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Barletta F, Zamudio C, Rigouts L, Seas C. Resistencia a drogas de segunda línea en cepas peruanas de Mycobacterium tuberculosis multidrogorresistentes. Rev Peru Med Exp Salud Publica 2014. [DOI: 10.17843/rpmesp.2014.314.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Barletta F, Zamudio C, Rigouts L, Seas C. [Resistance to second-line anti-tuberculosis drugs among peruvian multidrug resistant Mycobacterium tuberculosis strains]. Rev Peru Med Exp Salud Publica 2014; 31:676-682. [PMID: 25597717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 10/15/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES To determine the drug resistance profiles for quinolones: ciprofloxacin (CFX), ofloxacin (OFX), moxifloxacin (MFX), and gatifloxacin (GFX); and for injectables: kanamycin (KAN), amikacin (AMK), and capreomycin (CAP) in multidrug resistant (MDR) strains. We also investigated the correlation between mutations in rrs, tlyA and gyrA/B genes, and the in vitro resistance to the second-line anti-tuberculosis drugs. MATERIALS AND METHODS In this pilot study we selected MDR clinical isolates collected from June-December 2004 in the Tropical Medicine Institute "Alexander von Humboldt" (Lima, Perú). The Minimum Inhibitory Concentration (MIC) of CFX, OFX, MFX, GFX, KAN, AMK and CAP for 14 clinical isolates were determined and the sequences of rrs, tlyA and gyrA/B genes were analyzed by conventional PCR followed by sequencing. RESULTS We obtained valid results for 11 samples. Four isolates were resistant to injectable drugs, and in all the cases the MICs were; >120 µg/mL for KAN and >160 µg/mL for AMK and CAP. Only 2 isolates were resistant to OFX with MIC = 4 µg/mL. Sequencing results suggested that the mutation A1401T in rrs gene could be the molecular cause of the resistance to injectable drugs. In this study we did not find any mutation in tlyA and gyrA/B associated to resistance. CONCLUSIONS Our study suggests a possible association between the mutation A1401T in rrs and resistance to injectable drugs. However further studies should be done to confirm this hypothesis in Perú.
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Labarca JA, Salles MJC, Seas C, Guzmán-Blanco M. Carbapenem resistance in Pseudomonas aeruginosa and Acinetobacter baumannii in the nosocomial setting in Latin America. Crit Rev Microbiol 2014; 42:276-92. [PMID: 25159043 DOI: 10.3109/1040841x.2014.940494] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Increasing prevalence of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii strains in the nosocomial setting in Latin America represents an emerging challenge to public health, as the range of therapeutic agents active against these pathogens becomes increasingly constrained. We review published reports from 2002 to 2013, compiling data from throughout the region on prevalence, mechanisms of resistance and molecular epidemiology of carbapenem-resistant strains of P. aeruginosa and A. baumannii. We find rates of carbapenem resistance up to 66% for P. aeruginosa and as high as 90% for A. baumannii isolates across the different countries of Latin America, with the resistance rate of A. baumannii isolates greater than 50% in many countries. An outbreak of the SPM-1 carbapenemase is a chief cause of resistance in P. aeruginosa strains in Brazil. Elsewhere in Latin America, members of the VIM family are the most important carbapenemases among P. aeruginosa strains. Carbapenem resistance in A. baumannii in Latin America is predominantly due to the oxacillinases OXA-23, OXA-58 and (in Brazil) OXA-143. Susceptibility of P. aeruginosa and A. baumannii to colistin remains high, however, development of resistance has already been detected in some countries. Better epidemiological data are needed to design effective infection control interventions.
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Mendoza-Ticona A, Moore DAJ, Alarcón V, Samalvides F, Seas C. Propuesta de esquemas de tratamiento antituberculosis basados en la susceptibilidad a isoniacida y rifampicina. Rev Peru Med Exp Salud Publica 2014. [DOI: 10.17843/rpmesp.2013.302.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Pinto ME, Banda C, Seas C. Aspergiloma pulmonar secundaria a neutropenia inducida por metimazol: reporte de un caso. Rev Peru Med Exp Salud Publica 2014. [DOI: 10.17843/rpmesp.2012.292.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Ugarte-Gil C, Ponce M, Zamudio C, Canaza L, Samalvides F, Seas C. Knowledge about HIV prevention and transmission among recently diagnosed tuberculosis patients: a cross sectional study. BMC Public Health 2013; 13:1237. [PMID: 24373517 PMCID: PMC3883486 DOI: 10.1186/1471-2458-13-1237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 12/27/2013] [Indexed: 05/28/2023] Open
Abstract
Background Patients with Tuberculosis (TB) are a vulnerable group for acquiring HIV infection. Therefore, countries with a concentrated HIV epidemic and high prevalence of TB should provide adequate information about HIV prevention to TB patients. Methods We conducted a cross-sectional study to evaluate the level of knowledge on HIV prevention and transmission among newly diagnosed TB patients in Lima, Peru. The survey evaluated knowledge about HIV infection and prevention and was administered before HIV counseling and blood sampling for HIV testing were performed. Results A total of 171 TB patients were enrolled; mean age was 31.1 years, 101 (59%) were male. The overall mean level of knowledge of HIV was 59%; but the specific mean level of knowledge on HIV transmission and prevention was only 33.3% and 41.5%, respectively. Age and level of education correlated with overall level of knowledge in the multivariate model (P-value: 0.02 and <0.001 respectively). Conclusions The study shows inadequate levels of knowledge about HIV transmission and prevention among newly-diagnosed TB patients in this setting, and underscores the need for implementing educational interventions in this population.
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Abstract
We present the case of a 26-year-old male Peruvian patient who presented with disseminated intra-abdominal hydatidosis. The patient was treated with surgical removal of the cysts and prolonged medical treatment with albendazole.
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Ugarte-Gil C, Ruiz P, Zamudio C, Canaza L, Otero L, Kruger H, Seas C. Association of major depressive episode with negative outcomes of tuberculosis treatment. PLoS One 2013; 8:e69514. [PMID: 23922728 PMCID: PMC3726639 DOI: 10.1371/journal.pone.0069514] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/10/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pulmonary tuberculosis (TB) persists an important contributor to the burden of diseases in developing countries. TB control success is based on the patient's compliance to the treatment. Depressive disorders have been negatively associated with compliance of therapeutic schemes for chronic diseases. This study aimed to estimate the significance and magnitude of major depressive episode as a hazard factor for negative outcomes (NO), including abandon or death in patients receiving TB treatment. METHODOLOGY/PRINCIPAL FINDINGS A longitudinal study was conducted to evaluate the association of major depressive episode (MDE), as measured by a 5-item version of the Center for Epidemiological Studies Depression Scale (CES-D) with NO to TB treatment. Patients with confirmed TB were enrolled before the start of TB treatment. Baseline measurements included socio-demographic variables as well as the CES-D, which was also applied every month until the end of the treatment. Death and treatment default were assessed monthly. Survivor function (SF) for NO according to MDE status (CES-D≥6) at baseline (MDEb) was estimated. Cox's Regression was performed for bivariate analyses as well as for the multivariate model. A total of 325 patients accepted to participate in the study, of which 34 where excluded for diagnosis of MDR-TB. NO was observed in 24 patients (8.2%); 109 (37%) presented MDEb. Statistically significant difference was found on the SF of patients with and without MDEb (0.85 vs. 0.96, p-value = 0.002). The hazard ratio for NO, controlled for age, sex, marital status and instruction level was 3.54 (95%CI 1.43-8.75; p-value = 0.006). CONCLUSION The presence of MDE at baseline is associated to NO of TB treatment. Targeting detection and treatment of MDE may improve TB treatment outcomes.
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Mendoza-Ticona A, Moore DAJ, Alarcón V, Samalvides F, Seas C. [Proposal of anti-tuberculosis regimens based on susceptibility to isoniazid and rifampicin]. Rev Peru Med Exp Salud Publica 2013; 30:197-204. [PMID: 23949502 PMCID: PMC4000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 05/08/2013] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE To elaborate optimal anti-tuberculosis regimens following drug susceptibility testing (DST) to isoniazid (H) and rifampicin (R). DESIGN 12 311 M. tuberculosis strains (National Health Institute of Peru 2007-2009) were classified in four groups according H and R resistance. In each group the sensitivity to ethambutol (E), pirazinamide (Z), streptomycin (S), kanamycin (Km), capreomycin (Cm), ciprofloxacin (Cfx), ethionamide (Eto), cicloserine (Cs) and p-amino salicilic acid (PAS) was determined. Based on resistance profiles, domestic costs, and following WHO guidelines, we elaborated and selected optimal putative regimens for each group. The potential efficacy (PE) variable was defined as the proportion of strains sensitive to at least three or four drugs for each regimen evaluated. RESULTS Selected regimes with the lowest cost, and highest PE of containing 3 and 4 effective drugs for TB sensitive to H and R were: HRZ (99,5%) and HREZ (99,1%), respectively; RZECfx (PE=98,9%) and RZECfxKm (PE=97,7%) for TB resistant to H; HZECfx (96,8%) and HZECfxKm (95,4%) for TB resistant to R; and EZCfxKmEtoCs (82.9%) for MDR-TB. CONCLUSION Based on resistance to H and R it was possible to select anti-tuberculosis regimens with high probability of success. This proposal is a feasible alternative to tackle tuberculosis in Peru where the access to rapid DST to H and R is improving progressively.
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Bustamante B, Seas C, Salomon M, Bravo F. Lobomycosis successfully treated with posaconazole. Am J Trop Med Hyg 2013; 88:1207-8. [PMID: 23546805 DOI: 10.4269/ajtmh.12-0428] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Lobomycosis is a chronic subcutaneous mycosis for which no standard treatment is available to date. We describe a patient in Peru with lobomycosis on the left earlobe that was successfully treated with posaconazole for 27 months. No evidence of recurrence was observed after five years of follow-up.
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Pinto ME, Banda C, Seas C. [Pulmonary aspergillosis due to methimazole-induced neutropenia: a case report]. Rev Peru Med Exp Salud Publica 2012; 29:255-8. [PMID: 22858775 DOI: 10.1590/s1726-46342012000200015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 48-year old woman with a recent diagnosis of Graves' disease arrived at the emergency room with fever, palpitations, and a sore throat. Her regular treatment included methimazole. On admission, laboratory results showed suppressed TSH, elevated free thyroxine, and neutropenia. She was admitted and started on antibiotics and granulocyte-macrophage colony stimulating factor (gm-csf). After ten days, the patient developed leukocytosis, fever, and hemoptysis. Chest CT scan showed a lung cavity with multiple nodules in the upper right lobe. Cultures from a lung biopsy were positive for Aspergillus Fumigatus and Aspergillus Flavus. Amphotericin B was started but then switched to voriconazole, with both treatments failing to result in clinical improvement. The patient died of multi-organ failure.
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Arango C, Arango C, Seas C. A 29-year-old renal transplant recipient with acute respiratory failure. Am J Trop Med Hyg 2012; 86:911-912. [PMID: 22665592 PMCID: PMC3366531 DOI: 10.4269/ajtmh.2012.12-0017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Ponce M, Ugarte-Gil C, Zamudio C, Krapp F, Gotuzzo E, Seas C. Additional evidence to support the phasing-out of treatment category II regimen for pulmonary tuberculosis in Peru. Trans R Soc Trop Med Hyg 2012; 106:508-10. [DOI: 10.1016/j.trstmh.2012.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 01/25/2012] [Accepted: 05/21/2012] [Indexed: 10/28/2022] Open
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Bravo FG, Seas C. Balamuthia Mandrillaris Amoebic Encephalitis: An Emerging Parasitic Infection. Curr Infect Dis Rep 2012; 14:391-6. [DOI: 10.1007/s11908-012-0266-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Leon M, Alave J, Bustamante B, Gotuzzo E, Seas C. A probable association between HTLV-1 and endemic mycosis in Latin America. J Infect Dev Ctries 2012; 6:301. [PMID: 22421616 DOI: 10.3855/jidc.2305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Accepted: 09/28/2011] [Indexed: 10/31/2022] Open
Abstract
This item has no abstract. Follow the links below to access the full text.
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Seas C, Villaverde H, Maguiña C. A 60-year-old man from the highlands of Peru with fever and hemolysis. Am J Trop Med Hyg 2012. [PMID: 22403303 PMCID: PMC3284348 DOI: 10.4269/ajtmh.2012.10-0540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Seas C, Villaverde H, Maguiña C. A 60-Year-Old Man from the Highlands of Peru with Fever and Hemolysis. Am J Trop Med Hyg 2012; 86:381. [DOI: 10.4269/ajtmh.2012.11-0540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Ponce M, Mendoza A, Seas C. A 45-Year-Old Farmer with an Ulcerative Rash, Shock, and Hemorrhagic Meningitis. Am J Trop Med Hyg 2011; 85:792. [PMID: 22049028 PMCID: PMC3205620 DOI: 10.4269/ajtmh.2011.11-0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Otero L, Krapp F, Tomatis C, Zamudio C, Matthys F, Gotuzzo E, Van der Stuyft P, Seas C. High prevalence of primary multidrug resistant tuberculosis in persons with no known risk factors. PLoS One 2011; 6:e26276. [PMID: 22046266 PMCID: PMC3203110 DOI: 10.1371/journal.pone.0026276] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 09/23/2011] [Indexed: 11/19/2022] Open
Abstract
Introduction In high multidrug resistant (MDR) tuberculosis (TB) prevalence areas, drug susceptibility testing (DST) at diagnosis is recommended for patients with risk factors for MDR. However, this approach might miss a substantial proportion of MDR-TB in the general population. We studied primary MDR in patients considered to be at low risk of MDR-TB in Lima, Peru. Methods We enrolled new sputum smear-positive TB patients who did not report any MDR-TB risk factor: known exposure to a TB patient whose treatment failed or who died or who was known to have MDR-TB; immunosuppressive co-morbidities, ex prison inmates; prison and health care workers; and alcohol or drug abuse. A structured questionnaire was applied to all enrolled participants to confirm the absence of these factors and thus minimize underreporting. Sputum from all participants was cultured on Löwenstein-Jensen media and DST for first line drugs was performed using the 7H10 agar method. Results Of 875 participants with complete data, 23.2% (203) had risk factors for MDR-TB elicited after enrolment. Among the group with no reported risk factors who had a positive culture, we found a 6.3% (95%CI 4.4–8.3) (37/584) rate of MDR-TB. In this group no epidemiological characteristics were associated with MDR-TB. Thus, in this group, multidrug resistance occurred in patients with no identifiable risk factors. Conclusions We found a high rate of primary MDR-TB in a general population with no identifiable risk factors for MDR-TB. This suggests that in a high endemic area targeting patients for MDR-TB based on the presence of risk factors is an insufficient intervention.
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Brewer TF, Choi HW, Seas C, Krapp F, Zamudio C, Shah L, Ciampi A, Heymann SJ, Gotuzzo E. Self-reported risks for multiple-drug resistance among new tuberculosis cases: implications for drug susceptibility screening and treatment. PLoS One 2011; 6:e25861. [PMID: 22022459 PMCID: PMC3194818 DOI: 10.1371/journal.pone.0025861] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 09/13/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Multiple drug-resistance in new tuberculosis (TB) cases accounts for the majority of all multiple drug-resistant TB (MDR-TB) worldwide. Effective control requires determining which new TB patients should be tested for MDR disease, yet the effectiveness of global screening recommendations of high-risk groups is unknown. METHODS Sixty MDR-TB cases with no history of previous TB treatment, 80 drug-sensitive TB and 80 community-based controls were recruited in Lima, Peru between August and December, 2008 to investigate whether recommended screening practices identify individuals presenting with MDR-TB. Odd ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression to study the association of potential risk factors with case/control variables. RESULTS MDR-TB cases did not differ from drug-sensitive TB and community controls in rates of human immunodeficiency virus infection, reported hospital or prison visits in the 3 years prior to diagnosis. MDR-TB cases were more likely than drug-sensitive TB controls to have had a recent MDR-TB household contact (OR 4.66, (95% CI 1.56-13.87)); however, only 15 cases (28.3%) reported this exposure. In multivariate modeling, recent TB household contact, but not contact with an MDR-TB case, remained predictive of MDR-TB, OR 7.47, (95% CI 1.91-29.3). Living with a partner rather than parents was associated with a lower risk of MDR-TB, OR 0.15, (95% CI 0.04-0.51). CONCLUSION Targeted drug susceptibility testing (DST) linked to reported MDR-TB contact or other high-risk exposures does not identify the majority of new TB cases with MDR disease in Lima where it is endemic. All new TB cases should be screened with DST to identify MDR patients. These findings are likely applicable to other regions with endemic MDR-TB.
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Rodríguez-Noriega E, Seas C. The changing pattern of methicillin-resistant staphylococcus aureus clones in Latin America: implications for clinical practice in the region. Braz J Infect Dis 2011; 14 Suppl 2:S87-96. [PMID: 21180929 DOI: 10.1590/s1413-86702010000800004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) clones belonging to the Brazilian, Pediatric, Cordobes/Chilean and New York/Japan clonal complexes are widely distributed across Latin America, although their individual distribution patterns and resistance to antimicrobial drugs are constantly changing. Furthermore, clones with increased virulence are beginning to appear more frequently both in hospital and community settings, and there is evidence that virulence factors can be transferred between hospital- and community-associated clones through recombination. These changing patterns have significant implications for clinical practice in the region. Most importantly, clinicians need to be aware of the changing antimicrobial resistance profile of circulating MRSA clones in their region in order to choose the most appropriate empiric antimicrobial therapy. Thus, regional molecular epidemiology programs are required across the region to provide accurate identification and characterization of circulating MRSA clones.
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Alave J, Bustamante B, Soto L, Caceres J, Seas C. Acalculous Cholecystitis caused by Histoplasma capsulatum in a severely immunosuppressed HIV-infected patient. J Infect Dev Ctries 2011; 5:235-8. [DOI: 10.3855/jidc.1547] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 11/12/2010] [Accepted: 11/12/2010] [Indexed: 10/31/2022] Open
Abstract
Billiary tract involvement in the course of disseminated histoplasmosis has been rarely reported. Here we present a severely immunosuppressed HIV-infected patient who presented with symptomatic acalculous cholecystitis caused by Histoplasma capsulatum.
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Villaverde H, Gotuzzo E, Seas C. Chronic, progressive back pain, fever and a noticeable paravertebral mass. Am J Trop Med Hyg 2011; 84:363. [PMID: 21363970 PMCID: PMC3042808 DOI: 10.4269/ajtmh.2011.10-0672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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León M, Alave J, Martinez D, Bustamante B, Rodriguez M, Seas C. Symptomatic duodenal cryptococcosis in HIV-infected individuals. Med Mycol 2011; 49:775-8. [PMID: 21355712 DOI: 10.3109/13693786.2011.563325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Gastrointestinal involvement is an uncommon manifestation of cryptococcosis and, consequently, there are very few reports that have described symptomatic duodenal involvement. We present three cases of Cryptococcus-associated duodenitis in HIV-positive patients and review the literature.
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