ABORDAGEM DIAGNÓSTICA E TERAPÊUTICA EM PACIENTES COM LEUCEMIA MIELOIDE AGUDA (LMA) E SUSPEITA DE INFECÇÃO FÚNGICA INVASIVA, NO HOSPITAL DE CÂNCER DE BARRETOS Article Swipe
Sheilla Andrade de Oliveira
,
IAS Plentz
,
BM Borges
,
A. Domínguez Macías
,
DF Brasileiro
,
JAM Ramazoto
,
GF Colli
,
IZ Gonçalves
,
IA Siqueira
,
NS Castro
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1016/j.htct.2024.09.672
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1016/j.htct.2024.09.672
Objetivos: Relatar a abordagem e tratamento empregados em pacientes com Leucemia Mieloide aguda (LMA), internados para quimioterapia infusional com objetivo curativo, sob suspeita ou confirmação de infecção fúngica invasiva (IFI) durante internação hospitalar. Material e métodos: Estudo quantitativo, de caráter descritivo e análise retrospectiva, contemplando os anos de 2020 a 2023. Os dados foram obtidos através do prontuário eletrônico (Philips Tasy®), através de resultados laboratoriais e de imagem, critérios diagnósticos utilizados e tratamentos empregados. Resultados: Foram observados 86 pacientes com LMA internados em nosso serviço durante o período de 2020 a 2023, sendo que 16 (18,6%) desses receberam terapia anti-fúngica em algum momento do tratamento quimioterápico. Em relação ao diagnóstico e terapia empregada, três pacientes receberam tratamento com voriconazol e micafungina após confirmação da IFI, sendo duas confirmações por biópsia e uma por hemocultura, respectivamente. Dois desses três pacientes apresentaram dosagem de galactomanana positiva no diagnóstico. Ainda, houve um paciente classificado como “provável” Aspergilose pulmonar invasiva (API), contemplando imunossupressão, critérios clínicos, exame de imagem e galactomanana positivos, e dois pacientes classificados como “possível” API, contemplando imunossupressão, critérios clínicos e exame de imagem, sendo que em ambas as situações, todos receberam voriconazol. Em relação ao desfecho “óbito”, dos pacientes que receberam terapia antifúngica por suspeita ou confirmação de IFI, 10 deles (62,5%) vieram a óbito, sendo 7 deles por sepse, dois por sepse e progressão de doença, e um deles por progressão de doença apenas. Além disso, podemos afirmar que os pacientes com IFI confirmada vieram a óbito por sepse deste foco. Vale lembrar que todos os pacientes incluídos neste estudo, estavam em uso de profilaxia antifúngica com fluconazol e coleta de galactomanana de rotina, conforme protocolo institucional. Discussão: A IFI é uma realidade em pacientes imunossuprimidos, porém, Infelizmente, mesmo com os avanços diagnósticos e terapêuticos, ainda é uma entidade com alta mortalidade em nosso meio. Dentre as principais etiologias fúngicas nestes pacientes, há o predomínio de fungos filamentosos, destacando-se Aspergillus, seguido por zigomicose e fusariose. Ainda é de grande importância elencar a candidíase invasiva, também responsável por IFI nesses pacientes. A característica principal dos fungos filamentosos neste perfil de paciente é o tropismo pelos vasos sanguíneos, com alto poder de disseminação hematogênica. Considerando o quão desafiador é o diagnóstico na prática clínica, é importante citar meios diagnósticos incorporados atualmente, como a detecção de galactomanana, que foi incluída em consenso internacional como critério micológico de API “provável”: sua detecção reflete o crescimento da hifa nos tecidos, e apresenta excelente valor preditivo negativo em pacientes de alto risco antes mesmo das manifestações clínicas. Conclusão: A IFI é uma complicação potencialmente fatal em pacientes imunocomprometidos, em quimioterapia ou pós transplante de medula óssea, e por esse motivo, a suspeição e início precoce do tratamento são cruciais para melhor desfecho clínico e aumento da sobrevida nesses pacientes.
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https://doi.org/10.1016/j.htct.2024.09.672Digital Object Identifier
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ABORDAGEM DIAGNÓSTICA E TERAPÊUTICA EM PACIENTES COM LEUCEMIA MIELOIDE AGUDA (LMA) E SUSPEITA DE INFECÇÃO FÚNGICA INVASIVA, NO HOSPITAL DE CÂNCER DE BARRETOSWork title
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articleOpenAlex work type
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2024Year of publication
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2024-10-01Full publication date if available
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Sheilla Andrade de Oliveira, IAS Plentz, BM Borges, A. Domínguez Macías, DF Brasileiro, JAM Ramazoto, GF Colli, IZ Gonçalves, IA Siqueira, NS CastroList of authors in order
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https://doi.org/10.1016/j.htct.2024.09.672Publisher landing page
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diamondOpen access status per OpenAlex
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https://doi.org/10.1016/j.htct.2024.09.672Direct OA link when available
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Medicine, GynecologyTop concepts (fields/topics) attached by OpenAlex
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| abstract_inverted_index.nestes | 310 |
| abstract_inverted_index.perfil | 347 |
| abstract_inverted_index.sepse, | 218 |
| abstract_inverted_index.vieram | 211, 244 |
| abstract_inverted_index.óbito | 246 |
| abstract_inverted_index.(18,6%) | 95 |
| abstract_inverted_index.(62,5%) | 210 |
| abstract_inverted_index.Relatar | 1 |
| abstract_inverted_index.afirmar | 237 |
| abstract_inverted_index.apenas. | 233 |
| abstract_inverted_index.aumento | 458 |
| abstract_inverted_index.doença | 232 |
| abstract_inverted_index.dosagem | 140 |
| abstract_inverted_index.durante | 30, 85 |
| abstract_inverted_index.elencar | 330 |
| abstract_inverted_index.estavam | 260 |
| abstract_inverted_index.estudo, | 259 |
| abstract_inverted_index.imagem, | 67, 181 |
| abstract_inverted_index.início | 447 |
| abstract_inverted_index.lembrar | 252 |
| abstract_inverted_index.momento | 102 |
| abstract_inverted_index.motivo, | 443 |
| abstract_inverted_index.obtidos | 54 |
| abstract_inverted_index.podemos | 236 |
| abstract_inverted_index.porém, | 286 |
| abstract_inverted_index.precoce | 448 |
| abstract_inverted_index.reflete | 398 |
| abstract_inverted_index.rotina, | 273 |
| abstract_inverted_index.seguido | 320 |
| abstract_inverted_index.também | 334 |
| abstract_inverted_index.terapia | 98, 111, 200 |
| abstract_inverted_index.óbito, | 213 |
| abstract_inverted_index.óssea, | 439 |
| abstract_inverted_index.(Philips | 59 |
| abstract_inverted_index.Leucemia | 10 |
| abstract_inverted_index.Material | 33 |
| abstract_inverted_index.Mieloide | 11 |
| abstract_inverted_index.Tasy®), | 60 |
| abstract_inverted_index.análise | 42 |
| abstract_inverted_index.através | 55, 61 |
| abstract_inverted_index.avanços | 291 |
| abstract_inverted_index.biópsia | 129 |
| abstract_inverted_index.caráter | 39 |
| abstract_inverted_index.clínico | 456 |
| abstract_inverted_index.conforme | 274 |
| abstract_inverted_index.consenso | 388 |
| abstract_inverted_index.cruciais | 452 |
| abstract_inverted_index.desfecho | 194, 455 |
| abstract_inverted_index.doença, | 225 |
| abstract_inverted_index.entidade | 298 |
| abstract_inverted_index.fúngica | 27 |
| abstract_inverted_index.invasiva | 28, 155 |
| abstract_inverted_index.negativo | 410 |
| abstract_inverted_index.objetivo | 19 |
| abstract_inverted_index.paciente | 149, 349 |
| abstract_inverted_index.período | 87 |
| abstract_inverted_index.positiva | 143 |
| abstract_inverted_index.prática | 370 |
| abstract_inverted_index.pulmonar | 154 |
| abstract_inverted_index.serviço | 84 |
| abstract_inverted_index.suspeita | 22, 203 |
| abstract_inverted_index.tecidos, | 404 |
| abstract_inverted_index.tropismo | 352 |
| abstract_inverted_index.abordagem | 3 |
| abstract_inverted_index.apresenta | 406 |
| abstract_inverted_index.clínica, | 371 |
| abstract_inverted_index.clínicos | 177 |
| abstract_inverted_index.critério | 391 |
| abstract_inverted_index.curativo, | 20 |
| abstract_inverted_index.excelente | 407 |
| abstract_inverted_index.fúngicas | 309 |
| abstract_inverted_index.incluída | 386 |
| abstract_inverted_index.invasiva, | 333 |
| abstract_inverted_index.métodos: | 35 |
| abstract_inverted_index.pacientes | 8, 78, 114, 138, 169, 197, 240, 256, 284, 412, 430 |
| abstract_inverted_index.preditivo | 409 |
| abstract_inverted_index.principal | 342 |
| abstract_inverted_index.protocolo | 275 |
| abstract_inverted_index.realidade | 282 |
| abstract_inverted_index.receberam | 97, 115, 189, 199 |
| abstract_inverted_index.relação | 107, 192 |
| abstract_inverted_index.sobrevida | 460 |
| abstract_inverted_index.Objetivos: | 0 |
| abstract_inverted_index.clínicas. | 420 |
| abstract_inverted_index.clínicos, | 160 |
| abstract_inverted_index.confirmada | 243 |
| abstract_inverted_index.critérios | 68, 159, 176 |
| abstract_inverted_index.desafiador | 365 |
| abstract_inverted_index.descritivo | 40 |
| abstract_inverted_index.detecção | 381, 397 |
| abstract_inverted_index.empregada, | 112 |
| abstract_inverted_index.empregados | 6 |
| abstract_inverted_index.etiologias | 308 |
| abstract_inverted_index.fluconazol | 267 |
| abstract_inverted_index.fusariose. | 324 |
| abstract_inverted_index.importante | 373 |
| abstract_inverted_index.incluídos | 257 |
| abstract_inverted_index.infecção | 26 |
| abstract_inverted_index.infusional | 17 |
| abstract_inverted_index.internados | 14, 81 |
| abstract_inverted_index.observados | 76 |
| abstract_inverted_index.pacientes, | 311 |
| abstract_inverted_index.pacientes. | 339, 462 |
| abstract_inverted_index.positivos, | 166 |
| abstract_inverted_index.principais | 307 |
| abstract_inverted_index.profilaxia | 264 |
| abstract_inverted_index.resultados | 63 |
| abstract_inverted_index.tratamento | 5, 104, 116, 450 |
| abstract_inverted_index.utilizados | 70 |
| abstract_inverted_index.zigomicose | 322 |
| abstract_inverted_index.Aspergilose | 153 |
| abstract_inverted_index.Conclusão: | 421 |
| abstract_inverted_index.Discussão: | 277 |
| abstract_inverted_index.Resultados: | 74 |
| abstract_inverted_index.atualmente, | 378 |
| abstract_inverted_index.candidíase | 332 |
| abstract_inverted_index.crescimento | 400 |
| abstract_inverted_index.eletrônico | 58 |
| abstract_inverted_index.empregados. | 73 |
| abstract_inverted_index.hospitalar. | 32 |
| abstract_inverted_index.micafungina | 120 |
| abstract_inverted_index.micológico | 392 |
| abstract_inverted_index.mortalidade | 301 |
| abstract_inverted_index.predomínio | 314 |
| abstract_inverted_index.progressão | 223, 230 |
| abstract_inverted_index.prontuário | 57 |
| abstract_inverted_index.suspeição | 445 |
| abstract_inverted_index.transplante | 436 |
| abstract_inverted_index.tratamentos | 72 |
| abstract_inverted_index.voriconazol | 118 |
| abstract_inverted_index.Aspergillus, | 319 |
| abstract_inverted_index.Considerando | 362 |
| abstract_inverted_index.antifúngica | 201, 265 |
| abstract_inverted_index.apresentaram | 139 |
| abstract_inverted_index.classificado | 150 |
| abstract_inverted_index.contemplando | 44, 157, 174 |
| abstract_inverted_index.diagnóstico | 109, 368 |
| abstract_inverted_index.filamentosos | 345 |
| abstract_inverted_index.hemocultura, | 133 |
| abstract_inverted_index.importância | 329 |
| abstract_inverted_index.incorporados | 377 |
| abstract_inverted_index.internação | 31 |
| abstract_inverted_index.responsável | 335 |
| abstract_inverted_index.sanguíneos, | 355 |
| abstract_inverted_index.situações, | 187 |
| abstract_inverted_index.voriconazol. | 190 |
| abstract_inverted_index.Infelizmente, | 287 |
| abstract_inverted_index.anti-fúngica | 99 |
| abstract_inverted_index.classificados | 170 |
| abstract_inverted_index.complicação | 426 |
| abstract_inverted_index.confirmação | 24, 122, 205 |
| abstract_inverted_index.destacando-se | 318 |
| abstract_inverted_index.diagnóstico. | 145 |
| abstract_inverted_index.diagnósticos | 69, 292, 376 |
| abstract_inverted_index.filamentosos, | 317 |
| abstract_inverted_index.galactomanana | 142, 165, 271 |
| abstract_inverted_index.internacional | 389 |
| abstract_inverted_index.laboratoriais | 64 |
| abstract_inverted_index.quantitativo, | 37 |
| abstract_inverted_index.quimioterapia | 16, 433 |
| abstract_inverted_index.“óbito”, | 195 |
| abstract_inverted_index.confirmações | 127 |
| abstract_inverted_index.disseminação | 360 |
| abstract_inverted_index.galactomanana, | 383 |
| abstract_inverted_index.hematogênica. | 361 |
| abstract_inverted_index.institucional. | 276 |
| abstract_inverted_index.potencialmente | 427 |
| abstract_inverted_index.retrospectiva, | 43 |
| abstract_inverted_index.terapêuticos, | 294 |
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| abstract_inverted_index.manifestações | 419 |
| abstract_inverted_index.“possível” | 172 |
| abstract_inverted_index.“provável” | 152 |
| abstract_inverted_index.quimioterápico. | 105 |
| abstract_inverted_index.respectivamente. | 134 |
| abstract_inverted_index.“provável”: | 395 |
| abstract_inverted_index.imunossupressão, | 158, 175 |
| abstract_inverted_index.imunossuprimidos, | 285 |
| abstract_inverted_index.imunocomprometidos, | 431 |
| cited_by_percentile_year | |
| countries_distinct_count | 0 |
| institutions_distinct_count | 10 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.7200000286102295 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.36164916 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |