ADRIANA SATIE GONCALVES KONO MAGRI
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8
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
17 resultados
Resultados de Busca
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- First report of a clinical isolate of Candida haemulonii in Brazil(2012) ALMEIDA JR., Joao Nobrega de; MOTTA, Adriana Lopes; ROSSI, Flavia; ABDALA, Edson; PIERROTTI, Ligia Camera; KONO, Adriana Satie Goncalves; DIZ, Maria Del Pilar Estevez; BENARD, Gil; NEGRO, Gilda Maria Barbaro Del
- Itraconazole Serum Trough Concentrations Using Oral Capsules for the Treatment of Chronic Pulmonary Aspergillosis: What is the Target?(2023) OLIVEIRA, Vitor Falcao de; TABORDA, Mariane; ARCIERI, Vitor Ciampone; KRUSCHEWSKY, Wdson Luis Lima; COSTA, Andre Nathan; DUARTE, Nilo Jose Coelho; ROMANO, Paschoalina; EBNER, Persio de Almeida Rezende; MAGRI, Adriana Satie Goncalves Kono; ABDALA, Edson; LEVIN, Anna S. S.; MAGRI, Marcello Mihailenko ChavesBackgroundIn regions where there is only itraconazole capsule as a therapeutic option for treatment of chronic pulmonary aspergillosis (CPA), measuring the serum concentrations becomes even more important for therapeutic success.ObjectiveEvaluate the initial itraconazole serum trough concentrations after the administration of oral capsule of itraconazole for the treatment of CPA.MethodsThe measurement was performed at least 7-days after initiation of therapy. The standard treatment at our institution was a 200 mg capsule every 12 h. We defined that an adequate serum trough concentration of itraconazole during treatment was 1-4 mg/L.ResultsThis study recruited 28 patients. The median value was 0.30 mg/L (IQR 0.01-0.70). Only 11% (n = 3) had adequate serum concentrations based on guideline recommendation. All patients with clinical deterioration had itraconazole serum levels <= 0.8 mg/L.ConclusionThe initial serum concentrations of itraconazole after capsule formulation administration were low. Increasing the dose should be considered when the itraconazole concentration is low, especially if it is <= 0.8 mg/L, and the patient presents with clinical deterioration. Larger studies are needed to evaluate the adequate concentrations recommended for CPA.
- Sensitivity of Antigen, Serology, and Microbiology Assays for Diagnosis of the Subtypes of Chronic Pulmonary Aspergillosis at a Teaching Hospital in Sao Paulo, Brazil(2023) OLIVEIRA, Vitor Falcao de; VIANA, Joshua Araujo; SAWAMURA, Marcio Valente Yamada; MAGRI, Adriana Satie Goncalves Kono; COSTA, Andre Nathan; ABDALA, Edson; MARIANI, Alessandro Wasum; BENARD, Gil; MAGRI, Marcello Mihailenko ChavesChronic pulmonary aspergillosis (CPA) is divided into five subtypes. The diagnosis of CPA is complicated due to poor sensitivity of the laboratory tests. Diagnostic performance of different antigen, serological, and microbiologi-cal methods in subtypes of CPA is unknown. The purpose of this study was to evaluate the diagnostic performance in different subtypes of CPA. A total of 91 participants with CPA were included, and the study was performed at Hospital das Clinicas of University of Sao Paulo. Bronchoalveolar lavage galactomannan (73%, 11/15), serology by immunodiffu-sion test (81%, 61/75), and histology (78%, 39/50) had the best sensitivity. The counterimmunoelectrophoresis (CIE) titers had a significant statistical difference between the CPA subtypes (P < 0.001), in which the forms chronic fibrosing pulmonary aspergillosis (CFPA) and subacute invasive aspergillosis (SAIA) had higher titers: 1/64 (interquartile range [IQR]: 1/32-1/256) and 1/64 (1/32-1/128).C-reactive protein generally presented lower values (median 15 mg/L, IQR: 6-33), with higher values in SAIA and lower values for Aspergillus nodule. Overall, we found a low diagnostic sensitivity of current tests. Regarding the CPA subtypes, we did not find great differences in the performance of the tests, but it is observed that the inflammatory markers and CIE titers tend to be higher in forms of the more extensive lung parenchyma involvement, such as SAIA and CFPA.
- Chronic Meningitis and Hydrocephalus due to Sporothrix brasiliensis in Immunocompetent Adults: A Challenging Entity(2018) MIALSKI, Rafael; OLIVEIRA JR., Joao Nobrega de; SILVA, Larissa Honorato da; KONO, Adriana; PINHEIRO, Rosangela Lameira; TEIXEIRA, Manoel Jacobsen; GOMES, Renata Rodrigues; QUEIROZ-TELLES, Flavio de; PINTO, Fernando Gomes; BENARD, GilChronic meningitis caused by Sporothrix sp. is occasionally described in immunosuppressed patients. We report the challenges in diagnosing and managing 2 nonimmunocompro-mised patients with hydrocephalus and chronic meningitis caused by Sporothrix brasiliensis. This more virulent species appears to contribute more atypical and severe cases than other related species.
- Polymorphism in the Promoter Region of theIL18Gene and the Association With Severity on Paracoccidioidomycosis(2020) SATO, Paula Keiko; BUSSER, Felipe Delatorre; CARVALHO, Flavia Mendes da Cunha; SANTOS, Alexandra Gomes dos; SADAHIRO, Aya; DIOGO, Constancia Lima; KONO, Adriana Satie Goncalves; MORETTI, Maria Luiza; LUIZ, Olinda do Carmo; SHIKANAI-YASUDA, Maria AparecidaParacoccidioidomycosis (PCM) is an important endemic, systemic disease in Latin America caused byParacoccidioidesspp. This mycosis has been associated with high morbidity and sequels, and its clinical manifestations depend on the virulence of the infecting strain, the degree and type of immune response, infected tissues, and intrinsic characteristics of the host. The T helper(Th)1 and Th17/Th22 cells are related to resistance and control of infection, and a Th2/Th9 response is associated with disease susceptibility. In this study, we focused on interleukin(IL)-12p35 (IL12A), IL-18 (IL18), and IFN-gamma receptor 1 (IFNGR1) genetic polymorphisms because their respective roles have been described in human PCM. Real-time PCR was employed to analyzeIL12A-504 G/T (rs2243115),IL18-607 C/A (rs1946518), andIFNGR1-611 A/G (rs1327474) single nucleotide polymorphisms (SNP). One hundred forty-nine patients with the acute form (AF), multifocal chronic (MC), or unifocal chronic (UC) forms of PCM and 110 non-PCM individuals as a control group were included. In the unconditional logistic regression analysis adjusted by ethnicity and sex, we observed a high risk of theIL18-607A-allele for both AF [p= 0.015; OR = 3.10 (95% CI: 1.24-7.77)] and MC groups [p= 0.023; OR = 2.61 (95% CI: 1.14-5.96)] when compared with UC. TheIL18-607A-allele associated risk for the AF and MC groups as well as the protective role of theC-allele in UC are possibly linked to higher levels of IL-18 at different periods of the course of the disease. Therefore, a novel role ofIL18-607 C/A SNP is shown in the present study, highlighting its importance in the outcome of PCM.
- Polymorphisms on IFNG, IL12B and IL12RB1 genes and paracoccidioidomycosis in the Brazilian population(2016) CARVALHO, F. M. C.; BUSSER, F. D.; FREITAS, V. L. T.; FURUCHO, C. R.; SADAHIRO, A.; KONO, A. S. G.; CRIADO, P. R.; MORETTI, M. L.; SATO, P. K.; SHIKANAI-YASUDA, M. A.Paracoccidioidomycosis (PCM) is a systemic chronic mycosis, endemic in Latin America, especially Brazil, and is the eighth leading cause of death among chronic and recurrent infectious diseases. PCM infection is characterized by the presence of Th1 immune response; the acute form, by a mixed Th2/Th9, while the chronic form is characterized by Th17/Th22 profiles. The occurrence and severity of human PCM may also be associated with genetic factors such as single nucleotide polymorphisms (SNP) on cytokines encoding genes. We investigated the association between these polymorphisms and the different clinical forms of PCM. We included 156 patients with PCM(40 with the acute form, 99 with the chronic multifocal and 17 with the chronic unifocal form) and assayed their DNA samples for IFNG + 874 T/A SNP by PCR-ARMS (Amplification Refractory Mutational System), IL12B + 1188 A/C SNP on 3' UTR and IL12RB1 641 A/G SNP on exon 7 by PCR-RFLP (Restriction Fragment Length Polymorphism). We found similar genotypic and allelic frequencies of the investigated SNPs among the clinical forms of PCM. Considering male patients, the IL12RB1 641 AA genotype was more frequent in the chronic multifocal form while heterozygosis was in the chronic unifocal form of PCM (p = 0.048). Although our data suggest that the AA genotype (IL12RB1) may be associated with the more disseminated chronic disease, more patients of the chronic unifocal PCM group need to be analyzed as well as the secretion patterns of IFN-gamma combined with the IL-12R beta 1 expression for a better comprehension of this association.
- Brazilian guidelines for the clinical management of paracoccidioidomycosis(2017) SHIKANAI-YASUDA, Maria Aparecida; MENDES, Rinaldo Poncio; COLOMBO, Arnaldo Lopes; QUEIROZ-TELLES, Flavio de; KONO, Adriana Satie Goncalves; PANIAGO, Anamaria M. M.; NATHAN, Andre; VALLE, Antonio Carlos Francisconi do; BAGAGLI, Eduardo; BENARD, Gil; FERREIRA, Marcelo Simao; TEIXEIRA, Marcus de Melo; SILVA-VERGARA, Mario Leon; PEREIRA, Ricardo Mendes; CAVALCANTE, Ricardo de Souza; HAHN, Rosane; DURLACHER, Rui Rafael; KHOURY, Zarifa; CAMARGO, Zoilo Pires de; MORETTI, Maria Luiza; MARTINEZ, RobertoParacoccidioidomycosis is a systemic fungal disease occurring in Latin America that is associated with rural environments and agricultural activities. However, the incidence and prevalence of paracoccidiodomycosis is underestimated because of the lack of compulsory notification. If paracoccidiodomycosis is not diagnosed and treated early and adequately, the endemic fungal infection could result in serious sequelae. While the Paracoccidioides brasiliensis (P. brasiliensis) complex has been known to be the causal agent of paracoccidiodomycosis, a new species, Paracoccidioides lutzii (P. lutzii), has been reported in Rondonia, where the disease has reached epidemic levels, and in the Central West and Para. Accurate diagnoses and availability of antigens that are reactive with the patients' sera remain significant challenges. Therefore, the present guidelines aims to update the first Brazilian consensus on paracoccidioidomycosis by providing evidence-based recommendations for bedside patient management. This consensus summarizes etiological, ecoepidemiological, molecular epidemiological, and immunopathological data, with emphasis on clinical, microbiological, and serological diagnosis and management of clinical forms and sequelae, as well as in patients with comorbidities and immunosuppression. The consensus also includes discussion of outpatient treatments, severe disease forms, disease prevalence among special populations and resource-poor settings, a brief review of prevention and control measures, current challenges and recommendations.
- Chronic Meningitis and Hydrocephalus due to Sporothrix brasiliensis in Immunocompetent Adults: A Challenging Entity (vol 5, ofy081, 2018)(2018) MIALSKI, Rafael; ALMEIDA JR., Joao Nobrega de; SILVA, Larissa Honorato da; KONO, Adriana; PINHEIRO, Rosangela Lameira; TEIXEIRA, Manoel Jacobsen; GOMES, Renata Rodrigues; QUEIROZ-TELLES, Flavio de; PINTO, Fernando Gomes; BENARD, Gil
- Bloodstream infection caused by extensively drug-resistant Acinetobacter baumannii in cancer patients: high mortality associated with delayed treatment rather than with the degree of neutropenia(2016) FREIRE, M. P.; GARCIA, D. de Oliveira; GARCIA, C. P.; BUENO, M. F. Campagnari; CAMARGO, C. H.; MAGRI, A. S. G. Kono; FRANCISCO, G. R.; REGHINI, R.; VIEIRA, M. F.; IBRAHIM, K. Y.; ROSSI, F.; HAJJAR, L.; LEVIN, A. S.; HOFF, P. M.; PIERROTTI, L. C.; ABDALA, E.This study aimed to describe severe infections with extensively drug-resistant Acinetobacter baumannii-calcoaceticus complex (XDR-ABC), as well as to investigate risk factors for mortality, in cancer patients. It was a retrospective study including all patients diagnosed with XDR-ABC bacteraemia during hospitalization in the intensive care unit of a cancer hospital between July 2009 and July 2013. Surveillance cultures were collected weekly during the study period, and clonality was analysed using pulsed field gel electrophoresis (PFGE). We analysed underlying diseases, oncology therapy, neutrophil counts, infection site and management of infection, in terms of their correlation with 30-day mortality. During the study period, 92 patients with XDR-ABC bacteraemia were identified, of whom 35 (38.0%) were patients with haematological malignancy. We identified XDR-ABC strains with four different profile patterns, 91.3% of patients harbouring the predominant PFGE type. Of the 92 patients with XDR-ABC bacteraemia, 66 (71.7%) had central line-associated bloodstream infections; infection occurred during neutropenia in 22 (23.9%); and 58 (63.0%) died before receiving the appropriate therapy. All patients were treated with polymyxin, which was used in combination therapy in 30 of them (32.4%). The 30-day mortality rate was 83.7%. Multivariate analysis revealed that septic shock at diagnosis of XDR-ABC infection was a risk factor for 30-day mortality; protective factors were receiving appropriate therapy and invasive device removal within the first 48 h. Among cancer patients, ineffective management of such infection increases the risk of death, more so than do features such as neutropenia and infection at the tumour site.
bookPart Micoses Sistêmicas(2016) YASUDA, Maria Aparecida Shikanai; KONO, Adriana Satie Gonçalves; LáZARI, Carolina dos Santos; MIMICOS, Evanthia Vetos; MAGRI, Marcello Mihailenko Chaves; YOSHIDA, Márcia; CORRêA, Maria Cássia Jacintho Mendes; DUARTE, Maria Irma Seixas; BATISTA, Marjorie Vieria