- MeSH
- amfotericin B farmakologie terapeutické užití MeSH
- Aspergillus patogenita MeSH
- aspergilóza * diagnóza farmakoterapie MeSH
- debridement metody MeSH
- kazuistiky jako téma MeSH
- lidé MeSH
- mukormykóza * diagnóza farmakoterapie MeSH
- novorozenci extrémně nezralí * MeSH
- novorozenec MeSH
- Rhizopus patogenita MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
Pneumocystis pneumonia (PCP) is a life-threatening complication after allogeneic hematopoietic cell transplantation (allo-HCT). However, allo-HCT procedures have evolved toward older patients, unrelated donors, and reduced-intensity conditioning, possibly modifying the risks. Polymerase chain reaction (PCR), widely used nowadays, is more sensitive than microscopy diagnostic methods. This study aimed to assess the factors associated with PCP in allo-HCT recipients within 2 years of HCT and managed according to current procedures. This multicenter, nested case-control study included PCP cases diagnosed by PCR, cytology, or immunofluorescence on bronchoalveolar lavage fluid between 2016 and 2018. Two controls per case were selected from the ProMISe registry and matched for the center, transplant date, and underlying disease. Fifty-two cases and 104 controls were included among the 5452 patients who underwent allo-HCT in the participating centers. PCP occurred at a median of 11.5 months after transplantation. The mortality rate was 24% on day 30 after the PCP diagnosis and 37% on day 90. The clinical presentation and mortality rates of the 24 patients diagnosed using only PCR were not different from those diagnosed with microscopy methods. Our study demonstrates a substantial incidence of, and mortality from, PCP, after allogeneic HCT despite well-established prophylactic approaches. In our experience, PCP nowadays occurs later after transplant than previously reported, justifying the prolongation of prophylaxis after six months in many cases. Allo-HCT recipients diagnosed with PCR as the only PCP marker should benefit from specific treatment as for other patients.
- MeSH
- infekční nemoci * etiologie MeSH
- kostní dřeň MeSH
- lidé MeSH
- pneumocystová pneumonie * epidemiologie etiologie diagnóza MeSH
- rizikové faktory MeSH
- studie případů a kontrol MeSH
- transplantace hematopoetických kmenových buněk * škodlivé účinky metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Medically important pathogenic fungi invade vertebrate tissue and are considered primary when part of their nature life cycle is associated with an animal host and are usually able to infect immunocompetent hosts. Opportunistic fungal pathogens complete their life cycle in environmental habitats or occur as commensals within or on the vertebrate body, but under certain conditions can thrive upon infecting humans. The extent of host damage in opportunistic infections largely depends on the portal and modality of entry as well as on the host's immune and metabolic status. Diseases caused by primary pathogens and common opportunists, causing the top approximately 80% of fungal diseases [D. W. Denning, Lancet Infect Dis, 24:e428-e438, 2024, https://doi.org/10.1016/S1473-3099(23)00692-8], tend to follow a predictive pattern, while those by occasional opportunists are more variable. For this reason, it is recommended that diseases caused by primary pathogens and the common opportunists are named after the etiologic agent, for example, histoplasmosis and aspergillosis, while this should not be done for occasional opportunists that should be named as [causative fungus] [clinical syndrome], for example, Alternaria alternata cutaneous infection. The addition of a descriptor that identifies the location or clinical type of infection is required, as the general name alone may cover widely different clinical syndromes, for example, "rhinocerebral mucormycosis." A list of major recommended human and animal disease entities (nomenclature) is provided in alignment with their causative agents. Fungal disease names may encompass several genera of etiologic agents, consequently being less susceptible to taxonomic changes of the causative species, for example, mucormycosis covers numerous mucormycetous molds.
- MeSH
- houby * klasifikace patogenita MeSH
- lidé MeSH
- mykózy * mikrobiologie MeSH
- oportunní infekce mikrobiologie MeSH
- terminologie jako téma * MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
The current global scenario presents us with a growing increase in infections caused by fungi, referred to by specialists in the field as a "silent epidemic", aggravated by the limited pharmacological arsenal and increasing resistance to this therapy. For this reason, drug repositioning and therapeutic compound combinations are promising strategies to mitigate this serious problem. In this context, this study investigates the antifungal activity of the non-toxic, low-cost and widely available cationic polyelectrolyte Poly(diallyldimethylammonium chloride) (PDDA), in combination with different antifungal drugs: systemic (amphotericin B, AMB), topical (clioquinol, CLIO) and oral (nitroxoline, NTX). For each combination, different drug:PDDA ratios were tested and, through the broth microdilution technique, the minimum inhibitory concentration (MIC) of these drugs in the different ratios against clinically important Candida species strains was determined. Overall, PDDA combinations with the studied drugs demonstrated a significant increase in drug activity against most strains, reaching MIC reductions of up to 512 fold for the fluconazole resistant Candida krusei (Pichia kudriavzevii). In particular, the AMB-PDDA combination 1:99 was highly effective against AMB-resistant strains, demonstrating the excellent profile of PDDA as an adjuvant/association in novel antifungal formulations with outdated conventional drugs.
- MeSH
- amfotericin B farmakologie MeSH
- antifungální látky * farmakologie MeSH
- Candida * účinky léků MeSH
- fungální léková rezistence MeSH
- kandidóza mikrobiologie farmakoterapie MeSH
- kvartérní amoniové sloučeniny * farmakologie MeSH
- lidé MeSH
- mikrobiální testy citlivosti * MeSH
- Pichia MeSH
- polyelektrolyty farmakologie MeSH
- polyethyleny farmakologie chemie MeSH
- synergismus léků MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- HIV infekce komplikace MeSH
- infekce dýchací soustavy etiologie imunologie klasifikace komplikace MeSH
- lidé MeSH
- oportunní infekce * etiologie imunologie klasifikace komplikace MeSH
- pneumocystová pneumonie diagnóza etiologie farmakoterapie patologie MeSH
- respirační syncytiální viry patogenita MeSH
- transplantace plic škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Calcineurin-nuclear factor of activated T cells (CN-NFAT) inhibitors are widely clinically used drugs for immunosuppression, but besides their required T cell response inhibition, they also undesirably affect innate immune cells. Disruption of innate immune cell function can explain the observed susceptibility of CN-NFAT inhibitor-treated patients to opportunistic fungal infections. Neutrophils play an essential role in innate immunity as a defense against pathogens; however, the effect of CN-NFAT inhibitors on neutrophil function was poorly described. Thus, we tested the response of human neutrophils to opportunistic fungal pathogens, namely Candida albicans and Aspergillus fumigatus, in the presence of CN-NFAT inhibitors. Here, we report that the NFAT pathway members were expressed in neutrophils and mediated part of the neutrophil response to pathogens. Upon pathogen exposure, neutrophils underwent profound transcriptomic changes with subsequent production of effector molecules. Importantly, genes and proteins involved in the regulation of the immune response and chemotaxis, including the chemokines CCL2, CCL3, and CCL4 were significantly upregulated. The presence of CN-NFAT inhibitors attenuated the expression of these chemokines and impaired the ability of neutrophils to chemoattract other immune cells. Our results amend knowledge about the impact of CN-NFAT inhibition in human neutrophils.
- MeSH
- Aspergillus fumigatus imunologie MeSH
- Candida albicans imunologie MeSH
- chemotaxe MeSH
- kalcineurin * metabolismus MeSH
- lidé MeSH
- mykózy imunologie MeSH
- neutrofily * imunologie metabolismus MeSH
- signální transdukce * MeSH
- transkripční faktory NFATC * metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Súčasťou poskytovania ošetrovateľskej starostlivosti v rámci zabezpečenia hygieny u pacienta počas hospitalizácie je starostlivosť o ústnu dutinu geriatrického pacienta. Cieľom príspevku je poukázať práve na špecifiká starostlivosti o ústnu dutinu, kedy je nevyhnutné posúdenie stavu pier, chrupu, slizníc, zubov a ďasien. Zhodnotenie sebestačnosti, schopnosti a zručnosti seniora pri vykonávaní hygieny ústnej dutiny má tiež svoje významné miesto v starostlivosti o ústa seniora. Poznaním príčin vzniku prejavov komplikácií v ústnej dutine dokáže ošetrujúci poskytnúť kvalitnú ošetrovateľskú starostlivosť, predchádzať orálnym ochoreniam a zvládať možný výskyt komplikácií vyplývajúcich z celkových ochorení.
Part of the provision of nursing care as part of ensuring hygiene for the patient during hospitalization is the care of the oral cavity of the geriatric patient. The aim of the paper is to point out the specifics of oral care, when it is necessary to assess the condition of the lips, teeth, mucous membranes, teeth and gums. The evaluation of the senior’s self-sufficiency, ability and skills in performing oral hygiene also has an important place in the care of the senior’s mouth. By knowing the causes of complications in the oral cavity, the caregiver can provide quality nursing care, prevent oral diseases and manage the possible occurrence of complications resulting from general diseases.
- MeSH
- bulózní pemfigoid etiologie komplikace ošetřování prevence a kontrola terapie MeSH
- cheilitida etiologie komplikace ošetřování prevence a kontrola terapie MeSH
- geriatrické ošetřovatelství MeSH
- kandidóza etiologie komplikace ošetřování prevence a kontrola terapie MeSH
- leukoplakie etiologie komplikace ošetřování prevence a kontrola terapie MeSH
- nemoci jazyka etiologie komplikace ošetřování prevence a kontrola terapie MeSH
- nemoci úst etiologie komplikace ošetřování prevence a kontrola terapie MeSH
- orální hygiena MeSH
- orální zdraví MeSH
- senioři MeSH
- stomatitida etiologie komplikace ošetřování terapie MeSH
- ústní sliznice patologie MeSH
- Check Tag
- senioři MeSH
- Klíčová slova
- mykotická rinosinusitida,
- MeSH
- chronická nemoc MeSH
- mykózy chirurgie diagnostické zobrazování diagnóza farmakoterapie MeSH
- rinitida diagnóza epidemiologie etiologie mikrobiologie terapie MeSH
- sinusitida diagnóza epidemiologie etiologie mikrobiologie terapie MeSH
- Publikační typ
- kazuistiky MeSH
Invasive fungal disease (IFD) presents a life-threatening condition in immunocompromised patients, thus often prompting empirical administration of antifungal treatment, without adequate mycological evidence. Over the past years, wide use of antifungal prophylaxis resulted in decreased occurrence of IFD but has contributed to changes in the spectrum of fungal pathogens, revealing the occurrence of previously rare fungal genera causing breakthrough infections. The expanding spectrum of clinically relevant fungal pathogens required the implementation of screening approaches permitting broad rather than targeted fungus detection to support timely onset of pre-emptive antifungal treatment. To address this diagnostically important aspect in a prospective setting, we analyzed 935 serial peripheral blood (PB) samples from 195 pediatric and adult patients at high risk for IFD, involving individuals displaying febrile neutropenia during treatment of hematological malignancies or following allogeneic hematopoietic stem cell transplantation. Two different panfungal-PCR-screening methods combined with ensuing fungal genus identification by Sanger sequencing were employed. In the great majority of PB-specimens displaying fungal DNAemia, the findings were transient and revealed fungi commonly regarded as non-pathogenic or rarely pathogenic even in the highly immunocompromised patient setting. Hence, to adequately exploit the diagnostic potential of panfungal-PCR approaches for detecting IFD, particularly if caused by hitherto rarely observed fungal pathogens, it is necessary to confirm the findings by repeated testing and to identify the fungal genus present by ensuing analysis. If applied appropriately, panfungal-PCR-screening can help prevent unnecessary empirical therapy, and conversely, contribute to timely employment of effective pre-emptive antifungal treatment strategies.
- MeSH
- antifungální látky terapeutické užití MeSH
- dítě MeSH
- DNA fungální * analýza MeSH
- dospělí MeSH
- febrilní neutropenie * mikrobiologie MeSH
- hematologické nádory komplikace MeSH
- hostitel s imunodeficiencí * MeSH
- houby izolace a purifikace genetika MeSH
- invazivní mykotické infekce epidemiologie prevence a kontrola etiologie mikrobiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- předškolní dítě MeSH
- prevalence MeSH
- prospektivní studie MeSH
- senioři MeSH
- transplantace hematopoetických kmenových buněk škodlivé účinky MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- dopisy MeSH
