RESUMEN
We report the first case of Tintelnotia destructans associated keratitis in a contact lens wearer in Australia. Corneal scrape showed fungal elements on direct microscopy leading to a prompt diagnosis of fungal keratitis and early topical and systemic antifungal therapy. The isolate was eventually identified by ITS gene sequencing. This case highlights the importance of accurate identification and antifungal susceptibility testing for the management of fungal keratitis.
RESUMEN
BACKGROUND.: Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success. METHODS.: A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy. RESULTS.: Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using ß-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with ß-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34). CONCLUSIONS.: This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of ß-lactams are confirmed and maybe also a potential benefit from adding rifampin.
Asunto(s)
Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/terapia , Infecciones Relacionadas con Prótesis/terapia , Infecciones Estreptocócicas/terapia , Anciano , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Artritis Infecciosa/microbiología , Artritis Infecciosa/mortalidad , Biopelículas/efectos de los fármacos , Desbridamiento , Femenino , Humanos , Internacionalidad , Masculino , Pronóstico , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/mortalidad , Estudios Retrospectivos , Rifampin/administración & dosificación , Rifampin/uso terapéutico , Terapia Recuperativa , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus agalactiae/aislamiento & purificación , Insuficiencia del Tratamiento , beta-Lactamas/administración & dosificación , beta-Lactamas/uso terapéuticoRESUMEN
Buruli ulcer (BU) is a necrotizing infection of skin and soft tissue caused by Mycobacterium ulcerans. In Australia, most cases of BU are linked to temperate, coastal Victoria and tropical, northern Queensland, and strains from these regions are distinguishable by variable-number tandem repeat (VNTR) typing. We present an epidemiological investigation of five patients found to have been infected during interstate travel and describe two nucleotide polymorphisms that differentiate M. ulcerans strains from northern Australia.
Asunto(s)
Úlcera de Buruli/epidemiología , Tipificación Molecular , Mycobacterium ulcerans/clasificación , Mycobacterium ulcerans/genética , Polimorfismo Genético , Viaje , Adulto , Anciano , Australia/epidemiología , Úlcera de Buruli/microbiología , Úlcera de Buruli/patología , Análisis por Conglomerados , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Epidemiología Molecular , Mycobacterium ulcerans/aislamiento & purificación , FilogeniaAsunto(s)
Virus del Dengue/aislamiento & purificación , Dengue/transmisión , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Exposición Profesional , Médicos , Viaje , Adulto , Australia/epidemiología , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/virología , Dengue/diagnóstico , Dengue/epidemiología , Dengue/virología , Virus del Dengue/clasificación , Virus del Dengue/genética , Virus del Dengue/inmunología , Femenino , HumanosRESUMEN
We describe a simple trap modification for testing volatile attractants to collect flying mosquitoes. The trap uses a standard Centers for Disease Control and Prevention trap modified for release of test chemicals. Test chemicals and other materials can be added and removed easily without spills or cross contamination. In preliminary studies using lactic acid and octenol, modified traps collected 40% more mosquitoes than controls (n = 164 and n = 117, respectively). Modifications cost less than $2.00 per trap.