Toxoplasma reactivation after renal transplant – low expression of nitric oxide synthase and a Th2 pattern of immune response

Background: The mechanism of immunosuppression associated with reactivation of the toxoplasmosis in transplanted patients is known, but the interactions of the human cells and cytokines expression is not well established.Case report: We described a case of toxoplasmosis reactivation in a renal transplanted patient with pneumonitis. The in situ expression of cytokines and cellular phenotypes was evaluated in this case.Results: A Th2 pattern of immune response predominated with strong expression of TGF-beta, TNF-alpha and IL-10. The expression of IL-2 receptor, nitric oxide synthase and IFN-gamma were weak.Conclusion: The reactivation of toxoplasmosis in the lung was associated with a Th2 pattern of immune response and decreased activity of macrophages

Abscesso de pele por Candida albicans

Subcutaneous candidal abscess is a very rare infection even in immunocompromised patients. Some cases are reported when breakdown in the skin occurs, as bacterial cellulites or abscess, iatrogenic procedures, trauma and parenteral substance abuse. We describe a case of Candida albicans subcutaneous abscess without fungemia, which can be associated with central venous catheter.Abscesso subcutâneo por Candida é infecção muito rara mesmo em pacientes imunocomprometidos. Alguns casos são relatados quando ocorre dano na pele, como celulite bacteriana ou abscesso, procedimentos iatrogênicos, trauma e abuso de substância parenteral. Relatamos caso de abscesso subcutâneo por Candida albicans sem fungemia, que pode estar associado com cateter venoso central

Abscesso cerebral secundário à osteomielite frontal

Frontal osteomyelitis is a rare complication of sinusitis. Common intracranial complications of the frontal osteomyelitis are meningitis, epidural empyema, subdural empyema and brain abscess. We described a case of frontal osteomyelitis with brain abscess caused by Staphylococcus aureus with improve after needle aspiration and antibiotics to brain abscess for eight weeks and for chronic osteomyelitis for four months.A osteomielite de osso frontal é uma complicação rara da sinusite frontal. As complicações intracranianas mais comuns da osteomielite frontal são: meningite, empiema epidural, empiema subdural e abscesso cerebral. Relatamos um caso de osteomielite frontal com abscesso cerebral cujo agente etiológico foi o Staphylococcus aureus. Houve melhora significativa após drenagem guiada por agulha e antibiótico por oito semanas e para a osteomielite crônica por quatro meses

Sex, drugs, bugs, and age: Rational selection of empirical therapy for outpatient urinary tract infection in an era of extensive antimicrobial resistance

AbstractBackgroundOptimal empirical therapy of urinary tract infection requires accurate knowledge of local susceptibility patterns, which may vary with organism and patient characteristics.MethodsAmong 9,798 consecutive, non-duplicate, community-source urine isolates from ambulatory patients ≥ 13 years old, from clinical laboratory and an academic medical center in Curitiba, Brazil (May 1st to December 1st, 2009), susceptibility data for ampicillin, nitrofurantoin, trimethoprim-sulfamethoxazole, gentamicin, fluoroquinolones, and ceftriaxone/cefotaxime were compared with organism and patient gender and age.ResultsThe female-to-male ratio decreased with age, from 28.1 (among 20–29 year-olds) to 3.3 (among > 80 year-olds). Overall, susceptibility prevalence varied widely by drug class, from unacceptably low levels (53.5% and 61.1%: ampicillin and trimethoprimsulfamethoxazole) to acceptable but suboptimal levels (81.2% to 91.7%: fluoroquinolones, ceftriaxone, nitrofurantoin, and gentamicin). E. coli isolates exhibited higher susceptibility rates than other isolates, from 3–4% higher (fluoroquinolones, gentamicin) to ≥ 30% (nitrofurantoin, ceftriaxone). Males exhibited lower susceptibility rates than females. Within each gender, susceptibility declined with increasing age. For females, only nitrofurantoin and gentamicin were suitable for empirical therapy (≥ 80% susceptibility) across all age cohorts; fluoroquinolones were suitable only through age 60, and ceftriaxone only through age 80. For males, only gentamicin yielded ≥ 80% susceptibility in any age cohort.ConclusionFew suitable empirical treatment options for community-source urinary tract infection were identified for women aged over 60 years or males of any age. Empirical therapy recommendations must consider the patient's demographic characteristics. Site-specific, age and gender-stratified susceptibility surveillance involving all uropathogens is needed

Toxoplasma reactivation after renal transplant – low expression of nitric oxide synthase and a Th2 pattern of immune response

Background: The mechanism of immunosuppression associated with reactivation of the toxoplasmosis in transplanted patients is known, but the interactions of the human cells and cytokines expression is not well established.Case report: We described a case of toxoplasmosis reactivation in a renal transplanted patient with pneumonitis. The in situ expression of cytokines and cellular phenotypes was evaluated in this case.Results: A Th2 pattern of immune response predominated with strong expression of TGF-beta, TNF-alpha and IL-10. The expression of IL-2 receptor, nitric oxide synthase and IFN-gamma were weak.Conclusion: The reactivation of toxoplasmosis in the lung was associated with a Th2 pattern of immune response and decreased activity of macrophages

Acute pancreatitis associated with lamivudine therapy for chronic B hepatitis

Hyperamylasemia is a common complication during lamivudine use. We report a case of a pancreatitis following lamivudine therapy. A careful monitoring of amylase levels during treatment with lamivudine is discussed, mainly in the first weeks, considering the cost of this exam and further complication

Controlando Acinetobacter endêmico com hipoclorito de sódio.

Objetivo: Avaliar a eficácia de hipoclorito 1% como um agente de desinfecção ambiental para controlar Acinetobacter em um hospital onde este microrganismo é endêmico. Métodos: Uma avaliação foi realizada em três diferentes períodos: 10 meses antes, durante 3 meses e 5 meses após a intervenção com a higienização do ambiente, usando hipoclorito de 1% em todas as unidades do hospital. Os dados sobre infecção (pneumonia, infecção do trato urinário e bacteremia) foram apresentados como número por 1000 pacientes-dia. Resultados: A taxa de infecção Acinetobacter eram 16,7 por 1000 pacientes-dia antes da intervenção, 5,1 por 1000 pacientes-dia durante a intervenção e 25,0 por 1000 pacientes-dia de cinco meses após a intervenção de hipoclorito. A intervenção hipoclorito resultou numa redução significativa na infecção por Acinetobacter em todos os sítios (urinária, bacteremia e pneumonia) (p <0,05). Conclusão: hipoclorito foi eficaz na redução temporária da taxa de Acinetobacter infecção.