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Palmeiro AG, Peres S, Mansinho K, Sabino R, Veríssimo C, Toscano C, Viana I. Asymptomatic Leg Ulcer in a HIV-2+ Veteran: Challenge. Am J Dermatopathol 2024; 46:e3-e4. [PMID: 38086092 DOI: 10.1097/dad.0000000000002511] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
| | - Susana Peres
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Kamal Mansinho
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - R Sabino
- Mycology Laboratory, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal; and
| | - C Veríssimo
- Mycology Laboratory, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal; and
| | - C Toscano
- Molecular Biology and Clinical Microbiology Laboratory, Hospital Egas Moniz, Lisboa, Portugal
| | - Isabel Viana
- Dermatology Department, Hospital Egas Moniz, Lisboa, Portugal
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Palmeiro AG, Peres S, Mansinho K, Sabino R, Veríssimo C, Toscano C, Viana I. Asymptomatic Leg Ulcer in a HIV-2+ Veteran: Answer. Am J Dermatopathol 2024; 46:62-63. [PMID: 38086088 DOI: 10.1097/dad.0000000000002512] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
| | - Susana Peres
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Kamal Mansinho
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Raquel Sabino
- Mycology Laboratory, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal; and
| | - Cristina Veríssimo
- Mycology Laboratory, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal; and
| | - Cristina Toscano
- Molecular Biology and Clinical Microbiology Laboratory, Hospital Egas Moniz, Lisboa, Portugal
| | - Isabel Viana
- Dermatology Department, Hospital Egas Moniz, Lisboa, Portugal
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Pacheco P, Marques N, Rodrigues P, Mansinho K, Maltez F, Janeiro N, Franco C, Trigo D, Batista J, Duque L, Lopes MJ, Aleixo MJ, Silva AR, Tavares R, Alves J, Peres S, Póvoas D, Lino S, Gomes P, Araújo V, Lopes C. Safety and Efficacy of Triple Therapy With Dolutegravir Plus 2 Nucleoside Reverse Transcriptase Inhibitors in Treatment-Naive Human Immunodeficiency Virus Type 2 Patients: Results From a 48-Week Phase 2 Study. Clin Infect Dis 2023; 77:740-748. [PMID: 37288954 DOI: 10.1093/cid/ciad339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Integrase strand transfer inhibitor-based regimens are recommended for first-line therapy in human immunodeficiency virus type 2 (HIV-2). Nonetheless, dolutegravir (DTG) clinical trial data are lacking. METHODS We conducted a phase 2, single-arm, open-label trial to evaluate the safety and efficacy of a triple therapy regimen that included DTG in persons with HIV-2 (PWHIV-2) in Portugal. Treatment-naive adults receive DTG in combination with 2 nucleoside reverse transcriptase inhibitors (NRTIs). Treatment efficacy was evaluated by the proportion of patients who achieved a plasma viral load (pVL) <40 copies/mL and/or by the change from baseline in CD4+ T-cell count and in CD4/CD8 ratio at week 48. RESULTS A total of 30 patients were enrolled (22 women; median age, 55 years). At baseline, 17 (56.7%) individuals were viremic (median, pVL 190 copies/mL; interquartile range [IQR], 99-445). The median CD4 count was 438 cells/μL (IQR, 335-605), and the CD4/CD8 ratio was 0.8. Three patients discontinued the study. At week 48, all participants (27) had pVL <40 copies/mL. No virological failures were observed. Mean changes in CD4 count and CD4/CD8 ratio at week 48 were 95.59 cells/µL (95% confidence interval [CI], 28-163) and 0.32 (95% CI, .19 to .46). The most common drug-related adverse events were headache and nausea. One participant discontinued due to central nervous system symptoms. No serious adverse events were reported. CONCLUSIONS DTG plus 2 NRTIs is safe and effective as first-line treatment for PWHIV-2 with a tolerability profile previously known. No virological failures were observed that suggest a high potency of DTG in HIV-2 as occurs in HIV-1. CLINICAL TRIALS REGISTRATION M NCT03224338.
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Affiliation(s)
- Patrícia Pacheco
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Nuno Marques
- Infectious Diseases Department, Hospital Garcia de Orta, Almada, Portugal
| | - Paulo Rodrigues
- Infectious Diseases Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Kamal Mansinho
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Fernando Maltez
- Infectious Diseases Department, Hospital Curry Cabral, Lisboa, Portugal
| | - Nuno Janeiro
- Infectious Diseases Department, Hospital Santa Maria, Lisboa, Portugal
| | - Cláudia Franco
- Infectious Diseases Department, Hospital Santa Maria, Lisboa, Portugal
| | - Diva Trigo
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Joana Batista
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Luís Duque
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Maria João Lopes
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Maria João Aleixo
- Infectious Diseases Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Rita Silva
- Infectious Diseases Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Raquel Tavares
- Infectious Diseases Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - João Alves
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Susana Peres
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Diana Póvoas
- Infectious Diseases Department, Hospital Curry Cabral, Lisboa, Portugal
| | - Sara Lino
- Infectious Diseases Department, Hospital Curry Cabral, Lisboa, Portugal
| | - Perpétua Gomes
- Molecular Biology Laboratory, Hospital Egas Moniz, Lisboa, Portugal
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Garça M, Domingos J, Peres S. Pneumocystis jirovecii pneumonia following corticosteroid therapy. Rev Soc Bras Med Trop 2023; 56:e0553. [PMID: 36820664 PMCID: PMC9957118 DOI: 10.1590/0037-8682-0553-2022] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/01/2022] [Indexed: 02/22/2023] Open
Affiliation(s)
- Magda Garça
- Hospital de Santo Espírito da Ilha Terceira, Serviço de Medicina Interna, Açores, Portugal
| | - João Domingos
- Centro Hospitalar Lisboa Ocidental, Serviço de Infeciologia e Medicina Tropical do Hospital Egas Moniz, Lisboa, Portugal
| | - Susana Peres
- Centro Hospitalar Lisboa Ocidental, Serviço de Infeciologia e Medicina Tropical do Hospital Egas Moniz, Lisboa, Portugal
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Neto A, Lopes C, Vasconcelos J, Mourão AF, Costa M, de Sousa R, Peres S, Branco JC. Arthritis in cat scratch disease: an unusual manifestation. ARP Rheumatol 2022; 1:98-99. [PMID: 35633583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Cat scratch disease (CSD) is a zoonosis caused by Bartonella henselae, which is usually transmitted to humans through scratches or bites from infected cats. It is primarily a disease of children and adolescents, although it can affect individuals of any age. In approximately 10% of cases, patients can present atypical manifestations that may involve the musculoskeletal system. Herein, we report a case of a healthy 51-year-old man that developed low-grade fever and regional lymphadenopathy, followed by erythema nodosum and oligoarthritis. He had been scratched and bitten by his cat before the onset of symptoms. The diagnosis was confirmed serologically by the presence of high titers of specific IgG antibodies. Bartonella henselae was also detected in the blood of the owner's cat by PCR and DNA sequencing.
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Affiliation(s)
- Agna Neto
- Rheumatology Department, Hospital Central do Funchal, Madeira, Portugal; Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School
| | - Carina Lopes
- Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School
| | - Joana Vasconcelos
- Department of Infectious Diseases and Tropical Medicine, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Filipa Mourão
- Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School
| | - Manuela Costa
- Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School
| | - Rita de Sousa
- Centro de Estudos de Vectores e Doenças Infecciosas, National Institute of Health Dr. Ricardo Jorge, Águas de Moura, Portugal
| | - Susana Peres
- Department of Infectious Diseases and Tropical Medicine, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Jaime Cunha Branco
- Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School
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Santos A, Sousa LLD, Calça R, Lima A, Nascimento C, Jorge C, Adragão T, Bruges M, Peres S, Weigert A. SARS-CoV-2 infection in kidney transplant recipients: clinical impact and outcomes - a single center experience. J Bras Nefrol 2021; 44:376-382. [PMID: 34812470 PMCID: PMC9518613 DOI: 10.1590/2175-8239-jbn-2021-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Kidney transplant recipients are a subgroup of patients at higher risk of critical forms of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection and poor outcomes due to immunosuppression treatment. Herein, we present data from a single center cohort of kidney transplant recipients with SARS-CoV-2 infection. Methods: In a prospective study, baseline characteristics, clinical features, antiviral and immunosuppression management were compared between outpatients and hospitalized patients, during a one-year period. Results: Seventy-seven kidney transplant recipients were analyzed, including outpatients and hospitalized patients, with a median age of 57.7 (IQR 49.7-64.9) years. Twenty-eight (36.4%) were managed as outpatients, while 49 (63.6%) patients required hospital admission. Among hospitalized patients, 18.4% were admitted in ICU, 49% had AKI, and 20.4% died. Immunosuppression adjustments were performed in 95.9% of hospitalized patients, with dose of anti-metabolites adjusted in 83.7%, mTOR inhibitors in 14.3%, calcineurin inhibitors in 12.2%, and corticosteroid therapy in 81.6%. Conclusion: Among hospitalized patients, immunosuppression management included reduction or withdrawal of anti-metabolite and increase of corticosteroid dose. AKI occurred in almost half of patients and mortality in hospitalized patients reached 20%, reflecting greater disease severity than the general population.
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Affiliation(s)
- Afonso Santos
- Hospital Professor Fernando da Fonseca, Departamento de Nefrologia, Amadora, Portugal
| | - Luís Leite de Sousa
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Departamento de Nefrologia, Lisboa, Portugal
| | - Rita Calça
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Departamento de Nefrologia, Lisboa, Portugal
| | - Anna Lima
- Hospital Professor Fernando da Fonseca, Departamento de Nefrologia, Amadora, Portugal
| | - Célia Nascimento
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Departamento de Nefrologia, Lisboa, Portugal
| | - Cristina Jorge
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Departamento de Nefrologia, Lisboa, Portugal
| | - Teresa Adragão
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Departamento de Nefrologia, Lisboa, Portugal
| | - Margarida Bruges
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Departamento de Nefrologia, Lisboa, Portugal
| | - Susana Peres
- Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Departamento de Doenças Infecciosas, Lisboa, Portugal
| | - André Weigert
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Departamento de Nefrologia, Lisboa, Portugal
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Miranda AC, Miranda M, Pingarilho M, Pimentel V, Torres J, Peres S, Baptista Alberto T, Gomes P, Abecasis A, Mansinho K. Determinants of HIV-1 Late Presentation in a Cohort of Portuguese HIV-1 Patients. AIDS Res Hum Retroviruses 2021; 37:846-851. [PMID: 33461392 DOI: 10.1089/aid.2020.0175] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Undiagnosed HIV-1 patients still account for 25% of worldwide HIV patients. Studying late presenters (LPs) for HIV care may help to identify characteristics of such patients. The present study aims to identify factors associated with late presentation and late presentation with advanced disease based on a population of patients followed in a Portuguese hospital between 1984 and 2017. Sociodemographic and clinical data from infected patients with HIV-1 aged 18 years and older, followed in Egas Moniz Hospital, in Portugal were collected. Of the 907 patients included in this study, 68.7% were males and the median age was 37 years (interquartile range 30-47). Four hundred fifty-nine patients (50.6%) were LP and, of these, 284 patients (61.9%) were LPAD. The LP population mostly originated from Portugal and sub-Saharan Africa (64.4% and 28.8%; p = .004) and the HIV exposure category, mainly heterosexuals and men have sex with men (57.0% and 24.9%; p < .001). The stage of disease and viral load at diagnosis were significantly associated with both LP and LPAD (p < .001). Factors associated with LP in the logistic regression included age at diagnosis lower than 30 years (adjusted odds ratio [aOR] 0.34; 0.17-0.68; p = .002) and origin from sub-Saharan Africa (aOR 2.24; 1.44-3.50; p < .001). Late presentation is a major obstacle to halt the HIV epidemic. In this population, the majority of newly diagnosed HIV-infected individuals were LPs. Our results characterize vulnerable populations that should be frequently tested for HIV.
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Affiliation(s)
- Ana Cláudia Miranda
- Department of Infectious Diseases, Hospital Center Lisboa Ocidental, Egas Moniz Hospital, Lisbon, Portugal
| | - Mafalda Miranda
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine/New University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Marta Pingarilho
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine/New University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Victor Pimentel
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine/New University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - João Torres
- Department of Infectious Diseases, Hospital Center Lisboa Ocidental, Egas Moniz Hospital, Lisbon, Portugal
| | - Susana Peres
- Department of Infectious Diseases, Hospital Center Lisboa Ocidental, Egas Moniz Hospital, Lisbon, Portugal
| | - Teresa Baptista Alberto
- Department of Infectious Diseases, Hospital Center Lisboa Ocidental, Egas Moniz Hospital, Lisbon, Portugal
| | - Perpetua Gomes
- Laboratory of Molecular Biology (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal
- Egas Moniz Interdisciplinary Research Center (CiiEM), Egas Moniz University Institute, Caparica, Portugal
| | - Ana Abecasis
- Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine/New University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Kamal Mansinho
- Department of Infectious Diseases, Hospital Center Lisboa Ocidental, Egas Moniz Hospital, Lisbon, Portugal
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Neves MT, de Matos LV, Vasques AC, Sousa IE, Ferreira I, Peres S, Jesus S, Fonseca C, Mansinho K. COVID-19 and aging: Identifying measures of severity. SAGE Open Med 2021; 9:20503121211027462. [PMID: 34249362 PMCID: PMC8239978 DOI: 10.1177/20503121211027462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 12/16/2020] [Accepted: 06/03/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION We aimed to compare clinical features of older age group and young and middle-aged patients with COVID-19 and analyze mortality predictors. METHODS Retrospective analysis of ongoing collection of prespecified data, on a single institution, including patients hospitalized consecutively due to COVID-19 infection, from March to June 2020. RESULTS Of 195 patients, 56.9% were ⩾65 years (older age group). Older age group had multimorbidity (p < 0.001). At admission Early Warning Score-2 (p < 0.001), C-reactive protein, D-dimer, creatinine, anemia and lymphopenia were higher in older age group, as well as median time of hospitalization (14 vs 10 days, p = 0.004). Complications were more common in older age group, but there were no significant differences in admission to intensive care. There were 18 deaths, 16 in older age group. Modified Early Warning Score at admission (odds ratio = 1.60, 95% confidence interval = 1.07-1.37, p = 0.021) and C-reactive protein >5 mg/dL (odds ratio = 2.12, 95% confidence interval = 1.13-26.26, p = 0.034) were independent predictors of inhospital mortality in older age group but not in young and middle-aged. CONCLUSION Older age group was at higher risk for complications and inhospital mortality. Identification of specific scores of severity for this population is essential to ensure that best care is provided.
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Affiliation(s)
- Maria Teresa Neves
- Department of Medical Oncology Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Leonor Vasconcelos de Matos
- Department of Medical Oncology Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Ana Carolina Vasques
- Department of Medical Oncology Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Inês Egídio Sousa
- Department of Internal Medicine, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Inês Ferreira
- Department of Internal Medicine, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Susana Peres
- Department of Infectious Diseases, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Susana Jesus
- Department of Internal Medicine, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Cândida Fonseca
- Department of Internal Medicine, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Kamal Mansinho
- Department of Infectious Diseases, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
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Monteiro NF, Peres S, Mansinho K. Non-Tuberculous Mycobacteria: Seven-Year Experience of a Tertiary Hospital. ACTA MEDICA PORT 2019; 32:208-213. [PMID: 30946792 DOI: 10.20344/amp.10932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/14/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Non-tuberculous mycobacteria are ubiquitous organisms. Precise determination of infection numbers is difficult, since reporting them to public health departments is frequently not mandatory; furthermore, isolating a non-tuberculous mycobacteria does not necessarily translate into disease. The aims of this study were to ascertain non-tuberculous mycobacteria data of a tertiary hospital, determine the incidence and approach to colonization versus disease, and the incidence of predisposing comorbidities. MATERIAL AND METHODS Retrospective study in a tertiary hospital, involving patients with positive cultural exam for non-tuberculous mycobacteria in any biological sample, from 2010 to 2017. RESULTS A total of 125 non-tuberculous mycobacteria isolates was identified, corresponding to 96 patients. Of these, 57.4% were male (n = 54); median age was 65 years (interquartile range = [50 - 82]). From these, 60.7% (n = 57) had some degree of immunosuppression, most frequently due to malignant tumour (49.0%) or HIV infection (39.2%). It was found that 29 patients (31.0%) had structural respiratory tract changes. Colonization was defined in 65.6% of patients (n = 63). While 71.0% of non-tuberculous mycobacteria infections were pulmonary, the remaining 29.0% presented as disseminated. According to available clinical records, 60.6% (n = 20) of the presumably infected patients fulfilled American Thoracic Society diagnostic criteria for non-tuberculous mycobacteria disease. DISCUSSION Several cases of non-tuberculous mycobacteria infection in this study presented as life-threatening, multi-systemic disease, highlighting the importance of accurate diagnosis and timely treatment. Other cases of presumed infection might instead have corresponded to colonization, possibly resulting in futile therapy. CONCLUSION While there are diagnostic criteria for treatment of non-tuberculous mycobacteria infections, no such guidelines exist to assess colonization. One of the most challenging aspects remains the correct differentiation between colonization and early-stage infection.
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Affiliation(s)
- Nuno Ferreira Monteiro
- Department of Internal Medicine II. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisbon. Portugal
| | - Susana Peres
- Department of Infectious Diseases. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisbon. Portugal
| | - Kamal Mansinho
- Department of Infectious Diseases. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisbon. Portugal
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Alves J, Peres S, Gonçalves E, Mansinho K. [Anaerobic Bacteria with Clinical Relevance: Morphologic and Taxonomic Classification, Distribution among Human Microbiota and Microbiologic Diagnosis]. ACTA MEDICA PORT 2017; 30:409-417. [PMID: 28865506 DOI: 10.20344/amp.8098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 03/02/2017] [Indexed: 11/20/2022]
Abstract
The wide burden of anaerobic bacteria colonizing human body comprises about 90% of its total biomass. The biotic relationship between humans and its microbiota sets reciprocal benefits, albeit with pathogenic potencial for the human being in particular dysbiosis situations. Infections adjacent to or originating from the skin or mucous membranes of the intestinal, genitourinary and upper respiratory tracts are often polymicrobial in nature, whereby should anaerobes be invariably included in the etiological differential diagnosis of these conditions. Gram negative bacilli such as Bacteroides fragilis group, Fusobacterium spp., Porphyromonas spp., Prevotella spp. and Gram positive cocci such as Peptostreptococcus spp. stand out for their high virulence and frequence of isolation in suppurative infections and abcesses with metastatic or contiguous relation to human microbiota. The fastidious nature of anaerobic bacteria, especially of less aerotolerant species, compels to particular techniques of sample collection, transport and cultural isolation that challenge clinicians and microbiologists for a full efficient practice. Such requirements bring on a poor identification of anaerobic bacteria in the clinical practice and undervaluation of its aetiopathogenic potential amongst common polymicrobial infections. An approach over microbial flora's composition in the different human anatomical sites is a primary goal of the present article. Clinicians are intended to recognize the variability and proportion of likely involved anaerobic microorganisms in certain infectious processes related to human microbiota, in order to optimize samples processing and the establishment of an appropriate empirical antibiotic therapy, mindful of anaerobic coverage and according to known susceptibility profiles.
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Affiliation(s)
- João Alves
- Serviço de Infeciologia e Medicina Tropical. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Susana Peres
- Unidade Curricular de Especialidades Médico-Cirúrgicas. Clínica de Doenças Infecciosas e Parasitárias. Faculdade de Ciências Médicas. Universidade Nova de Lisboa. Lisboa. Portugal
| | - Elsa Gonçalves
- Unidade de Infeção: Etiologia, Patogénese e Bases Terapêuticas. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Kamal Mansinho
- Serviço de Infeciologia e Medicina Tropical. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal. Unidade de Infeção: Etiologia, Patogénese e Bases Terapêuticas. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
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Cochez C, Lootgieter R, Peres S, Rubenstrunk A, Prudhomme C, Carru V, Azar R. Faisabilité et bénéfices de l’activité physique adaptée (APA) perdialytique chez les patients hémodialysés. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.066] [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: 11/16/2022]
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Willemin MC, Fry S, Peres S, Wallaert B, Mallart A. [Effects of an educational program in non-adherent apneic patients treated with continuous positive airway pressure]. Rev Pneumol Clin 2013; 69:70-75. [PMID: 23489473 DOI: 10.1016/j.pneumo.2012.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 12/19/2012] [Accepted: 12/25/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Obstructive Sleep Apnea (OSA) is a chronic, frequent pathology impacting patients' quality of life. Continuous positive airways pressure (CPAP) is the most effective treatment, but is often considered binding and thus poorly observed. The aim of this study was to assess the impact of an educational program in non-adherent patients with OSA, to identify the factors of inobservance and to determine risk groups. PATIENTS AND METHODS We enrolled 21 patients presenting OSA in this monocentric, forward-looking study. Nineteen patients completed the study. The inclusion criterion was a daily observance less than 4 hours a night. Educational program was realized by a specialized, trained team, with the authorization of the Regional Agency of Health. RESULTS Our population consisted of 15 male and six female, all of them obese, with a medium age of 57.7 ± 12.9 years, treated for 10,7 ± 15 months. All of our patients had few symptoms. After the educational program, two groups were individualized according to their observance. Fifty-two percent of patients became compliant to CPAP treatment. Demographic data and medical histories did not differ between these two groups: nine patients remained inobservant (medium daily treatment duration of 57 ± 49 minutes); ten patients became observant (medium daily treatment duration raising from 104 ± 70 minutes to 322 ± 65 minutes, P=0.0002). Among these ten patients, seven were considered as having accepted their disease at initial educational diagnosis. CONCLUSION The educational program improved adherence to CPAP treatment in 52% of our patients. All included patients had few symptoms. This could raise the issue of a poorer perception of treatment efficacy in less symptomatic patients. Disease acceptance also appeared linked to CPAP treatment compliance.
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Affiliation(s)
- M-C Willemin
- Service de Pneumologie et Immuno-Allergologie, Université de Lille-2, Clinique des Maladies Respiratoires, Hôpital A.-Calmette, 59037 Lille Cedex, France
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Willemin M, Fry S, Peres S, Wallaert B, Mallart A. Éducation thérapeutique des patients apnéiques inobservants sous pression positive continue. Rev Mal Respir 2013. [DOI: 10.1016/j.rmr.2012.10.515] [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: 11/25/2022]
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Vercauteren J, Theys K, Carvalho AP, Valadas E, Duque LM, Teófilo E, Faria T, Faria D, Vera J, Aguas MJ, Peres S, Mansinho K, Vandamme AM, Camacho RJ. The demise of multidrug-resistant HIV-1: the national time trend in Portugal. J Antimicrob Chemother 2012; 68:911-4. [PMID: 23228933 PMCID: PMC3594492 DOI: 10.1093/jac/dks470] [Citation(s) in RCA: 6] [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] [Indexed: 11/29/2022] Open
Abstract
Objectives Despite a decreasing mortality and morbidity in treated HIV-1 patients, highly active antiretroviral treatment (HAART) can still fail due to the development of drug resistance. Especially, multidrug-resistant viruses pose a threat to efficient therapy. We studied the changing prevalence of multidrug resistance (MDR) over time in a cohort of HIV-1-infected patients in Portugal. Patients and methods We used data of 8065 HIV-1-infected patients followed from July 2001 up to April 2012 in 22 hospitals located in Portugal. MDR at a specific date of sampling was defined as no more than one fully active drug (excluding integrase and entry inhibitors) at that time authorized by the Portuguese National Authority of Medicines and Health Products (INFARMED), as interpreted with the Rega algorithm version 8.0.2. A generalized linear mixed model was used to study the time trend of the prevalence of MDR. Results We observed a statistically significant decrease in the prevalence of MDR over the last decade, from 6.9% (95% CI: 5.7–8.4) in 2001–03, 6.0% (95% CI: 4.9–7.2) in 2003–05, 3.7% (95% CI: 2.8–4.8) in 2005–07 and 1.6% (95% CI: 1.1–2.2) in 2007–09 down to 0.6% (95% CI: 0.3–0.9) in 2009–12 [OR = 0.80 (95% CI: 0.75–0.86); P < 0.001]. In July 2011 the last new case of MDR was seen. Conclusions The prevalence of multidrug-resistant HIV-1 is decreasing over time in Portugal, reflecting the increasing efficiency of HAART and the availability of new drugs. Therefore, in designing a new drug, safety and practical aspects, e.g. less toxicity and ease of use, may need more attention than focusing mainly on efficacy against resistant strains.
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Affiliation(s)
- Jurgen Vercauteren
- Department of Microbiology and Immunology, Minderbroedersstraat 10, 3000 Leuven, KU Leuven, Leuven, Belgium.
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Laranjeira C, Fortuna A, Teixeira A, Teles N, Peres S. [Familial 18p syndrome -- a clinical case]. An Pediatr (Barc) 2008; 70:89-90. [PMID: 19174127 DOI: 10.1016/j.anpedi.2008.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2008] [Revised: 07/27/2008] [Accepted: 08/01/2008] [Indexed: 11/26/2022] Open
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Vercauteren J, Deforche K, Theys K, Debruyne M, Duque LM, Peres S, Carvalho AP, Mansinho K, Vandamme AM, Camacho R. The incidence of multidrug and full class resistance in HIV-1 infected patients is decreasing over time (2001-2006) in Portugal. Retrovirology 2008; 5:12. [PMID: 18241328 PMCID: PMC2265747 DOI: 10.1186/1742-4690-5-12] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [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: 11/01/2007] [Accepted: 02/01/2008] [Indexed: 11/20/2022] Open
Abstract
Despite improvements in HIV treatment, the prevalence of multidrug resistance and full class resistance is still reported to be increasing. However, to investigate whether current treatment strategies are still selecting for multidrug and full class resistance, the incidence, instead of the prevalence, is more informative. Temporal trends in multidrug resistance (MDR defined as at most 1 drug fully susceptible) and full class resistance (FCR defined as no drug in this class fully susceptible) in Portugal based on 3394 viral isolates genotyped from 2000 to 2006 were examined using the Rega 6.4.1 interpretation system. From July 2001 to July 2006 there was a significant decreasing trend of MDR with 5.7%, 5.2%, 3.8%, 3.4% and 2.7% for the consecutive years (P = 0.003). Multivariate analysis showed that for every consecutive year the odds of having a new MDR case decreased with 20% (P = 0.003). Furthermore, a decline was observed for NRTI- and PI-FCR (both P < 0.001), whereas for NNRTI-FCR a parabolic trend over time was seen (P < 0.001), with a maximum incidence in 2003–'04. Similar trends were obtained when scoring resistance for only one drug within a class or by using another interpretation system. In conclusion, the incidence of multidrug and full class resistance is decreasing over time in Portugal, with the exception of NNRTI full class resistance which showed an initial rise, but subsequently also a decline. This is most probably reflecting the changing drug prescription, the increasing efficiency of HAART and the improved management of HIV drug resistance. This work was presented in part at the Eighth International Congress on Drug Therapy in HIV Infection, Glasgow (UK), 12-16 November 2006 (PL5.5); and at the Fifth European HIV Drug Resistance Workshop, Cascais (Portugal), 28-30 March 2007 (Abstract 1).
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Bataille R, Robinet-Levy M, Barchechath-Flaisler F, Peres S, Aznar R, Sany J. Immunofixation improves the detection of monoclonal gammopathy of undetermined significance (M.G.U.S.) in patients with rheumatoid arthritis. Clin Exp Rheumatol 1987; 5:259-61. [PMID: 3123112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) was detected by immunofixation (IFX) in 6% of patients with rheumatoid arthritis (RA), whereas it was detected by immunoelectrophoresis in only 1% of these patients. Most of the patients with both RA and MGUS had polyclonal B cell activation, together with their monoclonal band, extra-articular features and long-lasting disease, which suggests a direct relationship between MGUS and RA status.
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Affiliation(s)
- R Bataille
- Consultation d'Immuno-Rhumatologie and Inserm U291, Centre Gui-de-Chauliac, Hôpital Saint-Eloi, Montpellier, France
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Vanetti A, Donzeau-Gouge GP, Peres S, Daumet P. [Aortic valve replacement in 34 surgical patients over 70 years old]. Arch Mal Coeur Vaiss 1980; 73:1103-9. [PMID: 6776929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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