Clinical forms

  • 文章类型: Systematic Review
    组织胞浆菌病是由于双态真菌荚膜组织胞浆菌病。这项研究旨在提供组织胞浆菌病流行病学的概述,临床,诊断,以及过去30年的治疗方面。这篇综述是通过对1992年至2021年组织胞浆菌病的系统文献检索进行的。我们描述了临床特征,诊断方法和治疗。实证搜索是通过数据库PubMed进行的,谷歌学者和科学直接。在1992年至2021年之间,发表了190份手稿,并报告了212例组织胞浆菌病。这些出版物分别包括115例和97例美国和非洲组织胞浆菌病。在过去的十年中,出版物的数量有所增加,到2020年达到最高水平(占报告病例的12.34%)。与局部形式相比,组织胞浆菌病的传播形式是最常见的病例。美国组织胞浆菌病(75.65%)和非洲组织胞浆菌病(55.67%)就是这种情况。伊曲康唑(31.17%)和两性霉素B(26.62%)是这些病例处理中使用最多的药物。美国组织胞浆菌病分布在世界各地,而非洲组织胞浆菌病主要存在于热带非洲。迫切需要建立一个全球监控系统,更好地了解这种疾病。
    Histoplasmosis is a mycosis due to a dimorphic fungus Histoplasma capsulatum. This study aimed at providing an overview of histoplasmosis epidemiological, clinical, diagnostic, and therapeutic aspects from the last 30 years. This review was carried out using a systematic literature search on histoplasmosis from 1992 to 2021. We describe the clinical features, diagnostic methods and treatment. Empirical searches were conducted via the databases PubMed, Google Scholar and Science Direct. Between 1992 and 2021, 190 manuscripts were published and reported 212 cases of histoplasmosis. These publications included 115 and 97 cases of American and African histoplasmosis respectively. The number of publications increased over the last ten years with a maximum in 2020 (12.34 % of the cases reported). The disseminated forms of histoplasmosis were the most frequently reported cases as compared to the localized forms. This was the case with the American histoplasmosis (75.65 %) as well as with the African histoplasmosis (55.67 %). Itraconazole (31.17 %) and Amphotericin B (26.62 %) were the most used drugs in the management of these cases. American histoplasmosis is distributed worldwide whereas African histoplasmosis is mainly present in intertropical Africa. There is a critical need for setting up a global surveillance system, towards a better understanding of the disease.
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  • 文章类型: Journal Article
    缺乏关于查加斯病(ChD)临床表现的患病率的最新估计,因此,我们旨在评估血清阳性成人中临床形式的ChD的患病率,汇集可用数据。
    在Medline进行了系统评价,Embase,BibliotecaVirtualemSaúde和Cochrane数据库寻找1990年至2023年8月发表的研究,该研究调查了血清阳性成年人中ChD临床形式的患病率,包括:(i)不确定阶段,(ii)慢性查加斯心肌病(CCM),(iii)消化和(iv)混合(CCM+消化)形式。使用随机效应模型计算集合估计值和95%置信区间(CI)。使用Leboeuf-Yde和Lauritsen工具评估研究质量和偏倚风险。用I2统计量评估异质性。该研究在PROSPERO数据库(CRD42022354237)中注册。
    选择了1246篇文章进行筛选,最终分析包括73项研究(17,132例患者,44%的男性)。大多数研究是在门诊患者中进行的(n=50),其次是基于人群的研究(n=15)。ChD临床形式的合并患病率为:不确定的42.6%(95%CI:36.9-48.6),CCM42.7%(95%CI:37.3-48.3),消化系统17.7%(95%CI:14.9-20.9),混合10.2%(95%CI:7.9-13.2)。在基于人群的研究中,CCM的患病率较低(31.2%,95%CI:24.4-38.9),不确定的更高(47.2%,95%CI:39.0-55.5)形式。在元回归中,年龄与不确定(β=-0.05,P<0.001)形式的患病率呈负相关,并与CCM(β=0.06,P<0.001)和消化(β=0.02,P<0.001)直接相关。异质性总体较高。
    与以前的出版物相比,我们的汇总估计显示,在ChD血清阳性患者中,CCM的患病率更高,但消化形式的速率相似。
    这项研究由世界心脏联合会资助,通过与诺华制药公司的研究合作。
    UNASSIGNED: There is a lack of up-to-date estimates about the prevalence of Chagas disease (ChD) clinical presentations and, therefore, we aimed to assess the prevalence of clinical forms of ChD among seropositive adults, pooling available data.
    UNASSIGNED: A systematic review was conducted in Medline, Embase, Biblioteca Virtual em Saúde and Cochrane databases looking for studies published from 1990 to August 2023, which investigated the prevalence of ChD clinical forms among seropositive adults, including: (i) indeterminate phase, (ii) chronic Chagas cardiomyopathy (CCM), (iii) digestive and (iv) mixed (CCM + digestive) forms. Pooled estimates and 95% confidence intervals (CI) were calculated using random-effects models. Studies quality and risk of bias was assessed with the Leboeuf-Yde and Lauritsen tool. Heterogeneity was assessed with the I2 statistic. The study was registered in the PROSPERO database (CRD42022354237).
    UNASSIGNED: 1246 articles were selected for screening and 73 studies were included in the final analysis (17,132 patients, 44% men). Most studies were conducted with outpatients (n = 50), followed by population-based studies (n = 15). The pooled prevalence of the ChD clinical forms was: indeterminate 42.6% (95% CI: 36.9-48.6), CCM 42.7% (95% CI: 37.3-48.3), digestive 17.7% (95% CI: 14.9-20.9), and mixed 10.2% (95% CI: 7.9-13.2). In population-based studies, prevalence was lower for CCM (31.2%, 95% CI: 24.4-38.9) and higher for indeterminate (47.2%, 95% CI: 39.0-55.5) form. In meta-regression, age was inversely associated with the prevalence of indeterminate (β = -0.05, P < 0.001) form, and directly associated with CCM (β = 0.06, P < 0.001) and digestive (β = 0.02, P < 0.001) forms. Heterogeneity was overall high.
    UNASSIGNED: Compared to previous publications, our pooled estimates show a higher prevalence of CCM among ChD seropositive patients, but similar rates of the digestive form.
    UNASSIGNED: This study was funded by the World Heart Federation, through a research collaboration with Novartis Pharma AG.
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  • 文章类型: Journal Article
    (1)背景:感染性心内膜炎(IE)是心脏心内膜表面的疾病,由天然或人工瓣膜或留置心脏装置的感染引起。除了IE诱发风险因素,包括心脏病和医疗程序,近年来,从人口统计学因素到感知压力状况的新轨迹一直在调查中。本研究的目的是评估考纳斯IE幸存者的感知压力与人口统计学特征以及IE临床形式之间的关联,立陶宛。(2)方法:对2014-2017年期间立陶宛健康科学大学Kaunas诊所心脏科的IE病例(n=135)进行了横断面研究。有关IE临床特征的数据,收集诊断时的社会人口统计学特征和感知压力水平(感知压力量表(PSS-10))。在统计分析中使用“SPSS25.0”包。进行Logistic回归分析,包括性别,以前的职业,IE幸存者感知压力分析中IE的居住地和临床形式。本研究使用横断面研究的STROBE检查表。(3)结果:54.8%的受访者感受到了压力。在最终模型中,与男性相比,女性的感知压力的OR(比值比)为2.07;对于农村居民,与城市居民相比,OR为2.25。这些结果具有统计学意义。观察到与高技能工人和经典IE临床形式相比,与非经典形式相比,低技能工人的感知压力OR增加的趋势。但这些结果没有统计学意义.(4)结论:本研究旨在使IE研究者关注心理状态在疾病发展中的作用。感知压力和一些人口统计学特征的差异,以及IE临床形式的趋势,在考纳斯的IE幸存者中观察到,立陶宛。
    (1) Background: Infective endocarditis (IE) is a disease of the endocardial surface of the heart, caused by infection of the native or prosthetic valve or an indwelling cardiac device. Apart from IE predisposing risk factors that include heart conditions and medical procedures, the novel trajectories from demographic factors to perceived stress conditions have been under investigation in recent years. The aim of the present study was to evaluate the associations between perceived stress and demographic characteristics as well as clinical forms of IE among survivors of IE in Kaunas, Lithuania. (2) Methods: A cross-sectional study among IE cases (n = 135) at the Lithuanian University of Health Sciences Kaunas Clinics Cardiology department during the period 2014-2017 was performed. Data about IE clinical features, sociodemographic characteristics and perceived stress level (Perceived Stress Scale (PSS-10)) upon diagnosis were collected. Package \"SPSS 25.0\" was used in the statistical analysis. Logistic regression analysis was performed including gender, previous occupation, place of residence and clinical forms of IE in the analysis of perceived stress among survivors of IE. The STROBE checklist for cross-sectional studies was used in this study. (3) Results: Perceived stress was experienced by 54.8 percent of the respondents. In the final model, the OR (odds ratio) of perceived stress for females was 2.07 as compared to men; for rural residents, the OR was 2.25 as compared to urban residents. These results were statistically significant. A tendency for increased OR of perceived stress for low-skilled workers as compared to high-skilled ones and classical IE clinical form as compared to non-classical form was observed, but these results were not statistically significant. (4) Conclusions: The present study is an attempt to focus the attention of IE researchers on the effects of psychological state in the disease development. Differences in perceived stress and some demographic characteristics, as well as tendencies of IE clinical forms, were observed among survivors of IE in Kaunas, Lithuania.
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  • 文章类型: Journal Article
    痤疮是一种影响毛囊皮脂腺单位的慢性炎症,传统上被视为青春期的疾病。然而,在过去的几年里,据报道,越来越多的成年妇女患有这种疾病。成年女性痤疮的患病率在12%至54%之间。在这个人群中可以区分两种临床类型,“保留”和“炎症”类型,通常倾向于重叠。在进化方面,可以识别出三种主要亚型:持续性痤疮,这是最常见的亚型,迟发性痤疮和复发性痤疮。这种类型的痤疮的严重程度主要为轻度至中度,并且可能对常规治疗难以治疗。病因复杂,尚未完全阐明。它似乎涉及遗传易感性之间的相互作用,荷尔蒙因素,与外部因素重叠的先天免疫系统的慢性激活,比如每天的压力,西式饮食,使用烟草和化妆品。治疗可能具有挑战性,需要采取整体方法,特别关注成年女性的个人需求和特殊性。局部和全身治疗都是可用的,荷尔蒙疗法在这个人群中具有特殊价值。本条的目的是提供最新的,关于临床表现的循证信息,成年女性痤疮的病因和治疗。
    Acne is a chronic inflammatory condition affecting the pilosebaceous unit that was traditionally viewed as a disease of the adolescence. However, over the past several years, an increasing number of adult women have been reported to suffer from this condition. The prevalence of adult female acne ranges between 12 and 54%. Two clinical types can be distinguished in this population, a \'retentional\' and an \'inflammatory\' type, which usually tend to overlap. In terms of evolution, three main subtypes can be identified: Persistent acne, which is the most frequent subtype, late-onset acne and recurrent acne. This type of acne is mainly mild-to-moderate in severity and may be refractory to conventional treatment. The etiopathogenesis is complex and has yet to be fully elucidated. It appears to involve an interaction among genetic predisposition, hormonal factors, and chronic activation of the innate immune system overlapping with external factors, such as daily stress, Western-type diet, use of tobacco and cosmetics. The treatment may be challenging and a holistic approach is required, with special attention to the individual needs and particularities of adult women. Both topical and systemic treatments are available, with hormonal therapies being of special value in this population. The aim of the present article was to provide up-to-date, evidence-based information on the clinical presentation, etiopathogenesis and treatment of adult female acne.
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  • 文章类型: Journal Article
    Neisseria meningitidis (the meningococcus) causes significant morbidity and mortality worldwide through an epidemic or sporadic invasive infections. The epidemiology of N. meningitidis is changing and unpredictable. Certain emerging meningococcal genotypes seem to be associated with increasing unusual clinical presentations. Indeed, early symptoms may vary and are frequently non-specific. However, atypical clinical forms including abdominal presentations, septic arthritis, and bacteremic pneumonia may lead to misdiagnosis and some are usually associated with higher case fatality rates due to delayed optimal management. Improving awareness of clinicians and public health specialists about these unusual but potentially severe presentations should help establish prompt diagnoses and provide appropriate management of cases. In this review, we described unusual panels of clinical presentations of invasive meningococcal disease linked to the recent changes in meningococcal epidemiology.
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  • 文章类型: Journal Article
    OBJECTIVE: To present clinical and laboratory characteristics of various forms of idiopatic lobular panniculitis (ILP) in modern rheumatology practice.
    METHODS: The study included 67 people (58 women and 9 men aged 20 to 76) with the referral diagnosis of \"Erythema nodosa? Undifferentiated panniculitis?\" in 76.2% of cases with a median disease duration of 78.91 [48; 540] months observed in the V.A. Nasonova Research Institute of Rheumatology. In 2007-2017 in addition to general clinical examination immunological, histological and immunohistochemical studies, computed tomography (CT) of the chest organs and tuberculin tests were performed.
    RESULTS: Analysis of clinical manifestations allowed to distinguish four forms of ILP: nodular (n=30), plaque (n=10), infiltrative (n=15) and mesentric (n=12). The minimum median duration of the disease was detected in plaque form (8 [5; 11.5] months), while the median duration in case of infitrative form was 8.25 times longer (66 [36; 102] months, p38 °C and a small number (up to 5) of drain nodes; infiltrative - fever >38 °C, ulceration of nodes with the expiration of oily mass and scarring; mesenteric - pain in the abdominal area, the number of nodes less than 5 and the abdominal cavity CT results (inflammation of the adiopose tissue of the intestinal mesentery, omentum, adipose tissue of the pre - and retroperitoneal areas).
    CONCLUSIONS: The forms and activity of the disease determine the approaches to treatment in modern clinical practice. There is an obvious need to expand knowledge about this pathology among doctors and conduct further research in order to timely diagnose and search for the most effective methods of ILP treatment.
    Цель исследования: представить клинико - лабораторную характеристику различных форм идиопатического лобулярного панникулита (ИЛП) в современной ревматологической клинике. Материалы и методы. В исследование включено 67 человек (58 женщин и 9 мужчины в возрасте от 20 до 76 лет) с направительным диагнозом в 76,2% случаев «Узловатая эритема? Недифференцированный панникулит?», с медианой длительности заболевания 78,91 [48; 540] мес, наблюдавшихся в ФГБНУ «НИИР им. В.А. Насоновой» в 2007-2017 гг. Помимо общеклинического обследования проводили иммунологические, гистологическое и иммуногистохимическое исследования, компьютерную томографию (КТ) органов грудной клетки, туберкулиновые пробы. Результаты. Анализ клинических проявлений позволил выделить четыре формы ИЛП: узловатую (Уф; n=30), бляшечную (Бф; n=10), инфильтративную (Иф; n=15) и мезентериальную (Мф; n=12). Минимальная медиана длительности заболевания выявлена при Бф (8 [5; 11,5] мес), тогда как медиана при Иф была больше в 8,25 раза (66 [36;102] мес, р38 °C и небольшое количество (до 5) сливных узлов; для Иф - лихорадка >38 °C, изъязвление узлов с истечением маслянистой массы и образование рубцов; для Мф - боль в околопупочной области живота, количество узлов менее 5 и результаты КТ органов брюшной полости (воспаление жировой ткани брыжейки кишечника, сальника, жировой клетчатки пред - и забрюшинной областей). Заключение. Формы и активность заболевания определяют подходы к лечению в современной клинической практике. Очевидна необходимость раcширения знаний об этой патологии среди врачей и проведения дальнейших исследований с целью своевременной диагностики и поиска наиболее эффективных методов лечения ИЛП.
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  • 文章类型: Journal Article
    Canine primary chronic enteropathy (CE) includes a heterogeneous group of diseases characterized by chronic gastrointestinal signs.
    This study evaluated the occurrence of Giardia duodenalis infection in primary CE-affected dogs.
    Forty-seven CE-affected dogs of different age and sex were enrolled in the study. For each dog, frequency of defecation, fecal consistency, and eventual fecal abnormalities were evaluated. A clinical scoring index of CE severity (clinical chronic enteropathy activity index) was also assessed, and the type of enteropathy was retrospectively classified. For parasitological analysis, fresh fecal samples collected from each dog were examined by fresh and Lugol stained smears, flotation test, and a rapid immunoassay. Giardia duodenalis genotypes were identified by molecular analysis. Differences of clinical parameters between G. duodenalis positive and G. duodenalis negative dogs were statistically evaluated.
    Among the CE canine patients, 16 out of 47 (34%) dogs were found positive for G. duodenalis and assemblages C and D were identified. No statistical differences emerged according to the types of CE between G. duodenalis-positive and G. duodenalis-negative dog groups. The clinical index of CE severity was indicative of significant less severe clinical forms in G. duodenalis-positive dogs (p = 0.037).
    Results here obtained shows how G. duodenalis may be present in primary CE-affected dogs and further investigations are needed to clarify the real significance of mild clinical presentation in G. duodenalis-positive dogs affected by CE.
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  • 文章类型: Journal Article
    Lipophosphoglycan (LPG) is the major Leishmania surface glycoconjugate having importance during the host-parasite interface. Leishmania (Viannia) braziliensis displays a spectrum of clinical forms including: typical cutaneous leishmaniasis (TL), mucocutaneous (ML), and atypical lesions (AL). Those variations in the immunopathology may be a result of intraspecies polymorphisms in the parasite\'s virulence factors. In this context, we evaluated the role of LPG of strains originated from patients with different clinical manifestations and the sandfly vector. Six isolates of L. braziliensis were used: M2903, RR051 and RR418 (TL), RR410 (AL), M15991 (ML), and M8401 (vector). LPGs were extracted and purified by hydrophobic interaction. Peritoneal macrophages from C57BL/6 and respective knock-outs (TLR2-/- and TLR-4-/-) were primed with IFN-γ and exposed to different LPGs for nitric oxide (NO) and cytokine production (IL-1β, IL-6, IL-12, and TNF-α). LPGs differentially activated the production of NO and cytokines via TLR4. In order to ascertain if such functional variations were related to intraspecies polymorphisms in the LPG, the purified glycoconjugates were subjected to western blot with specific LPG antibodies (CA7AE and LT22). Based on antibody reactivity preliminary variations in the repeat units were detected. To confirm these findings, LPGs were depolymerized for purification of repeat units. After thin layer chromatography, intraspecies polymorphisms were confirmed especially in the type and/size of sugars branching-off the repeat units motif. In conclusion, different isolates of L. braziliensis from different clinical forms and hosts possess polymorphisms in their LPGs that functionally affected macrophage responses.
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  • 文章类型: Journal Article
    For a differentiation of clinical forms of ixodic tick-borne borreliosis clinical laboratory assessment of features of the most often defined hemostasis and complete blood count (CBC) indicators is carried out. Ixodic tick-borne borreliosis in the territory of the Republic of Bashkortostan is characterized by mainly erythematous forms of a disease with a medium-weight current. At the same time some increase in quantity of platelets was noted that could be caused by irritation of a megakaryocytic sprout of bone marrow in the conditions of infectious process and have compensatory character whereas other indicators of CBC and hemostasis at this clinical form practically didn\'t change. Not numerous cases of the ixodic tick-borne borreliosis non-erythematous forms clinically proceeded more hard, with significantly more expressed toxicinflammatory syndrome. At the same time it was followed by significant shifts in biochemical parameters, indicators of CBC and hemostasis. The clinical laboratory features of erythematous and non-erythematous forms of ixodic tick-borne borreliosis revealed as a result of the conducted researches reflect character of a course of disease and can serve for assessment of severity, the forecast of the infection and justification of this treatment.
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  • 文章类型: Journal Article
    This article describes the modern approaches to the diagnostics and treatment of fungoid conditions of the pharynx with special reference to the main methods for the detection of pharyngomycosis and its clinical manifestations based on the results of analysis of the investigations carried out during the period from 2012 till 2016. Among the 3,465 patients presenting with chronic inflammatory pathology of the pharynx who sought medical advice and treatment at the clinical departments of the Institute, 861 ones (25%) were found to have mycotic lesions of the pharynx. Erythematous (atrophic) chronic pharyngitis was the predominant form of the disease documented in 2,059 patients whereas the remaining 1, 406 ones presented with the hypertrophic forms. The fungal infection was diagnosed in 403 (19,5%) patients with erythematous atrophic chronic pharyngitis in comparison with 458 (32,5%) patients suffering from the hypertrophic forms of this pathology including pseudomembranous, hyperplastic (granulomatous), and erosive-ulcerative ones. The principal pathogenic agents responsible for the development of fungal pharyngitis in our patients were fungi of the genus Candida that accounted for 97 - 99% of all the cases of this disease. The currently available modalities for the treatment of pharyngomycosis are described.
    Представлены современные подходы к диагностике и лечению грибкового поражения глотки, рассмотрены основные методы диагностики ФМ и его клинические проявления на основании анализа проведенных исследований в период 2012-2016 гг. Среди 3 465 пациентов с хронической воспалительной патологией глотки, обратившихся в клинические отделения Института, грибковое поражение установлено у 861 (25%) больного от всех больных с хронической воспалительной патологией глотки. Наиболее часто выявляется эритематозно-атрофическая форма хронического фарингита - 2059 пациентов, у 1406 больных была диагностирована гипертрофическая форма фарингита. При этом среди пациентов с эритематозно-атрофической формой грибковое заболевание диагностировано у 403 (19,5%) пациентов, тогда как среди больных гипертрофическими формами фарингита (псевдомембранозной, гиперпластической (гранулематозной) и эрозивно-язвенной) - у 458 (32,5%) пациентов. Основными возбудителями при грибковом фарингите являются дрожжеподобные грибы рода Candida, их доля достигает 97-99% наблюдений. Представлены разработанные современные схемы лечения ФМ.
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