VITOR FALCAO DE OLIVEIRA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
PAHC, Hospital das Clínicas, Faculdade de Medicina - Médico
PAHC, Hospital das Clínicas, Faculdade de Medicina - Médico
7 resultados
Resultados de Busca
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- 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.
- Orthopedic infections due to Trichosporon species: Case series and literature review(2022) LOPEZ, Andres; NETO, Luiz Alves da Silva; OLIVEIRA, Vitor Falcao de; CARVALHO, Vladimir Cordeiro de; OLIVEIRA, Priscila Rosalba Domingos de; LIMA, Ana Lucia Lei MunhozReports of orthopedic fungal infections caused by Trichosporon species are extremely scarce, thus we aimed to describe a case series and review the cases published in the literature. Patients were retrospectively included if a previous culture of bone, joint, or soft tissues had resulted positive for Trichosporon species along with a clinical diagnosis of an orthopedic infection. Eight patients were included with diverse orthopedic conditions, most of them cases of osteomyelitis. The main isolated species was Trichosporon asahii. All patients were treated with antifungals, mainly voriconazole, and surgical management, resulting in high rates of clinical improvement and low associated mortality. Lay Summary Reports of orthopedic infections caused by Trichosporon species are scarce. We described a case series of orthopedic infections caused by Trichosporon species and reviewed the previous published cases in the literature. We observed a high rate of clinical improvement and a low associated mortality.
- Clinical, radiological and laboratory characteristics of central nervous system histoplasmosis: A systematic review of a severe disease(2023) OLIVEIRA, Vitor Falcao de; KRUSCHEWSKY, Wdson Luis Lima; SEKIGUCHI, William Kazunori; COSTA, Silvia F. F.; LEVIN, Anna S. S.; MAGRI, Marcello Mihailenko Chaves; SILVA, Guilherme DiogoBackgroundThe knowledge of central nervous system (CNS) histoplasmosis is limited to case reports and series. ObjectivesOur objective was to synthesise clinical, radiological and laboratory characteristics of CNS histoplasmosis to improve our understanding of this rare disease. MethodsWe performed a systematic review using Pubmed/MEDLINE, Embase and LILACS databases accessed on March 2023 without publication date restrictions. Inclusion criteria comprised: (1) histopathological, microbiological, antigen or serological evidence of histoplasmosis; (2) CNS involvement based on cerebrospinal fluid pleocytosis or neuroimaging abnormalities. We classified the certainty of the diagnosis in proven (CNS microbiological and histopathological confirmation), probable (CNS serological and antigen confirmation) or possible (non-CNS evidence of histoplasmosis). Metaproportion was used to provide a summary measure with 95% confidence intervals for the clinical, radiological and laboratory characteristics. Chi-squared test was used to compare mortality between pairs of antifungal drugs. ResultsWe included 108 studies with 298 patients. The median age was 31 years, predominantly male, and only 23% were immunocompromised (134/276, 95%CI: 3-71), mainly due to HIV infection. The most common CNS symptom was headache (130/236, 55%, 95%CI: 49-61), with a duration predominantly of weeks or months. Radiological presentation included histoplasmoma (79/185, 34%, 95%CI: 14-61), meningitis (29/185, 14%, 95%CI: 7-25), hydrocephalus (41/185, 37%, 95%CI: 7-83) and vasculitis (18/185, 6%, 95%CI: 1-22). There were 124 proven cases, 112 probable cases and 40 possible cases. The majority of patients presented positive results in CNS pathology (90%), serology (CSF: 72%; serum: 70%) or CSF antigen (74%). Mortality was high (28%, 56/198), but lower in patients who used liposomal amphotericin B and itraconazole. Relapse occurred in 13% (23/179), particularly in HIV patients, but less frequently in patients who used itraconazole. ConclusionCentral nervous system histoplasmosis usually presents subacute-to-chronic symptoms in young adults. Neuroimaging patterns included not only focal lesions but also hydrocephalus, meningitis and vasculitis. Positive results were commonly found in CSF antigen and serology. Mortality was high, and treatment with liposomal amphotericin B followed by itraconazole may decrease mortality.
- Systematic review of neuroparacoccidioidomycosis: The contribution of neuroimaging(2023) OLIVEIRA, Vitor Falcao de; MAGRI, Marcello Mihailenko Chaves; LEVIN, Anna S.; SILVA, Guilherme DiogoBackground Advanced neuroimaging demonstrated that neurological involvement occurs in up to 30% of paracoccidioidomycosis (PCM) cases. Current knowledge of neuroparacoccidioidomycosis (NPCM) is based on a 2009 systematic review. However, in the last decade, several new cases have been published, with modern neuroimaging techniques. Objectives We believe a new systematic review is needed to summarise these advances. Methods We searched PubMed/MEDLINE, Embase and LILACS for studies from January 2010 to May 2022. Case series and case reports of NPCM were included. We performed a metaproportion to estimate a summary proportion with 95% confidence intervals (CI). Results Thirty-four studies including 104 patients were evaluated. We combined our data with the results from the previous review that included 257 cases, totalling 361 patients. We found no new important demographic, clinical or laboratory characteristics. On magnetic resonance imaging (MRI), we found that 72% (95%CI: 38-91) had hyperintensity on T1-weighted image; 84% (95%CI: 71%-92%) had hypointensity on T2-weighted image; 80% (95%CI: 66-89) had contrast enhancement with the classical ring-enhancing pattern. All 8 patients undergoing spectroscopy presented lipid peaks. We found a 16% mortality, lower than in the previous review (44%). Conclusion NPCM presents a characteristic pattern on MRI that may help to differentiate it from other causes of single or multiple brain lesions. Albeit there is a frequent pattern, it is not specific, as other granulomatous diseases may show similar findings. Advances in neuroimaging with early diagnosis and appropriate management of the disease may have contributed to reducing its mortality.
- Clinical characteristics, diagnosis, and treatment of central nervous system sporotrichosis: Systematic review and meta-analysis(2024) OLIVEIRA, Vitor Falcao de; PETRUCCI, Julia Figueiredo; TABORDA, Mariane; BRENER, Pedro Zanetta; KREMER, Pedro Guilherme De Barros Brito; RANDI, Bruno Azevedo; MAGRI, Adriana Satie Goncalves Kono; MAGRI, Marcello Mihailenko Chaves; LEVIN, Anna S.; SILVA, Guilherme DiogoBackgroundThe clinical features of central nervous system (CNS) sporotrichosis are derived from case reports and a limited series of cases. Our objective was to carry out a systematic review and meta-analysis of CNS sporotrichosis.MethodsWe searched PubMed/MEDLINE, Embase, Scopus, and LILACS on 9 September 2023. Our inclusion criteria were documentation of Sporothrix and demonstrated CNS involvement. A metaproportion or metamean analysis was performed to estimate a summary proportion with 95% confidence intervals.ResultsWe included 52 cases of CNS sporotrichosis published from 1966 to 2023. Forty-six patients were male (88%, 95% CI: 77-95), and the mean age was 39 years (95% CI: 36-43). Close contact with cats was reported in 55% of cases (95% CI: 37-72). Thirty-two (61.5%) patients were from Brazil, 18 patients from the United State of America (34.6%). Only two Sporothrix species were reported: S. schenckii (26/41, 63%), and S. brasiliensis (15/41, 37%). The most common neurological symptom was headache. Meningitis was chronic in approximately 80% of cases. A significant majority of the patients were immunocompromised. HIV infection was the primary cause of immunosuppression (85%, 95% CI: 61-95). Overall mortality was 56% (22/39). The comparison of Kaplan-Meier survival curve showed a higher mortality with a statistically significant difference in immunosuppressed patients (p = .019).ConclusionCNS sporotrichosis represents a notable cause of chronic meningitis, especially in individuals living in the Americas with HIV infection and concurrent skin lesions.
- Challenges, Characteristics, and Outcomes of Chronic Pulmonary Aspergillosis: A 11-Year Experience in A Middle-Income Country(2023) OLIVEIRA, Vitor Falcao de; VIANA, Joshua Araujo; SAWAMURA, Marcio Valente Yamada; MAGRI, Adriana Satie Goncalves Kono; BENARD, Gil; COSTA, Andre Nathan; ABDALA, Edson; MARIANI, Alessandro Wasum; MAGRI, Marcello Mihailenko ChavesObjectives Chronic pulmonary aspergillosis (CPA) is a research priority in fungal diseases with a need for new studies to reduce misdiagnosis with more common diseases, discuss improvement in diagnostic methods and better characterize gaps in antifungal and surgical treatments to improve clinical outcomes. Methods In this retrospective study, we reviewed medical records of patients diagnosed with CPA from January 2010 to June 2021 at University of Sao Paulo, Sao Paulo, Brazil. We evaluated clinical characteristics, radiological findings, serology, treatment, and outcomes. Results The study included 91 participants, with 43 (47.3%) patients who underwent surgery and 69 (75.8%) received antifungal therapy. We found a predominance of middle-aged adults (median 51 years), males (n = 58, 64%) with lower BMI (median 21.3 kg/m(2)). The most common underlying lung disease was pulmonary tuberculosis (n = 70, 76.9%). The commonest symptoms were cough (n = 67, 74%), haemoptysis, and dyspnea (n = 63, 70%). The most common chest computerized tomography abnormalities were cavity (n = 86, 94.5%), with a predominance of mycetomas (n = 78, 91%). The serology was positive in 81% (61/75). The one-year mortality was low (3.3%). Clinical improvement and stability occurred in 89% of participants for constitucional symptoms and 86% for pulmonary symptoms. While serological improvement and stability occurred in 71%. Radiological improvement and stability occurred in 75%. Conclusion We observed a good outcome after 1-year follow-up, in which the majority had improvement or stability of pulmonary and constitutional symptoms, decrease in CIE titers and low mortality.
- A Rare Association of Chronic Pulmonary Aspergillosis and Pulmonary Cryptococcosis as an Underlying Risk Factor(2023) SEKIGUCHI, William Kazunori; ALBUQUERQUE, Ronniel Morais; RAPOZO, Marjorie Marini; POLLY, Matheus; NASTRI, Ana Catharina de Seixas Santos; MAGRI, Marcello Mihailenko Chaves; OLIVEIRA, Vitor Falcao de; BERNARDI, Fabiola del Carlo; SOTTO, Mirian Nacagami