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Peixoto D, Callia JPB, Bittencourt MS, Generoso G, Anastácio VM, Alves-Jr JL, Silva TLD, Belizário JC, Araújo BLM, Ho W, Diz MDPE, Hoff PM, Abdala E, Ibrahim KY. Clinical presentation and in-hospital prognosis of lung cancer patients presenting with suspected and confirmed COVID-19. Braz J Med Biol Res 2022; 55:e12140. [PMID: 36102415 PMCID: PMC9467285 DOI: 10.1590/1414-431x2022e12140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/13/2022] [Indexed: 01/08/2023] Open
Abstract
We sought to compare the clinical presentation and prognosis of patients with lung cancer and confirmed COVID-19 infection to those with negative RT-PCR SARS-CoV-2 results. We included patients with confirmed lung cancer and suspected COVID-19 who presented to the emergency department. The primary outcome was in-hospital mortality and secondary outcomes included admission to intensive care unit (ICU) or mechanical ventilation. We analyzed the characteristics according to RT-PCR results and primary outcome. We constructed a logistic regression for each RT-PCR result group to find potential predictors of the primary outcome. Among 110 individuals with confirmed lung cancer (65±9 years, 51% male), 38 patients had positive RT-PCR and 72 patients had negative RT-PCR. There was no difference between groups for any clinical characteristic or comorbidities though individuals with confirmed COVID-19 had higher functionality in the ECOG scale. Leucocytes and lymphocytes were lower in individuals with positive tests. The primary outcome occurred in 58 (53%) individuals, 37 (34%) were admitted to the ICU, and 29 (26%) required mechanical ventilation. Although mortality was similar between the two groups, individuals with confirmed COVID-19 were significantly more likely to be admitted to the ICU or receive mechanical ventilation. Only lower lymphocytes and higher CRP were significantly associated with higher mortality. The clinical presentation of COVID-19 in lung cancer is not sufficient to identify higher or lower probability groups among symptomatic individuals, the overall mortality is high irrespective of RT-PCR results, and lymphopenia on admission was associated with the diagnosis and prognosis for COVID-19.
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Affiliation(s)
- D Peixoto
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J P B Callia
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M S Bittencourt
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - G Generoso
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - V M Anastácio
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J L Alves-Jr
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - T L da Silva
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J C Belizário
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - B L M Araújo
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - W Ho
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M D P E Diz
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - P M Hoff
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - E Abdala
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - K Y Ibrahim
- Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Vicente BM, Neto JV, Quaresma MVLDS, Vasconcelos JS, Espíndola Bauchiunas R, Dos Santos ECM, Picone CM, Ibrahim KY, Avelino-Silva VI, de Melo CM, Segurado AC, Lima Ribeiro SM. Covid-19 Social Distancing, Lifestyle and Health Outcomes Among Persons Living with HIV (PLWH): A Web-based Survey. AIDS Behav 2022; 26:4144-4155. [PMID: 35699860 PMCID: PMC9194884 DOI: 10.1007/s10461-022-03740-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/24/2022]
Abstract
We investigated changes in lifestyle, depressive symptoms, self-perception of health, and body weight changes of persons living with HIV (PLWH) during the COVID-19 social distancing (SD). In a Web-based cross-sectional survey, participants (n = 406) were questioned about lifestyle and health status before and during SD. Most responders were men, 50 + years old, high education level; 49.8% had their income reduced during SD. About 9% were diagnosed with COVID-19, of whom 13.5% required hospitalization. During SD: - most participants did not change their food intake, although 25% replaced healthy foods with unhealthy ones; -more than half mentioned poor sleep quality; -about 50% increased their sedentary behavior. Depressive symptoms (reported by 70.9%) were associated with sedentary behavior, poor sleep quality, and reduced income. About one-third had a negative perception of their health status, which was inversely associated with practicing physical exercises and positively associated with sedentarism and poor sleep quality. More than half increased their body weight, which was associated with a lower intake of vegetables. The older age reduced the odds of the three outcomes. Carefully monitoring PLWH regarding SD will enable early interventions toward health.
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Affiliation(s)
- Beatriz M Vicente
- Department of Nutrition, School of Public Health, University of São Paulo, Av Dr Arnaldo, 715- São Paulo, CEP 01246-904, São Paulo, Brazil
| | - João Valentini Neto
- Department of Nutrition, School of Public Health, University of São Paulo, Av Dr Arnaldo, 715- São Paulo, CEP 01246-904, São Paulo, Brazil
| | | | - Janaína Santos Vasconcelos
- Department of Nutrition, School of Public Health, University of São Paulo, Av Dr Arnaldo, 715- São Paulo, CEP 01246-904, São Paulo, Brazil
| | - Roseli Espíndola Bauchiunas
- Department of Nutrition, School of Public Health, University of São Paulo, Av Dr Arnaldo, 715- São Paulo, CEP 01246-904, São Paulo, Brazil
| | - Elisabete C M Dos Santos
- Division of Infectious Diseases, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Camila M Picone
- Division of Infectious Diseases, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Karim Y Ibrahim
- Division of Infectious Diseases, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vivian I Avelino-Silva
- Division of Infectious Diseases, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Camila M de Melo
- Department of Nutrition, Federal University of Lavras, Lavras, Minas Gerais, Brazil
| | - Aluísio C Segurado
- Division of Infectious Diseases, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Sandra Maria Lima Ribeiro
- Department of Nutrition, School of Public Health, University of São Paulo, Av Dr Arnaldo, 715- São Paulo, CEP 01246-904, São Paulo, Brazil. .,School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil.
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Netto LC, Ibrahim KY, Picone CM, Alves APPS, Aniceto EV, Santiago MR, Parmejani PSS, Aikawa NE, Medeiros-Ribeiro AC, Pasoto SG, Yuki EFN, Saad CGS, Pedrosa T, Lara AN, Ceneviva C, Bonfa E, Kallas EG, Avelino-Silva VI. Safety and immunogenicity of CoronaVac in people living with HIV: a prospective cohort study. The Lancet HIV 2022; 9:e323-e331. [PMID: 35338835 PMCID: PMC8942475 DOI: 10.1016/s2352-3018(22)00033-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 12/14/2022]
Abstract
Background People living with HIV might have a poor or delayed response to vaccines, mainly when CD4 cell counts are low, and data concerning COVID-19 vaccines in this population are scarce. This prospective cohort study assessed the safety and immunogenicity of the inactivated SARS-CoV-2 vaccine CoronaVac in people with HIV compared with people with no known immunosuppression. Methods In this prospective cohort study, adults (aged ≥18 years) living with HIV who were regularly followed up at the University of Sao Paulo HIV/AIDS outpatient clinic in Sao Paulo, Brazil, were included in the study. Eligibility for people with HIV was independent of antiretroviral use, HIV viral load, or CD4 cell count. Adults with no known immunosuppression with CoronaVac vaccination history were included as a control group. CoronaVac was given intramuscularly in a two-dose regimen, 28 days apart. Blood was collected before vaccine administration and 6 weeks after the second dose (day 69). Immunogenicity was assessed at baseline (day 0), before second vaccine (day 28), and 6 weeks after second vaccine dose (day 69) through SARS-CoV-2 IgG titre and seroconversion, neutralising antibody (NAb) positivity and percentage activity, and factor increase in IgG geometric mean titres (FI-GMT). We investigated whether HIV status and CD4 count (<500 or ≥500 cells per μL) were associated with CoronaVac immunogenicity by use of multivariable models adjusted for age and sex. Findings Between Feb 9, 2021, and March 4, 2021, 776 participants were recruited. Of 511 participants included, 215 (42%) were people with HIV and 296 (58%) were people with no known immunosuppression. At 6 weeks after the second vaccine dose (day 69), 185 (91%) of 204 participants with HIV and 265 (97%) of 274 participants with no known immunosuppression had seroconversion (p=0·0055). 143 (71%) of 202 participants with HIV were NAb positive compared with 229 (84%) of 274 participants with no known immunosuppression (p=0·0008). Median IgG titres were 48·7 AU/mL (IQR 26·6–88·2) in people with HIV compared with 75·2 AU/mL (50·3–112·0) in people with no known immunosuppression (p<0·0001); and median NAb activity was 46·2% (26·9–69·7) compared with 60·8% (39·8–79·9; p<0·0001). In people with HIV who had CD4 counts less than 500 cells per μL seroconversion rates, NAb positivity, and NAb activity were lower than in those with CD4 counts of at least 500 cells per μL. In multivariable models for seroconversion, NAb positivity, IgG concentration, and NAb activity after a complete two-dose regimen, adjusted for age and sex, people with HIV who had CD4 counts of at least 500 cells per μL and people with no known immunosuppression had higher immunogenicity than did people with HIV with CD4 counts less than 500 cells per μL. No serious adverse reactions were reported during the study. Interpretation Immunogenicity following CoronaVac in people with HIV seems strong but reduced compared with people with no known immunosuppression. Our findings highlight the need for strategies to improve vaccine immunogenicity in people with HIV. Funding Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), and B3—Bolsa de Valores do Brasil.
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Tozetto-Mendoza TR, Ibrahim KY, Tateno AF, Oliveira CM, Sumita LM, Sanchez MC, Luna EJ, Pierrotti LC, Drexler JF, Braz-Silva PH, Pannuti CS, Romano CM. A50 Genotypic distribution of HHV-8 in aids individuals without and with Kaposi sarcoma. Virus Evol 2018. [PMCID: PMC5905436 DOI: 10.1093/ve/vey010.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- T R Tozetto-Mendoza
- Laboratory of Virology, Institute of Tropical Medicine, Universidade de Sao Paulo, Brazil
| | - K Y Ibrahim
- Department of Infectious Diseases, Clinics Hospital of the School of Medicine, Universidade de Sao Paulo, Brazil
| | - A F Tateno
- Laboratory of Virology, Institute of Tropical Medicine, Universidade de Sao Paulo, Brazil
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany Centre for Infection Research (DZIF), Partner Site, BonnCologne, Germany
| | - C M Oliveira
- Laboratory of Virology, Institute of Tropical Medicine, Universidade de Sao Paulo, Brazil
| | - L M Sumita
- Laboratory of Virology, Institute of Tropical Medicine, Universidade de Sao Paulo, Brazil
| | - M C Sanchez
- Laboratory of Virology, Institute of Tropical Medicine, Universidade de Sao Paulo, Brazil
| | - E J Luna
- Laboratory of Virology, Institute of Tropical Medicine, Universidade de Sao Paulo, Brazil
| | - L C Pierrotti
- Laboratory of Virology, Institute of Tropical Medicine, Universidade de Sao Paulo, Brazil
| | - J F Drexler
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany Centre for Infection Research (DZIF), Partner Site, BonnCologne, Germany
| | - P H Braz-Silva
- Department of Pathology, School of Dentistry, University of São Paulo, Brazil
| | - C S Pannuti
- Laboratory of Virology, Institute of Tropical Medicine, Universidade de Sao Paulo, Brazil
| | - C M Romano
- Laboratory of Virology, Institute of Tropical Medicine, Universidade de Sao Paulo, Brazil
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Romi RP, Freire M, Bittencourt DP, Bonazzi PR, Hatanaka VM, Ibrahim KY, Diz MDPE, Hoff PM, Abdala E, Pierrotti LC. Does the Gram-negative Bacteria Colonization Impact on the Risk of Develop Infection by Those Organisms During Neutropenia? Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Freire MP, de Oliveira Garcia D, Garcia CP, Campagnari Bueno MF, Camargo CH, Kono Magri ASG, Francisco GR, Reghini R, Vieira MF, Ibrahim KY, Rossi F, Hajjar L, Levin AS, Hoff PM, Pierrotti LC, Abdala E. Bloodstream infection caused by extensively drug-resistant Acinetobacter baumannii in cancer patients: high mortality associated with delayed treatment rather than with the degree of neutropenia. Clin Microbiol Infect 2015; 22:352-358. [PMID: 26711434 DOI: 10.1016/j.cmi.2015.12.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 11/30/2022]
Abstract
This study aimed to describe severe infections with extensively drug-resistant Acinetobacter baumannii-calcoaceticus complex (XDR-ABC), as well as to investigate risk factors for mortality, in cancer patients. It was a retrospective study including all patients diagnosed with XDR-ABC bacteraemia during hospitalization in the intensive care unit of a cancer hospital between July 2009 and July 2013. Surveillance cultures were collected weekly during the study period, and clonality was analysed using pulsed field gel electrophoresis (PFGE). We analysed underlying diseases, oncology therapy, neutrophil counts, infection site and management of infection, in terms of their correlation with 30-day mortality. During the study period, 92 patients with XDR-ABC bacteraemia were identified, of whom 35 (38.0%) were patients with haematological malignancy. We identified XDR-ABC strains with four different profile patterns, 91.3% of patients harbouring the predominant PFGE type. Of the 92 patients with XDR-ABC bacteraemia, 66 (71.7%) had central line-associated bloodstream infections; infection occurred during neutropenia in 22 (23.9%); and 58 (63.0%) died before receiving the appropriate therapy. All patients were treated with polymyxin, which was used in combination therapy in 30 of them (32.4%). The 30-day mortality rate was 83.7%. Multivariate analysis revealed that septic shock at diagnosis of XDR-ABC infection was a risk factor for 30-day mortality; protective factors were receiving appropriate therapy and invasive device removal within the first 48 h. Among cancer patients, ineffective management of such infection increases the risk of death, more so than do features such as neutropenia and infection at the tumour site.
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Affiliation(s)
- M P Freire
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | | | - C P Garcia
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - C H Camargo
- Bacteriology Centre, Adolfo Lutz Institute, São Paulo, Brazil
| | - A S G Kono Magri
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - G R Francisco
- Bacteriology Centre, Adolfo Lutz Institute, São Paulo, Brazil
| | - R Reghini
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - M F Vieira
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - K Y Ibrahim
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - F Rossi
- Microbiology Section, Central Laboratory, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - L Hajjar
- Intensive Care Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - A S Levin
- Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil
| | - P M Hoff
- Department of Oncology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - L C Pierrotti
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil
| | - E Abdala
- Hospital Infection Control and Infectious Diseases Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil
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de Almeida Júnior JN, Ibrahim KY, Del Negro GMB, Bezerra ED, Duarte Neto AN, Batista MV, Siciliano RF, Giudice MC, Motta AL, Rossi F, Pierrotti LC, Freire MP, Bellesso M, Pereira J, Abdala E, Benard G. Rhizopus arrhizus and Fusarium solani Concomitant Infection in an Immunocompromised Host. Mycopathologia 2015; 181:125-9. [PMID: 26346377 DOI: 10.1007/s11046-015-9936-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022]
Abstract
Neutropenic patients are at risk of the development of hyalohyphomycosis and mucormycosis. Correct identification is essential for the initiation of the specific treatment, but concomitant mold infections are rarely reported. We report one unprecedented case of concomitant mucormycosis and fusariosis in a neutropenic patient with acute myeloid leukemia. The patient developed rhino-orbital infection by Rhizopus arrhizus and disseminated infection by Fusarium solani. The first culture from a sinus biopsy grew Rhizopus, which was consistent with the histopathology report of mucormycosis. A second sinus biopsy collected later during the patient's clinical deterioration was reported as hyalohyphomycosis, and the culture yielded F. solani. Due to the discordant reports, the second biopsy was reviewed and two hyphae types suggestive of both hyalohyphomycetes and mucormycetes were found. The dual mold infection was confirmed by PCR assays from paraffinized tissue sections. Increased awareness of the existence of dual mold infections in at-risk patients is necessary. PCR methods in tissue sections may increase the diagnosis of dual mold infections. In case of sequential biopsies showing discrepant results, mixed infections have to be suspected.
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Affiliation(s)
- João N de Almeida Júnior
- Laboratory of Medical Mycology (LIM-53), Division of Dermatology Clinic, Hospital das Clínicas da FMUSP and Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil. .,Central Laboratory Division (LIM-03), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Cerqueira César, São Paulo, 05403-000, Brazil.
| | - Karim Y Ibrahim
- Infection Control Division, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Gilda M B Del Negro
- Laboratory of Medical Mycology (LIM-53), Division of Dermatology Clinic, Hospital das Clínicas da FMUSP and Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Evandro D Bezerra
- Hemathology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Amaro N Duarte Neto
- Pathology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marjorie V Batista
- Infectious Diseases Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rinaldo F Siciliano
- Cardiology Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Mauro C Giudice
- Laboratory of Medical Mycology (LIM-53), Division of Dermatology Clinic, Hospital das Clínicas da FMUSP and Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Adriana L Motta
- Central Laboratory Division (LIM-03), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Cerqueira César, São Paulo, 05403-000, Brazil
| | - Flávia Rossi
- Central Laboratory Division (LIM-03), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Cerqueira César, São Paulo, 05403-000, Brazil
| | - Ligia C Pierrotti
- Infection Control Division, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maristela P Freire
- Infection Control Division, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Bellesso
- Hemathology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Juliana Pereira
- Hemathology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Edson Abdala
- Infection Control Division, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Infectious Diseases Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Gil Benard
- Laboratory of Medical Mycology (LIM-53), Division of Dermatology Clinic, Hospital das Clínicas da FMUSP and Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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Freire MP, Pierrotti LC, Zerati AE, Araújo PHXN, Motta-Leal-Filho JM, Duarte LPG, Ibrahim KY, Souza AAL, Diz MPE, Pereira J, Hoff PM, Abdala E. Infection related to implantable central venous access devices in cancer patients: epidemiology and risk factors. Infect Control Hosp Epidemiol 2013; 34:671-7. [PMID: 23739070 DOI: 10.1086/671006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the epidemiology of infections related to the use of implantable central venous access devices (CVADs) in cancer patients and to evaluate measures aimed at reducing the rates of such infections. DESIGN Prospective cohort study. SETTING Referral hospital for cancer in São Paulo, Brazil. PATIENTS We prospectively evaluated all implantable CVADs employed between January 2009 and December 2011. Inpatients and outpatients were followed until catheter removal, transfer to another facility, or death. METHODS Outcome measures were bloodstream infection and pocket infection. We also evaluated the effects that the creation of a multidisciplinary team for CVAD care, avoiding in-hospital implantation of CVADs, and limiting CVAD insertion in neutropenic patients have on the rates of such infections. RESULTS During the study period, 966 CVADs (mostly venous ports) were implanted in 933 patients, for a combined total of 243,792 catheter-days. We identified 184 episodes of infection: 154 (84%) were bloodstream infections, 21 (11%) were pocket infections, and 9 (5%) were surgical site infections. During the study period, the rate of CVAD-related infection dropped from 2.2 to 0.24 per 1,000 catheter-days ([Formula: see text]). Multivariate analysis revealed that relevant risk factors for such infection include surgical reintervention, implantation in a neutropenic patient, in-hospital implantation, use of a cuffed catheter, and nonchemotherapy indication for catheter use. CONCLUSIONS Establishing a multidisciplinary team specifically focused on CVAD care, together with systematic reporting of infections, appears to reduce the rates of infection related to the use of these devices.
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Affiliation(s)
- Maristela P Freire
- Infection Control Service, Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
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9
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Abdala E, Costa SF, Strabelli TMV, Pierrotti LC, Caramori ML, Azevedo LSFD, Ibrahim KY, Dulley FL, Varkulja GF, Castro Junior GD, Almeida GMDD, Marques HHDS, Shikanai-Yasuda MA. Prophylaxis of fungal infections in transplant patients. Clinics (Sao Paulo) 2012; 67:681-4. [PMID: 22760912 PMCID: PMC3370325 DOI: 10.6061/clinics/2012(06)23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Edson Abdala
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Sartori AMC, Ibrahim KY, Nunes Westphalen EV, Braz LMA, Oliveira OC, Gakiya E, Lopes MH, Shikanai-Yasuda MA. Manifestations of Chagas disease (American trypanosomiasis) in patients with HIV/AIDS. Ann Trop Med Parasitol 2007; 101:31-50. [PMID: 17244408 DOI: 10.1179/136485907x154629] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Between June 1989 and December 2005, an observational study of adults co-infected with HIV and Trypanosoma cruzi was conducted, to investigate the spectrum of manifestations of chronic Chagas disease (American trypanosomiasis) in the HIV-positive. The 31 men and 22 women investigated were aged 23-59 years. Each subject was investigated by ambulatory (Holter) and non-ambulatory electrocardiography, chest X-ray, oesophagography and echocardiography (to determine the clinical form of trypanosomiasis), by xenodiagnosis, blood culture and the microscopical examination of blood (to explore their T. cruzi parasitaemia), and by counting their CD4 T cells (to stage their HIV infection). The subjects were followed-up for 1-190 months (median = 58 months) and checked for re-activation of their Chagas disease, which was usually defined by the occurrence of unusual clinical manifestations and/or the detection, by microscopical examination, of trypanosomes in the blood or cerebrospinal fluid. Eleven (20.8%) of the subjects showed re-activation, another nine (17.0%) were found to have developed high T. cruzi parasitaemias but these were only detected by xenodiagnosis or culture, and 15 (28.3%) had illnesses typical of chronic Chagas disease in HIV-negative individuals, with low parasitaemias. Anti-T. cruzi therapy (benznidazole), recommended for 17 patients, resulted in the sustained reduction of parasitaemia in 11 of the 12 subjects who completed treatment. Chagas disease was the cause of death of eight of the 14 subjects who died during the study. Four of the women investigated gave birth, each to a single child, during follow-up, and three of the four babies showed evidence of the congenital transmission of T. cruzi.
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Affiliation(s)
- A M C Sartori
- AIDS Clinic and Clinic of Infectious and Parasitic Diseases, Hospital das Clinicas, University of São Paulo School of Medicine, Rua Frei Caneca 557, São Paulo, SP, 01307 001, Brazil.
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Yasuda MAS, de Freitas VLT, Ibrahim KY, Furuchó C. [Laboratory diagnosis of Chagas disease in the immunocompromised]. Rev Soc Bras Med Trop 2006; 39 Suppl 3:110-1. [PMID: 17605217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Affiliation(s)
- Maria Aparecida Shikanai Yasuda
- Depto. Moléstias Infecciosas e Parasitárias da Faculdade de Medicina da USP, Laboratório de Imunologia (LIM 48) e Ambulatório de Doença de Chagas do Hospital das Clínicas da Faculdade de Medicina da USP
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