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Clinical Outcomes of Radical Surgery and Antimicrobial Agents in Vascular Pythiosis: A Multicenter Prospective Study
Vascular pythiosis is a rare, neglected, life-threatening disease with mortality of 100% in patients with incomplete surgical resection or patients with persistently elevated serum β-d-glucan (BDG). The study was conducted to understand the clinical outcomes of new treatment protocols and potential...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913857/ https://www.ncbi.nlm.nih.gov/pubmed/33557064 http://dx.doi.org/10.3390/jof7020114 |
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author | Torvorapanit, Pattama Chuleerarux, Nipat Plongla, Rongpong Worasilchai, Navaporn Manothummetha, Kasama Thongkam, Achitpol Langsiri, Nattapong Diewsurin, Jaruwan Kongsakpaisan, Prasopchai Bansong, Ratiporn Susaengrat, Nuttapon Wattanasoontornsakul, Watchara Chindamporn, Ariya Permpalung, Nitipong |
author_facet | Torvorapanit, Pattama Chuleerarux, Nipat Plongla, Rongpong Worasilchai, Navaporn Manothummetha, Kasama Thongkam, Achitpol Langsiri, Nattapong Diewsurin, Jaruwan Kongsakpaisan, Prasopchai Bansong, Ratiporn Susaengrat, Nuttapon Wattanasoontornsakul, Watchara Chindamporn, Ariya Permpalung, Nitipong |
author_sort | Torvorapanit, Pattama |
collection | PubMed |
description | Vascular pythiosis is a rare, neglected, life-threatening disease with mortality of 100% in patients with incomplete surgical resection or patients with persistently elevated serum β-d-glucan (BDG). The study was conducted to understand the clinical outcomes of new treatment protocols and potential use of erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) as alternative monitoring tools, given recent favorable minimum inhibitory concentrations (MICs) of antibacterial agents and prohibitive cost of serum BDG in Thailand. A prospective cohort study of patients with vascular pythiosis was conducted between February 2019 and August 2020. After diagnosis, patients were followed at 0.5, 1, 1.5, 3, and 6 months. Descriptive statistics, Spearman’s correlation coefficient, and general linear model for longitudinal data were used. Amongst the cohort of ten vascular pythiosis patients, four had residual disease after surgery. Among four with residual disease, one developed disseminated disease and died, one developed relapse disease requiring surgery, and two were successfully managed with antimicrobial agents. The spearman’s correlation coefficients between BDG and ESR, and between BDG and CRP in patients without relapse or disseminated disease were 0.65 and 0.60, respectively. Tetracyclines and macrolides had most favorable minimum inhibitory concentrations and synergistic effects were observed in combinations of these two antibiotic classes. Adjunctive use of azithromycin and doxycycline preliminarily improved survival in vascular pythiosis patients with residual disease. Further studies are needed to understand the trends of ESR and CRP in this population. |
format | Online Article Text |
id | pubmed-7913857 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-79138572021-02-28 Clinical Outcomes of Radical Surgery and Antimicrobial Agents in Vascular Pythiosis: A Multicenter Prospective Study Torvorapanit, Pattama Chuleerarux, Nipat Plongla, Rongpong Worasilchai, Navaporn Manothummetha, Kasama Thongkam, Achitpol Langsiri, Nattapong Diewsurin, Jaruwan Kongsakpaisan, Prasopchai Bansong, Ratiporn Susaengrat, Nuttapon Wattanasoontornsakul, Watchara Chindamporn, Ariya Permpalung, Nitipong J Fungi (Basel) Article Vascular pythiosis is a rare, neglected, life-threatening disease with mortality of 100% in patients with incomplete surgical resection or patients with persistently elevated serum β-d-glucan (BDG). The study was conducted to understand the clinical outcomes of new treatment protocols and potential use of erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) as alternative monitoring tools, given recent favorable minimum inhibitory concentrations (MICs) of antibacterial agents and prohibitive cost of serum BDG in Thailand. A prospective cohort study of patients with vascular pythiosis was conducted between February 2019 and August 2020. After diagnosis, patients were followed at 0.5, 1, 1.5, 3, and 6 months. Descriptive statistics, Spearman’s correlation coefficient, and general linear model for longitudinal data were used. Amongst the cohort of ten vascular pythiosis patients, four had residual disease after surgery. Among four with residual disease, one developed disseminated disease and died, one developed relapse disease requiring surgery, and two were successfully managed with antimicrobial agents. The spearman’s correlation coefficients between BDG and ESR, and between BDG and CRP in patients without relapse or disseminated disease were 0.65 and 0.60, respectively. Tetracyclines and macrolides had most favorable minimum inhibitory concentrations and synergistic effects were observed in combinations of these two antibiotic classes. Adjunctive use of azithromycin and doxycycline preliminarily improved survival in vascular pythiosis patients with residual disease. Further studies are needed to understand the trends of ESR and CRP in this population. MDPI 2021-02-04 /pmc/articles/PMC7913857/ /pubmed/33557064 http://dx.doi.org/10.3390/jof7020114 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Torvorapanit, Pattama Chuleerarux, Nipat Plongla, Rongpong Worasilchai, Navaporn Manothummetha, Kasama Thongkam, Achitpol Langsiri, Nattapong Diewsurin, Jaruwan Kongsakpaisan, Prasopchai Bansong, Ratiporn Susaengrat, Nuttapon Wattanasoontornsakul, Watchara Chindamporn, Ariya Permpalung, Nitipong Clinical Outcomes of Radical Surgery and Antimicrobial Agents in Vascular Pythiosis: A Multicenter Prospective Study |
title | Clinical Outcomes of Radical Surgery and Antimicrobial Agents in Vascular Pythiosis: A Multicenter Prospective Study |
title_full | Clinical Outcomes of Radical Surgery and Antimicrobial Agents in Vascular Pythiosis: A Multicenter Prospective Study |
title_fullStr | Clinical Outcomes of Radical Surgery and Antimicrobial Agents in Vascular Pythiosis: A Multicenter Prospective Study |
title_full_unstemmed | Clinical Outcomes of Radical Surgery and Antimicrobial Agents in Vascular Pythiosis: A Multicenter Prospective Study |
title_short | Clinical Outcomes of Radical Surgery and Antimicrobial Agents in Vascular Pythiosis: A Multicenter Prospective Study |
title_sort | clinical outcomes of radical surgery and antimicrobial agents in vascular pythiosis: a multicenter prospective study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913857/ https://www.ncbi.nlm.nih.gov/pubmed/33557064 http://dx.doi.org/10.3390/jof7020114 |
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