RESUMEN
Actinomycosis is a rare infection caused by Actinomyces spp. Of all actinomycosis infections, only 5% of Hepatic Actinomycosis (HA) infection has been reported. This disease is often misdiagnosed as a malignancy. This case report presents a 45-year-old woman with diabetes, initially suspected of intrahepatic cholangiocarcinoma, but after careful tissue staining, we found the results supported HA infection.
Asunto(s)
Actinomyces , Actinomicosis , Humanos , Actinomicosis/diagnóstico , Actinomicosis/microbiología , Actinomicosis/patología , Actinomicosis/tratamiento farmacológico , Femenino , Persona de Mediana Edad , Actinomyces/aislamiento & purificación , Hígado/patología , Hígado/microbiología , Hepatopatías/microbiología , Hepatopatías/diagnóstico , Hepatopatías/patología , Histocitoquímica , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To characterise commensal Escherichia coli and other Enterobacteriaceae with reduced susceptibility to cefotaxime that were collected in a large survey carried out among 3995 patients and healthy persons in two urban regions on Java, Indonesia, in 2001-2002. METHODS: The putative extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae were analysed using double-disk synergy tests, isoelectric focusing, PCR assays, DNA sequencing, and pulsed-field gel electrophoresis (PFGE). RESULTS: On the day of discharge after five or more days of hospitalisation, at least 95 of 999 (9.5%) patients carried ESBL-positive Enterobacteriaceae as dominant faecal flora. Six patients were simultaneously colonised with E. coli and Klebsiella pneumoniae isolates with ESBL activity. On admission, only 6 of 998 (0.6%) patients were colonised. Faecal carriage of ESBL-producing Enterobacteriaceae among healthy persons or persons visiting a public health centre was not detected. The 107 ESBL-positive strains included 68 E. coli, 35 K. pneumoniae, and four other Enterobacteriaceae. bla(CTX-M-15) was the most prevalent ESBL in both E. coli (47.1%) and K. pneumoniae (45.7%), but the E. coli O25b-ST131 clone was virtually absent. Other ESBL types found were: SHV-2, -2a, -5, -12, CTX-M-3, -9, -14, and TEM-19. PFGE revealed extensive genetic diversity among the isolates. CONCLUSIONS: In 2001-2002, faecal carriage of ESBL-producing Enterobacteriaceae as dominant flora in Indonesia was almost exclusively hospital-associated. The presence of various bla(ESBL) genes and the extensive genetic diversity among isolates argue against a single/dominant strain outbreak.
Asunto(s)
Infecciones por Escherichia coli/epidemiología , Escherichia coli/aislamiento & purificación , Heces/microbiología , Pacientes Internos/estadística & datos numéricos , Infecciones por Klebsiella/epidemiología , Klebsiella pneumoniae/aislamiento & purificación , beta-Lactamasas/aislamiento & purificación , Adulto , Análisis por Conglomerados , Electroforesis en Gel de Campo Pulsado , Escherichia coli/genética , Infecciones por Escherichia coli/microbiología , Femenino , Humanos , Indonesia/epidemiología , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/genética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Análisis de Secuencia de ADN , Adulto Joven , beta-Lactamasas/genéticaRESUMEN
BACKGROUND: No detailed reports regarding extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are currently available from Indonesia, the fourth most populous country in the world. METHODS: A survey was carried out to investigate the molecular epidemiology and genetic characteristics of clinical ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates originating from the Dr. Soetomo Academic Hospital in Surabaya, Indonesia, over a 4 month period (January to April 2005). ESBLs were characterized by isoelectric focusing and PCR assays. Clonality of the isolates was assessed by PFGE and repetitive-sequence-based PCR (rep-PCR). Phylogenetic grouping was performed among CTX-M-15-producing E. coli. RESULTS: In total, 73 consecutive non-duplicate ESBL-positive E. coli and 72 K. pneumoniae strains were isolated. The bla(CTX-M-15) gene was found to be highly prevalent (69/73 strains, 94.5%) among the 73 ESBL-positive E. coli isolates. The gene was detected in both clonal and non-clonal isolates, as defined by PFGE and rep-PCR. Sixteen CTX-M-15-positive E. coli could be assigned to a single rep-PCR type and phylogenetic group B2 and belonged to the well-known O25b-ST131 clone. Among the 72 ESBL-positive K. pneumoniae isolates, bla(CTX-M-15) was again the most prevalent ESBL (40/72, 55.6%). Several SHV-type enzymes were also frequently detected: SHV-5 (n = 28); SHV-12 (n = 13); and SHV-2 (n = 6). TEM-type ESBLs were not detected in any of the isolates. CONCLUSIONS: Indonesia is another developing country affected by the emergence and spread of bacterial strains harbouring ESBL genes, including the CTX-M-15-producing B2-E. coli O25b-ST131 clone.
Asunto(s)
Infecciones por Escherichia coli/microbiología , Escherichia coli/enzimología , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/enzimología , beta-Lactamasas/química , beta-Lactamasas/genética , Técnicas de Tipificación Bacteriana , Análisis por Conglomerados , Dermatoglifia del ADN , Electroforesis en Gel de Campo Pulsado , Escherichia coli/clasificación , Escherichia coli/genética , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/epidemiología , Genotipo , Hospitales Universitarios , Humanos , Indonesia/epidemiología , Infecciones por Klebsiella/epidemiología , Klebsiella pneumoniae/clasificación , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , Epidemiología MolecularRESUMEN
In a recent, population-based survey of 3,996 persons in Indonesia, fluoroquinolone (FQ)-resistant Escherichia coli was prevalent in the fecal flora of 6% of patients at hospital admission and 23% of patients at discharge, but not among healthy relatives or patients visiting primary healthcare centers (2%). Molecular typing showed extensive genetic diversity with only limited clonality among isolates. This finding suggests that independent selection of resistant mutants occurs frequently. FQ-resistant isolates exhibited a higher rate of spontaneous mutation, but sparser virulence profiles, than FQ-susceptible isolates from the same population. The resistant isolates belonged predominantly to phylogenetic groups A (57%) and B1 (22%) but also to the moderately virulent group D (20%). Hypervirulent strains from the B2 cluster were underrepresented (1%). Because FQ-resistant E. coli can cause disease, especially nosocomial infections in immunocompromised patients, spread of such strains must be stopped.