RESUMEN
A 37-year-old man in a status epilepticus due to meningitis was admitted to Intensive Care because of respiratory insufficiency. Spinal fluid culture yielded Streptococcus salivarius. Despite extensive diagnostics, the source of this bacterium could not be found. However, the patient had recently undergone spinal anaesthesia for surgery on a toe ulcer, from which other bacteria were cultured. The patient died 2 weeks after admission with a picture of multiple organ failure. Bacterial meningitis following spinal anaesthesia may be the result of impairment of the blood-brain barrier due to a sudden drop of spinal fluid pressure during the puncture, or of the introduction of bacteria from the hair follicles or from a haematoma caused by the needle or the introducer. Hygienic measures and a proper technique when performing regional anaesthesia are important in preventing the dissemination of bacteria.
Asunto(s)
Anestesia Raquidea/efectos adversos , Meningitis Bacterianas/etiología , Infecciones Estreptocócicas/etiología , Adulto , Resultado Fatal , Humanos , Masculino , Insuficiencia Multiorgánica , Streptococcus/aislamiento & purificaciónRESUMEN
OBJECTIVE: To examine the association between Kaposi's sarcoma (KS), human herpes virus 8 (HHV8) and AIDS dementia complex (ADC). DESIGN: A total of 599 HIV-1 infected homosexual men participated in a prospective cohort study (Amsterdam, 1984-1996). METHODS: The risk for ADC in patients with prior KS or HHV8 infection was estimated using the Cox proportional hazards method with adjustments for antiretroviral medication and low CD4 cell counts. RESULTS: Of the 599 participants, 290 (48.4%) had HHV8 antibodies, 99 (16.5%) had KS and 30 (5.0%) had ADC. ADC was diagnosed in 5.2% of participants with KS and 5.0% of those without KS, and in 4.8% of HHV8 seropositive compared to 5.2% seronegative individuals and thus was not associated with KS or HHV8 infection. Using a time-dependent Cox proportional hazards analysis with the date of KS as risk factor, the risk for ADC was 2.7 [95% confidence interval (CI), 0.92-7.96; P = 0.07) and when only definite ADC was considered it was 3.5 (95% CI, 1.00-12.26;P = 0.05). After adjusting for decreases in CD4 cell count and use of medication, the hazards ratio for participants with KS to develop ADC was 2.0 (95% CI, 0.66-5.77; P = 0.23) and 2.6 (95% CI, 0.73-9.12; P = 0.14), respectively. HHV8 seropositivity, adjusted for the same variables, showed a risk for ADC of 0.85 (95% CI, 0.41-1.77;P = 0.66) and for definite ADC 0.69 (95% CI, 0.27-1.73; P = 0.42). The expected neuroprotective effects of antiretroviral medication were observed. CONCLUSIONS: KS or HHV8 does not significantly influence the risk for developing ADC in a group with a uniform risk for developing KS therefore we recommend caution in searching for a KS-associated or HHV8-derived therapy for ADC.
Asunto(s)
Complejo SIDA Demencia/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones por Herpesviridae/epidemiología , Herpesvirus Humano 8/inmunología , Homosexualidad Masculina , Sarcoma de Kaposi/epidemiología , Complejo SIDA Demencia/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Anticuerpos Antivirales/sangre , Estudios Transversales , Anticuerpos Anti-VIH/sangre , VIH-1/inmunología , Infecciones por Herpesviridae/diagnóstico , Humanos , Masculino , Estudios Prospectivos , Factores de Riesgo , Sarcoma de Kaposi/diagnósticoRESUMEN
The UV dose-response behavior of laboratory cultures of waterborne bacteria were examined for UV doses ranging from ca. 0-100 mW.s/cm2 using a collimated-beam reactor. Specific physiological responses measured in these tests included viability (ability to reproduce) and respiration (oxygen uptake rate). The results of these exposures indicated that resistance to UV-imposed loss of viability in E. coli cultures can be partially attributed to agglomeration during the irradiation process. From these results, it is conjectured that a bacterial population may be comprised of two sub-populations: one with low resistance (discrete or paired cells) and a second with high resistance (bacterial aggregates). A small fraction of the high-resistance portion of the population appears to be essentially unaffected by UV irradiation, thereby causing a discontinuity in the measured dose-response behavior. Moreover, the dose-response behavior of the highly resistant fraction is variable and difficult to describe quantitatively. The basis of these statements and most information in the literature is microbial viability as quantified by the membrane filtration assay. In contrast to these findings, the results of analyses for bacterial activity (respiration) suggest that comparatively little change in the population can be found to result from UV irradiation. This suggests that UV radiation accomplishes inactivation of the bacteria, but does not "kill" the bacterial cells per se, thereby highlighting the importance of considering bacterial repair processes in the design of UV disinfection systems.
Asunto(s)
Bacterias/efectos de la radiación , Rayos Ultravioleta , Bacterias/citología , Desinfección/métodos , Relación Dosis-Respuesta en la Radiación , Enterobacteriaceae/citología , Enterobacteriaceae/efectos de la radiación , Microbiología del Agua , Abastecimiento de AguaRESUMEN
We report on a case of phaeohyphomycosis caused by Alternaria infectoria in a renal transplant recipient with pulmonary infiltrates and multiple skin lesions. Diagnosis was based on microscopy and culture of the skin lesions. Treatment consisted of a combination of surgical excision and systemic antifungal therapy, first with itraconazole and subsequently with liposomal amphotericin B, for 39 days. At a 20-month follow-up visit, no recurrence of the skin lesions or the pulmonary infiltrates had occurred.
Asunto(s)
Alternaria/aislamiento & purificación , Dermatomicosis/microbiología , Huésped Inmunocomprometido , Trasplante de Riñón , Micosis/microbiología , Dermatomicosis/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Micosis/diagnóstico , Piel/microbiologíaRESUMEN
Streptococcus suis infection is a zoonosis that has been mainly reported in pig-rearing and pork-consuming countries. The most common disease manifestation is meningitis, often associated with cochleovestibular signs. The causative agent is Streptococcus suis serotype 2, found as a commensal in the tonsils of its natural host, the pig. Persons at risk are mostly those with an occupational exposure to domestic pigs or their meat products. A case of meningitis caused by Streptococcus suis in a poacher who had killed and butchered a wild boar is reported. It appears that wild boar hunters are at additional risk of contracting the disease.
Asunto(s)
Meningitis Bacterianas/diagnóstico , Infecciones Estreptocócicas/transmisión , Streptococcus suis , Enfermedades de los Porcinos/transmisión , Zoonosis , Animales , Animales Salvajes , Humanos , Masculino , Meningitis Bacterianas/microbiología , Persona de Mediana Edad , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/veterinaria , Porcinos , Enfermedades de los Porcinos/microbiologíaRESUMEN
BACKGROUND: The finding of antibodies against human herpesvirus 8 (HHV-8) is associated with the occurrence of Kaposi's sarcoma in persons infected with HIV. However, the predictive value of HHV-8 antibodies for Kaposi's sarcoma in HIV infection is unknown. METHODS: The Amsterdam Cohort Studies on HIV infection and AIDS started in 1984 for homosexual men and in 1985 for injecting drug users. Serum samples from 1459 homosexual men and 1167 drug users were tested for antibodies to recombinant HHV-8 lytic-phase capsid (ORF65) antigen and latent-phase nuclear (ORF73) antigen. Individuals were retrospectively identified as HHV-8-positive or HHV-8-negative at enrolment or HHV-8 seroconverter during the study. Kaposi's sarcoma-free survival time was compared between HIV-infected men who were positive for HHV-8 at enrolment and those who later seroconverted for HHV-8. Hazard ratios were estimated for Kaposi's sarcoma, lymphoma, and opportunistic infection according to the HHV-8 serostatus. RESULTS: The incidence of HHV-8 seroconversion among drugs users was 0.7 per 100 person-years based on 31 seroconversions, whereas an incidence of 3.6 was found among homosexual men based on 215 seroconversions. The hazard ratio for Kaposi's sarcoma was 3.15 (95% CI: 1.89-5.25) in HIV-infected individuals if HHV-8 antibodies were present either at enrolment or at HIV seroconversion. In HIV-infected persons who later seroconverted to HHV-8, Kaposi's sarcoma developed more rapidly: hazard ratio of 5.04 (95% CI: 2.94-8.64), an additional risk of 1.60 (95% CI: 1.01-2.53; P = 0.04). Time-dependent adjustment for CD4+ cell count and HIV RNA had no impact on the additional risk, although the CD4+ cell count was an independent risk factor for Kaposi's sarcoma. HHV-8 infection did not increase the risk of AIDS-related lymphoma or opportunistic infections. CONCLUSIONS: The incidence of HHV-8 infection is higher in homosexual men than in drug users. The presence of HHV-8 antibodies in HIV-infected persons increases the risk of Kaposi's sarcoma. Among HIV-infected persons, those who subsequently seroconvert for HHV-8 are at highest risk. These results strongly confirm the causal role of HHV-8 in Kaposi's sarcoma and emphasize the clinical relevance of HHV-8 seroconversion before and after the HIV infection.