Diss. (sammanfattning) Stockholm : Karol. inst., 2001. / Härtill 6 uppsatser.

Thesis (Ph. D.)--University of Florida, 2004. / Typescript. Title from title page of source document. Document formatted into pages; contains 149 pages. Includes vita. Includes bibliographical references.

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.

Durante e após o tratamento de câncer, de portadores de HIV ou transplantes, a alimentação pode oferecer um bem estar ao paciente, pois o ato de se alimentar corretamente auxilia as pessoas a se sentirem fortalecidas normalmente. Pessoas saudáveis possuem o seu sistema imunológico funcionando de maneira adequada, podendo combater pequenas quantidades de bactérias. Entretanto, pessoas imunocomprometidas podem não conseguir combater esta pequena quantidade de microrganismos e necessitam de uma dieta com baixa contagem microbiológica para evitar o contato com bactérias potencialmente danosas à saúde. Esta dieta é denominada dieta neutropênica. Esses pacientes são suscetíveis à contaminação alimentar, não sendo aconselhável a ingestão de produtos crus. A irradiação em vegetais, com baixas doses, tem a finalidade de reduzir a carga microbiana. Dessa forma a proposta deste trabalho foi obter dados de aspectos microbiológicos, sensoriais e físico-químicos em Mix Primavera minimamente processados submetidos a diferentes doses de radiação ionizante em dietas destinadas a pacientes imunocomprometidos ou imunossuprimidos. Foram utilizadas doses de 1,0kGy, 2,0kGy, 3,0kGy e 4,0kGy irradiadas no Irradiador Multipropósito 60Co localizado no Centro de Tecnologia das Radiações (CTR) IPEN-CNEN/SP. Foram realizadas análises microbiológicas (n=25), utilizando Petrifilm, análises sensoriais utilizando o teste sensorial de aceitação (n=30) e triangular (n=15) e análise de textura (n=90) no Laboratório de Microbiologia de Alimentos no Centro de Tecnologia das Radiações. As análises de textura foram realizadas com o auxílio de um texturômetro T.A.XT. Plus (Stable Micro System) equipado com a célula de carga de 50kg utilizando a sonda (probe) de corte triangular com lâmina Warner-Bratzler Knife com velocidade de descida de 2mm/s. Todos os resultados foram expressos em Newtons (N). Os resultados obtidos demostraram que para as análises microbiológicas os padrões foram seguidos de acordo com a RDC nº 12/01 ANVISA. A análise sensorial não apresentou diferença significativa entre as amostras, entretanto no teste triangular com as doses de 4,0kGy e controle houve diferença significativa entre as amostras, demonstrando que a amostra de 3,0kGy seria a mais indicada para o público específico deste trabalho. Pode-se concluir que para uma dieta neutropênica sugere-se uma dose de 2,0kGy. / During and after the treatment of cancer, people with HIV or transplants, the food intake can offer a well-being to the patient, because the action of eating right helps people to feel strong. Healthy people have their immune system working properly and can tolerate small amounts of bacteria. However, immunocompromised persons may not be able to and however immunocompromised people cannot fight this small amount of microorganisms and require a diet with very low microbiological count to avoid contact with potentially harmful bacteria. This is called neutropenic diet. These patients are susceptible to food contamination, so that its not advisable the ingestion of raw products. The vegetable irradiation with low doses has the purpose of reducing the microbial load. The aim of this study was to obtain data on microbiological, sensorial e physicochemical aspects in minimally processed Primavera salad irradiated with different doses of gamma radiation designed to immunocompromised patients. It were used doses of 1.0kGy, 2.0kGy, 3.0kGy and 4.0kGy irradiated in the Multipurpose Irradiator 60Co located in Radiation Technology Center. Microbiological analyzes were performed (n=25) using Petrifilm, sensory analysis using the sensory acceptance test (n=30) and triangular (n=15) and texture analysis (n=90) in the Food Microbiology Laboratory located at the Radiation Technology Center. The texture analysis was performed with the aid of a texturometer equipped with 5 kg load cell using a triangular cutting Warner-Bratzler Knife blade probe with the descent speed of 2mm/sec. All results were expressed in Newtons (N). The results showed that for microbiological analyzes the standards were followed according to the RDC 12/01 ANVISA. For the sensory test of acceptation no difference was found among the samples, however in the triangular test could be found slight differences between samples irradiated with 4.0kGy and control and there was significant difference among the sample, showing that the sample of 3.0kGy would be indicate for this specific public. It can be concluded that for a neutropenic diet the suggested dose is 2.0kGy.

Durante e após o tratamento de câncer, de portadores de HIV ou transplantes, a alimentação pode oferecer um bem estar ao paciente, pois o ato de se alimentar corretamente auxilia as pessoas a se sentirem fortalecidas normalmente. Pessoas saudáveis possuem o seu sistema imunológico funcionando de maneira adequada, podendo combater pequenas quantidades de bactérias. Entretanto, pessoas imunocomprometidas podem não conseguir combater esta pequena quantidade de microrganismos e necessitam de uma dieta com baixa contagem microbiológica para evitar o contato com bactérias potencialmente danosas à saúde. Esta dieta é denominada dieta neutropênica. Esses pacientes são suscetíveis à contaminação alimentar, não sendo aconselhável a ingestão de produtos crus. A irradiação em vegetais, com baixas doses, tem a finalidade de reduzir a carga microbiana. Dessa forma a proposta deste trabalho foi obter dados de aspectos microbiológicos, sensoriais e físico-químicos em Mix Primavera minimamente processados submetidos a diferentes doses de radiação ionizante em dietas destinadas a pacientes imunocomprometidos ou imunossuprimidos. Foram utilizadas doses de 1,0kGy, 2,0kGy, 3,0kGy e 4,0kGy irradiadas no Irradiador Multipropósito 60Co localizado no Centro de Tecnologia das Radiações (CTR) IPEN-CNEN/SP. Foram realizadas análises microbiológicas (n=25), utilizando Petrifilm, análises sensoriais utilizando o teste sensorial de aceitação (n=30) e triangular (n=15) e análise de textura (n=90) no Laboratório de Microbiologia de Alimentos no Centro de Tecnologia das Radiações. As análises de textura foram realizadas com o auxílio de um texturômetro T.A.XT. Plus (Stable Micro System) equipado com a célula de carga de 50kg utilizando a sonda (probe) de corte triangular com lâmina Warner-Bratzler Knife com velocidade de descida de 2mm/s. Todos os resultados foram expressos em Newtons (N). Os resultados obtidos demostraram que para as análises microbiológicas os padrões foram seguidos de acordo com a RDC nº 12/01 ANVISA. A análise sensorial não apresentou diferença significativa entre as amostras, entretanto no teste triangular com as doses de 4,0kGy e controle houve diferença significativa entre as amostras, demonstrando que a amostra de 3,0kGy seria a mais indicada para o público específico deste trabalho. Pode-se concluir que para uma dieta neutropênica sugere-se uma dose de 2,0kGy. / During and after the treatment of cancer, people with HIV or transplants, the food intake can offer a well-being to the patient, because the action of eating right helps people to feel strong. Healthy people have their immune system working properly and can tolerate small amounts of bacteria. However, immunocompromised persons may not be able to and however immunocompromised people cannot fight this small amount of microorganisms and require a diet with very low microbiological count to avoid contact with potentially harmful bacteria. This is called neutropenic diet. These patients are susceptible to food contamination, so that its not advisable the ingestion of raw products. The vegetable irradiation with low doses has the purpose of reducing the microbial load. The aim of this study was to obtain data on microbiological, sensorial e physicochemical aspects in minimally processed Primavera salad irradiated with different doses of gamma radiation designed to immunocompromised patients. It were used doses of 1.0kGy, 2.0kGy, 3.0kGy and 4.0kGy irradiated in the Multipurpose Irradiator 60Co located in Radiation Technology Center. Microbiological analyzes were performed (n=25) using Petrifilm, sensory analysis using the sensory acceptance test (n=30) and triangular (n=15) and texture analysis (n=90) in the Food Microbiology Laboratory located at the Radiation Technology Center. The texture analysis was performed with the aid of a texturometer equipped with 5 kg load cell using a triangular cutting Warner-Bratzler Knife blade probe with the descent speed of 2mm/sec. All results were expressed in Newtons (N). The results showed that for microbiological analyzes the standards were followed according to the RDC 12/01 ANVISA. For the sensory test of acceptation no difference was found among the samples, however in the triangular test could be found slight differences between samples irradiated with 4.0kGy and control and there was significant difference among the sample, showing that the sample of 3.0kGy would be indicate for this specific public. It can be concluded that for a neutropenic diet the suggested dose is 2.0kGy.

Trichodysplasia spinulosa (TS) é uma doença proliferativa de pele observada em pacientes imunocomprometidos. Caracteriza-se pela formação de espinhas de queratina conhecidos como espículas, acantose epidérmica, dilatação do folículo piloso, queratose actínica, queda dos pelos, pápulas foliculares e, que normalmente, se manifestam na região facial do paciente e extremidades do corpo (constantemente confundida com danos por exposição prolongada ao sol). A TS resulta da infecção ativa com o poliomavírus TSassociado (TSPyV), onde observa-se alta carga viral, expressão de proteína do vírus e formação de partículas. Este estudo desenvolveu métodos moleculares de detecção e sequenciamento do genoma total e parcial de TSPyV e utilizou-se destes métodos para determinar padrões de excreção e viremia em indivíduos imunocompromentidos e imunocompetentes, bem como explorar possíveis vias de transmissão. Ainda, características genéticas e filogenéticas do TSPyV também foram determinadas. Apesar de observamos alta taxa de excreção urinaria em indivíduos imunocomprometidos (57,7%), o vírus não foi encontrado em amostras de água do meio ambiente. Ainda em termos de excreção urinária do TSPyV, apenas 1,4% dos indivíduos imunocompetentes apresentaram virúria (diferente do que se observa para os poliomavirus JCPyV e BKPyV), mas o vírus foi encontrado em leite materno, sugerindo assim a possibilidade de haver transmissão vertical do TSPyV. As análises filogenéticas revelaram a existência de 2 linhagens de vírus circulantes em nosso meio, com características distintas dos já descritos na literatura. As diferenças observadas foram suficientes para que os vírus sejam caracterizados como novos genótipos circulantes de TSPyV. / Trichodysplasia spinulosa (TS) is a proliferative skin disease seen in immunocompromised patients. It is characterized by the formation of keratin spines known as spicules, epidermal acanthosis, hair follicle dilatation, actinic keratosis, hair loss, follicular papules and, which usually manifest in the facial region and extremities of the body (constantly confounded with damage from prolonged exposure to the sun). TS results from active infection with TS-associated polyomavirus (TSPyV), where high viral load, virus protein expression and particle formation are observed. This study developed molecular methods for detection and sequencing the total and partial genome of TSPyV and, employing these methods, determined patterns of excretion and viremia in immunocompromised and immunocompetent individuals, as well as explored possible transmission pathways. Genetic and phylogenetic characteristics were also determined. Although we observed high rate of urinary shedding in immunocompromised individuals (57.7%), the virus was not found in environmental water samples. Also in terms of urinary excretion of TSPyV, only 1.4% of immunocompetent individuals presented viruria (different from what is observed for polyomaviruses JCPyV and BKPyV), but the virus was found in breast milk, thus suggesting the possibility of vertical transmission. Phylogenetic analyzes revealed the existence of 2 circulating virus strains in our country, with different characteristics from those already described in the literature. The differences seem to be sufficient to characterize the viruses as new genotypes of TSPyV.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2002. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

The aim of this study was to develop a sensitive and specific method of detecting Toxoplasma gondii in the immunocompromised host which would reduce the need for other tests and would ensure the prompt initiation of the appropriate treatment, the effects of which could be monitored. Such a system would also be of benefit in theinvestigation of parasite/host interaction. Initial work investigated an antigen ELISA and the PCR using two different gene targets CB 1 and P30) to find the most sensitive system. The ELISA was insensitive but both PCR systems were capable of detecting parasite in blood, lymph and tissue samples from experimentally infected sheep. The B 1 PCR detected parasite earlier and over a significantly longer period than the P30 PCR, this greater sensitivity being due to the higher copy number of the B 1 gene. The PCR was applied to samples from patients with AIDS with the aim of finding an ideal sample for the diagnosis of infection. Parasite was detected in blood up to a month prior to clinical signs of infection, and therefore blood samples are ideal for monitoringpatients at risk of recrudescence of a chronic infection. This result indicates that recrudescence is not due to local reactivation, but is due to a more widespread parasitaemia. However, as parasitaemia was shown to be transient in cases of recrudescence, sampling time may be critical. Parasite was also detected in urine, biopsytissue and post mortem material, but was not detected in CSF.Dexamethasone was used to create a mouse model of recrudescence in the immunocompromised patient to further investigate interaction between the parasite and host. The PCR detected parasite in blood, brain and heart of chronically infected animals, however the detection rate was significantly higher in groups receiveing immunosuppressive therapy. Dexamethasone treatment mimicked the effects seen in the AIDS population where 30-35% of chronically infected individuals showed clinical signsof toxoplasmosis. However the PCR may also be detecting latent cysts in tissue samples, and blood samples were occasionally positive without clinical evidence of infection. This could be due to small amounts of parasite circulating intermittently, or to breakdownproducts from parasite degradation. There was therefore a need to differentiate between active and chronic infection, and this was carried out by developing a quantitative PCR based on competitive amplification. A novel Sma I restriction site was created within the P30 gene, and known amounts were co-amplified with samples. The amplified products were then digested with Sma I to differentiate between mutated and T. gondii DNA and the point at which product yield was equalled indicated the amount of original DNA present in the sample. The system was shown to work using human PM samples, and could be adapted to indicate a cut-off point where parasite DNA levels reveal active infection. In conclusion the B 1 PCR is the method of choice in detecting T. gondii in AIDS patients. Any patient in which active parasite is detected should be treated and closely monitored using the qPCR for any evidence of reactivation.