 % of patients were male. IAC mainly consisted of secondary peritonitis (41 %) and abdominal abscesses (30 %); 68 (14 %) cases were also candidemic and 331 (69 %) hadconcomitant bacterial infections. The most commonly isolated Candida species were C. albicans (n = 308 isolates, 64 %) and C. glabrata (n = 76, 16 %). Antifungal treatment included echinocandins (64 %), azoles (32 %), and amphotericin B (4 %). Septic shock was documented in 40.5 % of patients. Overall 30-day hospital mortality was 27 % with 38.9 % mortality in ICU. Multivariate logistic regression showed that age (OR 1.05, 95 % CI 1.03\u20131.07, P\0.001), increments in 1-point APACHE II scores (OR 1.05, 95 % CI 1.01\u20131.08, P = 0.028), secondary peritonitis (OR 1.72, 95 % CI 1.02\u20132.89, P = 0.019), septic shock (OR 3.29, 95 % CI 1.88\u20135.86, P\0.001), and absence of adequate abdominal source control (OR 3.35, 95 % CI 2.01\u20135.63, P\0.001) wereassociated with mortality. In patients with septic shock, absence of source control correlated with mortality rates above 60 % irrespective of administration of an adequate antifungal therapy. Conclusions: Low percentages of concomitant candidemia and high mortality rates are documented in IAC. In patients presenting with septic shock, source control is fundamental

Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores

A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do município de Tangará da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola não vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, não entendimento da EA como processo de ensino-aprendizagem, falta de recursos didáticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prática, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vínculo “EA e ecologia, lixo e horta”.Facultad de Humanidades y Ciencias de la Educació

Brain Abscesses Caused by Nocardia paucivorans in a Multiple Myeloma Patient Treated with Lenalidomide and Dexamethasone: a Case Report and Review of Literature

6noWe report the first case of multiple brain abscesses caused by Nocardia paucivorans in a patient suffering from multiple myeloma on treatment with lenalidomide and dexamethasone. N. paucivorans is a recently described species of the genus Nocardia, which is supposed to have a heightened neurotropism in cases of disseminated infection. Although nocardiosis itself is an uncommon infectious complication in multiple myeloma so far, nocardial brain abscess should be added to the spectrum of adverse effects due to this novel chemotherapy regimen.openopenMonticelli, Jacopo; Luzzati, Roberto; Maurel, Cristina; Rosin, Chiara; Valentinotti, Romina; Farina, ClaudioMonticelli, Jacopo; Luzzati, Roberto; Maurel, Cristina; Rosin, Chiara; Valentinotti, Romina; Farina, Claudi

Brain abscesses caused by Nocardia paucivorans in a multiple myeloma patient treated with lenalidomide and dexamethasone: a case report and review of literature.

We report the first case of multiple brain abscesses caused by Nocardia paucivorans in a patient suffering from multiple myeloma on treatment with lenalidomide and dexamethasone. Nocardia  paucivorans is a recently described species of the genus Nocardia, which is supposed to have a heightened neurotropism in cases of disseminated infection. Although nocardiosis itself is an uncommon infectious complication in multiple myeloma so far, nocardial brain abscess should be added to the spectrum of adverse effects due to this novel chemotherapy regimen