RESUMEN

Mucormycosis is a rare life-threatening opportunistic infection, with rhinocerebral mucormycosis (ROCM) being the most common presentation. Trichosporon asahii is an emerging pathogen that often causes fatal infections in patients with underlying hematologic malignancies due to its high drug resistance. We report a rare case of concomitant rhinocerebral mucormycosis and T. asahii fungemia secondary to Pseudomonas aeruginosa sepsis in a patient with neutropenia and acute lymphoblastic leukemia. A boy aged one year and two months was diagnosed with B-cell acute lymphoblastic leukemia on January 10 and underwent three courses of regular chemotherapy. He experienced neutropenia for 154 days and was hospitalized for vomiting, diarrhea and fever for 3 days. The day after hospitalization, Pseudomonas aeruginosa was isolated by blood culture and ceftazidime/avibactam was administered. Extracorporeal Membrane Oxygenation (ECMO) was used to provide continuous extracorporeal respiration and circulation for the patient. On day 8, the patient developed T. asahii fungemia. On day 10, he presented with necrotizing skin caused by Rhizopus delemar. He was treated with liposomal amphotericin B for Rhizopus delemar and voriconazole for T. asahii infection. Unfortunately, his health deteriorated and he died on day 11 due to the rapid progression of the infection and multiple organ failure. The management and treatment of such a complex infection requires a multidisciplinary approach and close monitoring of the patient's condition. Therefore, it is imperative to continue to research and report rare cases such as this to further understand the complexities of mucormycosis and trichosporidiosis coinfection and improve patient outcomes.

Asunto(s)

Coinfección , Fungemia , Mucormicosis , Leucemia-Linfoma Linfoblástico de Células Precursoras , Tricosporonosis , Humanos , Masculino , Mucormicosis/complicaciones , Mucormicosis/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Fungemia/microbiología , Fungemia/tratamiento farmacológico , Resultado Fatal , Coinfección/microbiología , Tricosporonosis/microbiología , Tricosporonosis/diagnóstico , Tricosporonosis/tratamiento farmacológico , Lactante , Infecciones Oportunistas/microbiología , Infecciones Oportunistas/complicaciones , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/microbiología , Infecciones por Pseudomonas/complicaciones , Antifúngicos/uso terapéutico , Basidiomycota

RESUMEN

Cystic fibrosis (CF) is a genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator gene that leads to respiratory complications and mortality. Studies have shown shifts in the respiratory microbiota during disease progression in individuals with CF. In addition, CF patients experience short cycles of acute intermittent aggravations of symptoms called pulmonary exacerbations, which may be characterized by a decrease in lung function and weight loss. The resident microbiota become imbalanced, promoting biofilm formation, and reducing the effectiveness of therapy. The aim of this study was to monitor patients aged 8-23 years with CF to evaluate their lower respiratory microbiota using 16S rRNA sequencing. The most predominant pathogens observed in microbiota, Staphylococcus (Staph) and Pseudomonas (Pseud) were correlated with clinical variables, and the in vitro capacity of biofilm formation for these pathogens was tested. A group of 34 patients was followed up for 84 days, and 306 sputum samples were collected and sequenced. Clustering of microbiota by predominant pathogen showed that children with more Staph had reduced forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) compared to children with Pseud. Furthermore, the patients' clinical condition was consistent with the results of pulmonary function. More patients with pulmonary exacerbation were observed in the Staph group than in the Pseud group, as confirmed by lower body mass index and pulmonary function. Additionally, prediction of bacterial functional profiles identified genes encoding key enzymes involved in virulence pathways in the Pseud group. Importantly, this study is the first Brazilian study to assess the lower respiratory microbiota in a significant group of young CF patients. In this sense, the data collected for this study on the microbiota of children in Brazil with CF provide a valuable contribution to the knowledge in the field.

Asunto(s)

Fibrosis Quística , Microbiota , Infecciones por Pseudomonas , Brasil , Niño , Fibrosis Quística/genética , Volumen Espiratorio Forzado , Humanos , Pulmón , Microbiota/genética , Pseudomonas/genética , Infecciones por Pseudomonas/complicaciones , ARN Ribosómico 16S/genética , Esputo/microbiología , Staphylococcus/genética

RESUMEN

Background: Osteomyelitis is defined as a bone inflammation involving the cortical and medullary regions, usually caused by the local invasion of opportunistic microorganisms. The inflammatory reaction of bone may extend to the periosteum and soft tissues, compromising adjacent structures far from the initially infected foci. Different classifications of transmission routes, gravity levels, and tissues involved in animal and human osteomyelitis are available. In humans, the infection can reach bone tissue by exogenous or hematogenous pathways. This paper reports an atypical case of mandibular pyogranulomatous osteomyelitis in an ewe caused by concomitant Pseudomonas aeruginosa and Lactococcus raffinolactis infection. Case: The animal presented a 1-month history of progressive mandibular enlargement refractory to conventional therapy. In a physical examination, an increased volume located in the ventrolateral region of the right ramus of the mandible was observed. Fine-needle aspiration of the lesion enabled isolation in bacteriological culture of Pseudomonas aeruginosa and Lactococcus raffinolactis using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDITOF MS). Besides support care procedures and antimicrobial treatment approaches for the sheep based on in vitro tests, the animal died due to the severity of the clinical signs and the progressive worsening of the general health status. The radiographic image examination of the mandibular region revealed a severe and infiltrative periodontal reaction, with a predominance of a great number of neutrophils and macrophages, necrotic areas, and bone destruction, characterized histologically as a pyogranulomatous rection. At post mortem examination, a large pyogranuloma was observed in the entire horizontal branch of the mandible as well, showing a dark yellowish content of coarse consistency, caseous appearance, and bone fragmentation. Discussion: Ovine mandibular osteomyelitis is a well-established bone inflammation involving the cortical and medullary regions, characterized clinically by local enlargement, asymmetry, pain sensitivity, edema, hyperthermia, infiltrate caseous or suppurative material, and bone rarefaction. In the current report, 1-month history of progressive enlargement of the mandibular region, prostration, and weight loss in an ewe were referred. Where clinical and epidemiological features, bacteriological, cytological, histological, and mass spectrometry diagnostic approaches were assessed to diagnostic. Most reports involving the etiology of ovine mandibular osteomyelitis have been diagnosed based on classical phenotypic tests. Here, the concomitant identification of P. aeruginosa and L. raffinolactis infection was possible using mass spectrometry (MALDI-TOF), highlighting the importance of molecular methods in the diagnosis of animal diseases. In addition, the differentiation between Lactococcus and Enterococcus species is difficult, which could underestimate the diagnosis of Lactococcus species as a primary pathogen from animal diseases. We report, for the first time, a fatal case of mandibular pyogranulomatous osteomyelitis in a sheep caused by Pseudomonas aeruginosa and Lactococcus raffinolactis coinfection.

Asunto(s)

Animales , Osteomielitis/veterinaria , Infecciones por Pseudomonas/complicaciones , Ovinos , Lactococcus/patogenicidad , Mandíbula/patología , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción/veterinaria

RESUMEN

Introduction. Carbapenem-resistant Pseudomonas aeruginosa is responsible for increased patient mortality.Gap Statement. Five and 30 day in-hospital all-cause mortality in patients with P. aeruginosa infections were assessed, followed by evaluations concerning potential correlations between the type III secretion system (TTSS) genotype and the production of metallo-ß-lactamase (MBL).Methodology. This assessment comprised a retrospective cohort study including consecutive patients with carbapenem-resistant infections hospitalized in Brazil from January 2009 to June 2019. PCR analyses were performed to determine the presence of TTSS-encoding genes and MBL genes.Results. The 30-day and 5-day mortality rates for 262 patients were 36.6 and 17.9 %, respectively. The unadjusted survival probabilities for up to 5 days were 70.55 % for patients presenting exoU-positive isolates and 86 % for those presenting exo-negative isolates. The use of urinary catheters, as well as the presence of comorbidity conditions, secondary bacteremia related to the respiratory tract, were independently associated with death at 5 and 30 days. The exoS gene was detected in 64.8 % of the isolates, the presence of the exoT and exoY genes varied and exoU genes occurred in 19.3 % of the isolates. The exoU genotype was significantly more frequent among multiresistant strains. MBL genes were not detected in 92 % of the isolates.Conclusions. Inappropriate therapy is a crucial factor regarding the worse prognosis among patients with infections caused by multiresistant P. aeruginosa, especially those who died within 5 days of diagnosis, regardless of the genotype associated with TTSS virulence.

Asunto(s)

Infección Hospitalaria/mortalidad , Infecciones por Pseudomonas/mortalidad , Pseudomonas aeruginosa , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Brasil , Carbapenémicos/farmacología , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Infecciones por Pseudomonas/complicaciones , Infecciones por Pseudomonas/virología , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/genética , Estudios Retrospectivos , Sistemas de Secreción Tipo III , Adulto Joven , Resistencia betalactámica

RESUMEN

Diabetic foot infection is a global epidemic and a major public health concern. Development of microbial resistance to many antimicrobial agents in foot ulcer leads to serious complications. Therefore, the study aims to identify the microbiological profile and the potential risk factors among diabetic and non-diabetic foot ulcer patients. A prospective cross sectional study was carried out among 183 ulcer patients from diabetic foot clinic and wound dressing clinic at the public health hospital, Guyana. A total of 254 bacteria were isolated from the study with an average of 1.4 organism per lesion. Gram negative bacteria (63.0%) were prevalent than gram positive bacteria (37.0%) in this study. Among DF patients, Pseudomonas aeruginosa (18.8%) was the most common isolate followed by Escherichia coli (13.9%) among gram negative group. Were as MRSA (12.1%) followed by MSSA (7.9%) dominated among gram positive group in diabetic foot patients. Almost 42.1% (95% CI 34.8-49.6) of the infections were caused by poly-microbial. Interestingly, a stepwise logistic regression model determined increasing age and lack of health education as independent risk factor identified for acquiring an MDR wound infection (OR = 1.1; p ≥ 0.05; 95% CI 1.0-1.1). Mild, moderate and severe infection among MDR and NMDR patients were recorded as 45.3% (95% CI 32.8-58.3), 26.5% (95% CI 16.3-39.1), 28.1% (95% CI 17.6-40.8) and 51.3% (95% CI 41.9-60.5), 32.8% (95% CI 24.4-42.0), 16.0% (95% CI 9.9-23.8). Therefore, it is concluded that there's an urgent need for surveillance of resistant bacteria in diabetic foot infections to reduce the risk of major complications.

Asunto(s)

Biomarcadores/análisis , Diabetes Mellitus Tipo 2/fisiopatología , Pie Diabético/epidemiología , Infecciones por Pseudomonas/complicaciones , Pseudomonas aeruginosa/patogenicidad , Glucemia/análisis , Estudios de Casos y Controles , Estudios Transversales , Pie Diabético/microbiología , Femenino , Estudios de Seguimiento , Hemoglobina Glucada/análisis , Guyana/epidemiología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa/aislamiento & purificación , Factores de Riesgo

RESUMEN

A gama-proteobactéria Pseudomonas aeruginosa é um patógeno oportunista humano frequentemente associado a pacientes com queimadura grave e aos portadores de fibrose cística. O estabelecimento de infecção depende de uma série de fatores que contribuem para a virulência deste patógeno, dentre eles a produção de sideróforos e outros sistemas de captação de ferro. Pioverdina é o principal sideróforo sintetizado por bactérias do gênero Pseudomonas e linhagens deficientes na sua produção são incapazes de estabelecer infecção em modelos animais. A regulação da biossíntese deste sideróforo envolve a agregação entre as células, indicando a dependência de contato para completa indução da sua produção. O contato com uma superfície altera o comportamento das células e diversos fenótipos são dependentes deste sinal mecânico. PrlC é uma oligopeptidase A putativamente envolvida na degradação de peptídeo-sinais e PA14_00800, uma pequena proteína com domínio de função desconhecida, codificada por um gene imediatamente à jusante de prlC. Existem poucos trabalhos na literatura sobre PrlC e seus homólogos e nenhuma informação sobre PA14_00800. Este trabalho teve como objetivo elucidar o envolvimento de PrlC e PA14_00800 na regulação da produção de pioverdina por células em contato com uma superfície. Para estabelecer uma correlação na expressão destes genes, um estudo da organização gênica foi realizado por RT-PCR, confirmando que eles fazem parte do mesmo operon e, portanto, que a expressão destes genes é regulada pelos mesmos fatores. Ensaios classicamente modulados pelo segundo mensageiro c-di-GMP, como formação de biofilme e motilidade, não apresentaram variações nas linhagens mutantes ΔprlC, ΔPA14_00800 ou Δoperon, indicando que a deleção destes genes não altera significativamente os níveis de c-di-GMP nas células. A motilidade do tipo swarming é, no entanto, severamente afetada na linhagem ΔPA14_00800 quando o meio de cultura não contém cloreto de cálcio e glicose, indicando um defeito na sinalização celular ou requerimento energértico desta linhagem nestas condições. PA14_00800 regula a fluorescência de P. aeruginosa em meio sólido e semissólido, mas não em meio líquido. Esta fluorescência depende tanto de pioverdina quanto de PQS, umamolécula de comunicação celular fluorescente, e a possibilidade de outros fatores estarem envolvidos neste fenótipo ainda está sob investigação. Análise do transcritoma por RNASeq com a linhagem ΔPA14_00800 comparada à linhagem parental foi realizada a partir de colônias destas linhagens crescidas em M9 modificado. Genes envolvidos no sistema de secreção do tipo III e do tipo VI e na biossíntese de PQS apareceram dentre os genes diferencialmente expressos, bem como genes para o catabolismo de glicose. Este trabalho foi o primeiro a investigar o papel de PA14_00800 na fisiologia de P. aeruginosa, e os conhecimentos adquiridos aqui podem ser transpostos, com cautela, para compreensão da função dos homólogos de PA14_00800 em outras bactérias

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The gamma-proteobacterium Pseudomonas aeruginosa is a human opportunistic pathogen frequently associated with patients with severe burns and those with cystic fibrosis. The establishment of infection depends on several factors that contribute to the virulence of this pathogen, among them siderophore production and other iron uptake systems. Pyoverdine is the main siderophore synthesized by the bacteria of the genus Pseudômonas and pyoverdinedeficient strains are unable to establish infection in animal models. The regulation of biosynthesis of this siderophore involves cell aggregation, indicating contact dependency for complete induction of pyoverdine production. Surface contact alters cell behavior and several phenotypes are dependent on this mechanical cue. PrlC is an oligopeptidase A putatively involved in peptide-signals degradation and PA14_00800, a small protein with a domain of unknown function, encoded by a gene immediately downstream of prlC. There are few papers in the literature on PrlC and its homologues and no information on PA14_00800. This work aimed to elucidate the role of PrlC and PA14_00800 in surface-dependent regulation of pyoverdine production. To establish a correlation in the expression of these genes, a study of the gene organization was performed by RT-PCR, confirming that they are part of an operon and therefore the expression of these genes is regulated by the same factors. Traits classically modulated by the second messenger c-di-GMP, such as biofilm formation and motility, did not show variations in the ΔprlC, ΔPA14_00800 or Δoperon, indicating that the deletion of these genes does not significantly alter the levels of c-di-GMP within the cells. Swarming motility is, however, severely affected in the strain ΔPA14_00800 when the culture medium does not contain calcium chloride and glucose, indicating a cell signaling defect or energetic requirement under these conditions. PA14_00800 regulates surface-dependent fluorescence of P. aeruginosa, in solid and semi-solid medium. This fluorescence depends on both pyoverdine and PQS, a fluorescent cell-to-cell communication molecule, and the investigation of other putative factors involved in this phenotype is still under study. Transcriptomic analysis by RNASeq with the strain ΔPA14_00800 compared to PA14 was performed from colonies ofthese strains grown in modified M9 1% agar. Genes involved in the type III and type VI secretion systems, in PQS biosynthesis and glucose catabolism were differentially expressed. This work was the first to investigate the role of PA14_00800 in the physiology of P. aeruginosa, and the knowledge obtained here can be cautiously transposed to understanding the role of PA14_00800 homologues in other bactéria

Asunto(s)

Proteínas/análisis , Regulación de la Expresión Génica , Factores de Virulencia/análisis , Operón , Pseudomonas aeruginosa/fisiología , Infecciones por Pseudomonas/complicaciones

RESUMEN

PURPOSE: A patient with carbapenem-resistant Klebsiella pneumoniae infection is described, and treatment options are discussed. SUMMARY: Few antibiotics to treat carbapenem-resistant Enterobacteriaceae (CRE) infection are available, and treatment is further complicated by the limited ability of many antibiotics to penetrate into the cerebrospinal fluid (CSF). Currently, there is a lack of clinical data on the treatment of central nervous system CRE infections, and therapy is based on case reports, case series, and small retrospective studies. A patient was admitted to the emergency department with intracranial hemorrhage and ventriculitis due to traumatic injury. A ventriculostomy and, subsequently, a ventriculoperitoneal (VP) shunt were placed. After approximately a month of treatment with various antibiotic regimens, the patient's VP shunt was externalized, and a CSF culture speciated carbapenem-resistant K. pneumoniae and Pseudomonas aeruginosa. The patient was then switched to i.v. ceftazidime-avibactam and intrathecal amikacin therapy. His CSF cultures were sterile 3 days after initiation of those antibiotics, and subsequent CSF cultures resulted in no growth. After the patient was treated with intrathecal amikacin 30 mg daily for 4 weeks and i.v. ceftazidime-avibactam 2.5 g every 8 hours for 6 weeks, the ventriculitis resolved, the external ventricular drain was removed, and he was transferred to a long-term care facility for rehabilitation. CONCLUSION: A man with ventriculitis caused by P. aeruginosa and carbapenem-resistant K. pneumoniae was successfully treated with i.v. ceftazidime-avibactam and intrathecal amikacin.

Asunto(s)

Amicacina/uso terapéutico , Antibacterianos/uso terapéutico , Compuestos de Azabiciclo/uso terapéutico , Ceftazidima/uso terapéutico , Ventriculitis Cerebral/tratamiento farmacológico , Infecciones por Klebsiella/tratamiento farmacológico , Klebsiella pneumoniae , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa , Adulto , Amicacina/administración & dosificación , Antibacterianos/administración & dosificación , Compuestos de Azabiciclo/administración & dosificación , Enterobacteriaceae Resistentes a los Carbapenémicos , Ceftazidima/administración & dosificación , Ventriculitis Cerebral/microbiología , Ventriculitis Cerebral/cirugía , Combinación de Medicamentos , Quimioterapia Combinada , Humanos , Inyecciones Intravenosas , Inyecciones Espinales , Infecciones por Klebsiella/complicaciones , Infecciones por Klebsiella/microbiología , Masculino , Infecciones por Pseudomonas/complicaciones , Infecciones por Pseudomonas/microbiología , Derivación Ventriculoperitoneal , Ventriculostomía

RESUMEN

BACKGROUND: Cystic fibrosis (CF) is due to dysfunction of the CFTR channel and function of this channel is, in turn, affected by modifier genes that can impact the clinical phenotype. In this context, we analyzed the interaction among rs3788766*SLC6A14, rs7512462*SLC26A9, rs17235416*SLC11A1, and rs17563161*SLC9A3 variants, CFTR mutations and 40 CF severity markers by the Multifactor Dimensionality Reduction (MDR) model. METHODS: A total of 164 patients with CF were included in the study. The variants in the modifier genes were identified by real-time PCR and the genotype of the CFTR gene in the diagnostic routine. Analysis of interaction between variants, CFTR mutations groupings and demographic, clinical and laboratory data were performed by the MDR. RESULTS: There were interaction between the rs3788766, rs7512462, rs17235416, and rs17563161 variants, and CFTR mutations with pancreatic insufficiency (PI), onset of digestive symptoms, and presence of mucoid Pseudomonas aeruginosa. Regarding PI, the interaction was observed for CFTR*rs17563161 (P-value = 0.015). Also, for onset of digestive symptoms the interaction was observed for CFTR*rs3788766*rs7512462*rs17235416*rs17563161 (P-value = 0.036). Considering the presence of mucoid P. aeruginosa, the interaction occurred for CFTR*rs3788766*rs7512462*rs17563161 (P-value = 0.035). CONCLUSION: Interaction between variants in the SLC family genes and the grouping for CFTR mutations were associated with PI, onset of digestive symptoms and mucoid P. aeruginosa, being important to determine one of the factors that may cause the diversity among the patients with CF.

Asunto(s)

Fibrosis Quística/genética , Insuficiencia Pancreática Exocrina/genética , Proteínas de Transporte de Membrana/genética , Infecciones por Pseudomonas/genética , Adolescente , Adulto , Anciano , Biomarcadores , Niño , Preescolar , Fibrosis Quística/complicaciones , Fibrosis Quística/microbiología , Insuficiencia Pancreática Exocrina/complicaciones , Insuficiencia Pancreática Exocrina/microbiología , Femenino , Genotipo , Humanos , Lactante , Masculino , Persona de Mediana Edad , Mutación , Fenotipo , Infecciones por Pseudomonas/complicaciones , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa , Adulto Joven

RESUMEN

Resumen Introducción: La infección crónica por Pseudomonas aeruginosa (PA) es frecuente en pacientes con bronquiectasias (BQ) y representa un quiebre en la historia natural de la enfermedad, asociándose a mal pronóstico y mayor severidad. Objetivo: Caracterizar la población portadora de BQ no fibrosis quística (BQ no-FQ) del Instituto Nacional del Tórax (INT) infectados crónicamente con PA comparándolos con pacientes que mantienen cultivos de expectoración negativos para este germen. Metodología: Revisión retrospectiva de fichas clínicas de pacientes portadores de BQ del INT entre julio de 2007 y abril de 2017. Se caracterizó la población y se comparó score de FACED y otros índices de gravedad. Resultados: El promedio de edad fue de 55 ± 17,3 años, 81% de los pacientes fue de género femenino. De acuerdo a aislamiento de Pseudomonas en cultivo esputo se clasificaron como infectados crónicamente (BQ con PA; n = 61) y no infectados con PA (BQ sin PA; n = 59). No hubo diferencias entre los grupos en edad y sexo. El VEF1 fue más bajo en el grupo con PA los que tienen más hospitalizaciones. Se calculó el índice de riesgo FACED siendo mayor en los pacientes colonizados. La etiología más frecuente es la postinfecciosa, principalmente secuelas de TBC, con 30,8% de etiología no identificada. Conclusiones: Los pacientes con bronquiectasias con infección crónica por Pseudomonas aeruginosa tienen una enfermedad más severa, con VEF1 más bajo, y con mayor índice de severidad de FACED. Destaca en nuestro grupo la etiología postinfecciosa.

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Introduction: Chronic airways infection with Pseudomonas aeruginosa (PA) is a common situation in patients with Bronchiectasis (BQ) and constitutes a breakdown in the natural history of the latter. Moreover, BQ is also associated with a poor prognosis and an increased severity of the disease. Objective: To describe the characteristics of the population diagnosed with non-Cystic Fibrosis Bronchiectasis (non-CFB) who are chronically infected with PA, and to perform a comparison with patients with negative sputum cultures. Methodology: We performed a retrospective analysis of the clinical files of patients diagnosed with non-CFB who were attended at the 'Instituto Nacional del Tórax' (Chile) between July 2007 and April 2017. The characteristics of the population were described and the FACED scores and other severity indexes were compared. Results: The average age of patients was 55 ± 17.3 years-old, and 81% of them were female. According to PA isolation in sputum culture, they were classified as "chronically infected" (non-CFB with PA, n = 61) and "not infected with PA" (non-CFB without PA, n = 59). There were no differences in age and gender between the two groups. On the other hand, FEV1 was lower in the non-CFB PA group. The calculated FACED score was higher in colonized patients. The most frequent etiology was post-infectious, mainly TB sequels, with a 30.8% unidentified etiology. Conclusions: Patients with bronchiectasis chronically infected with Pseudomonas aeruginosa show increases in the severity of the disease, with a lower FEV1 and a higher FACED score. The postinfectious etiology is highlighted in our group.

Asunto(s)

Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Infecciones por Pseudomonas/complicaciones , Bronquiectasia/microbiología , Pseudomonas aeruginosa/aislamiento & purificación , Pruebas de Función Respiratoria , Índice de Severidad de la Enfermedad , Bronquiectasia/etiología , Bronquiectasia/fisiopatología , Enfermedad Crónica , Estudios Retrospectivos

RESUMEN

Ecthyma gangrenosum is a rare skin infection classically associated with Pseudomonas aeruginosa. We performed a retrospective study of all cases diagnosed with ecthyma gangrenosum from 2004-2010 in a university hospital in Mexico (8 cases, 5 female patients and 3 male patients, ages between 4 months and 2 years). The most common risk factor for ecthyma gangrenosum is neutropenia in immunocompromised patients. In previously healthy patients, immunological evaluation is important to rule out underlying immunodeficiency. Ecthyma gangrenosum in healthy patients has a high mortality rate and early diagnosis and aggressive antibiotic treatment is imperative as it can improve patients' prognosis.

Asunto(s)

Ectima/microbiología , Gangrena/microbiología , Infecciones por Pseudomonas/complicaciones , Pseudomonas aeruginosa/aislamiento & purificación , Preescolar , Ectima/tratamiento farmacológico , Femenino , Gangrena/tratamiento farmacológico , Humanos , Lactante , Masculino , Estudios Retrospectivos

RESUMEN

Abstract: Ecthyma gangrenosum is a rare skin infection classically associated with Pseudomonas aeruginosa. We performed a retrospective study of all cases diagnosed with ecthyma gangrenosum from 2004-2010 in a university hospital in Mexico (8 cases, 5 female patients and 3 male patients, ages between 4 months and 2 years). The most common risk factor for ecthyma gangrenosum is neutropenia in immunocompromised patients. In previously healthy patients, immunological evaluation is important to rule out underlying immunodeficiency. Ecthyma gangrenosum in healthy patients has a high mortality rate and early diagnosis and aggressive antibiotic treatment is imperative as it can improve patients' prognosis.

Asunto(s)

Humanos , Masculino , Femenino , Lactante , Preescolar , Pseudomonas aeruginosa/aislamiento & purificación , Infecciones por Pseudomonas/complicaciones , Ectima/microbiología , Gangrena/microbiología , Estudios Retrospectivos , Ectima/tratamiento farmacológico , Gangrena/tratamiento farmacológico

RESUMEN

We assessed the diagnostic ability of an enzyme-linked immunosorbent assay test for measurement of specific secretory IgA (sIgA) in saliva to identify cystic fibrosis (CF) patients with Pseudomonas aeruginosa chronic lung infection and intermittent lung colonization. A total of 102 Brazilian CF patients and 53 healthy controls were included. Specific serum IgG response was used as a surrogate to distinguish CF patients according to their P. aeruginosa colonization/infection status. The rate of sIgA positivity was 87.1% in CF chronically infected patients (median value = 181.5 U/mL), 48.7% in intermittently colonized patients (median value = 45.8 U/mL) and 21.8% in free of infection patients (median value = 22.1 U/mL). sIgA levels in saliva were significantly associated with serum P. aeruginosa IgG and microbiological culture results. The sensitivity, specificity, PPV and NPV for differentiation between presence and absence of chronic lung infection were 87%, 63%, 51% and 92%, respectively. Measurement of sIgA in saliva may be used for screening patients in risk of developing P. aeruginosa chronic lung infection in CF and possibly also for paranasal sinusitis, and, most importantly, to efficiently rule out chronic P. aeruginosa lung infection.

Asunto(s)

Anticuerpos Antibacterianos/análisis , Fibrosis Quística/diagnóstico , Inmunoglobulina A Secretora/análisis , Inmunoglobulina G/análisis , Infecciones Oportunistas/diagnóstico , Infecciones por Pseudomonas/diagnóstico , Saliva/química , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Preescolar , Estudios Transversales , Fibrosis Quística/complicaciones , Fibrosis Quística/inmunología , Fibrosis Quística/microbiología , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Pulmón/inmunología , Pulmón/microbiología , Pulmón/patología , Masculino , Infecciones Oportunistas/complicaciones , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/microbiología , Infecciones por Pseudomonas/complicaciones , Infecciones por Pseudomonas/inmunología , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa , Saliva/inmunología , Saliva/microbiología , Sensibilidad y Especificidad

Asunto(s)

Impedancia Eléctrica , Neumonía Bacteriana/complicaciones , Neumotórax/diagnóstico por imagen , Infecciones por Pseudomonas/complicaciones , Síndrome de Dificultad Respiratoria/complicaciones , Choque Séptico/etiología , Tomografía/métodos , Anciano , Infección Hospitalaria/etiología , Infección Hospitalaria/microbiología , Progresión de la Enfermedad , Humanos , Masculino , Monitoreo Fisiológico , Neumonía Bacteriana/microbiología , Neumotórax/etiología , Sistemas de Atención de Punto , Respiración con Presión Positiva/métodos , Pseudomonas aeruginosa/aislamiento & purificación , Síndrome de Dificultad Respiratoria/diagnóstico por imagen , Síndrome de Dificultad Respiratoria/terapia , Choque Séptico/microbiología

RESUMEN

The prevalence of chronic sinus disease in cystic fibrosis (CF) has gradually increased. Sinonasal involvement may have influence on pulmonary exacerbations and can have a negative impact on the quality of life. To evaluate nasal characteristics and quality of life in adult patients with CF; to establish an association and determine the predictors in SNOT-22 questionnaire. Cross- sectional study with prospective data collection was performed to evaluate adult CF patients. Patients underwent clinical evaluation, lung function tests, nasal endoscopy, and paranasal sinuses CT scan. All the patients answered the SNOT-22 questionnaire. RESULTS: A total of 91 patients were allocated, of which, 45.1% were male. Patients were divided into three groups by SNOT-22. A high average age, late age of diagnosis, rhinitis symptoms, and clinical criteria for rhinosinusitis were observed more frequently in patients with high SNOT-22 scores (p < 0.05). Overall, 84.6% patients had abnormal CT findings, with aplasia/hypoplasia of the sphenoid sinus being the most common finding. In multiple regression model, age, female gender, and Pseudomonas aeruginosa in the sputum were associated with high SNOT-22 scores in the nasal domain. Hyposmia and lack of medial bulging of lateral nasal wall were variables associated with high SNOT-22 scores in the quality of life domain. In total score, there was a positive association with age and the presence of P. aeruginosa in sputum. Despite high prevalence of abnormal tomographic findings, patients reported mild intensity of sinonasal symptoms. Advanced age and the presence of P. aeruginosa were associated with higher SNOT-22 scores.

Asunto(s)

Fibrosis Quística/complicaciones , Indicadores de Salud , Infecciones por Pseudomonas/complicaciones , Calidad de Vida , Rinitis/complicaciones , Sinusitis/complicaciones , Adolescente , Adulto , Factores de Edad , Enfermedad Crónica , Estudios Transversales , Fibrosis Quística/diagnóstico por imagen , Femenino , Humanos , Masculino , Estudios Prospectivos , Infecciones por Pseudomonas/diagnóstico , Pseudomonas aeruginosa , Rinitis/diagnóstico , Índice de Severidad de la Enfermedad , Sinusitis/diagnóstico , Encuestas y Cuestionarios , Tomografía Computarizada por Rayos X , Adulto Joven

RESUMEN

High glucose concentration in the airway surface liquid (ASL) is an important feature of diabetes that predisposes to respiratory infections. We investigated the role of alveolar epithelial SGLT1 activity on ASL glucose concentration and bacterial proliferation. Non-diabetic and diabetic rats were intranasally treated with saline, isoproterenol (to increase SGLT1 activity) or phlorizin (to decrease SGLT1 activity); 2 hours later, glucose concentration and bacterial proliferation (methicillin-resistant Sthaphylococcus aureus, MRSA and Pseudomonas aeruginosa, P. aeruginosa) were analyzed in bronchoalveolar lavage (BAL); and alveolar SGLT1 was analyzed by immunohistochemistry. BAL glucose concentration and bacterial proliferation increased in diabetic animals: isoproterenol stimulated SGLT1 migration to luminal membrane, and reduced (50%) the BAL glucose concentration; whereas phlorizin increased the BAL glucose concentration (100%). These regulations were accompanied by parallel changes of in vitro MRSA and P. aeruginosa proliferation in BAL (r = 0.9651 and r = 0.9613, respectively, Pearson correlation). The same regulations were observed in in vivo P. aeruginosa proliferation. In summary, the results indicate a relationship among SGLT1 activity, ASL glucose concentration and pulmonary bacterial proliferation. Besides, the study highlights that, in situations of pulmonary infection risk, such as in diabetic subjects, increased SGLT1 activity may prevent bacterial proliferation whereas decreased SGLT1 activity can exacerbate it.

Asunto(s)

Diabetes Mellitus Experimental/metabolismo , Glucosa/metabolismo , Pulmón/metabolismo , Neumonía Bacteriana/metabolismo , Infecciones por Pseudomonas/metabolismo , Transportador 1 de Sodio-Glucosa/genética , Infecciones Estafilocócicas/metabolismo , Aloxano , Células Epiteliales Alveolares/efectos de los fármacos , Células Epiteliales Alveolares/metabolismo , Células Epiteliales Alveolares/microbiología , Animales , Líquido del Lavado Bronquioalveolar/química , Líquido del Lavado Bronquioalveolar/microbiología , Broncodilatadores/farmacología , Recuento de Colonia Microbiana , Diabetes Mellitus Experimental/inducido químicamente , Diabetes Mellitus Experimental/complicaciones , Diabetes Mellitus Experimental/genética , Regulación de la Expresión Génica , Isoproterenol/farmacología , Pulmón/efectos de los fármacos , Pulmón/microbiología , Pulmón/patología , Masculino , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/crecimiento & desarrollo , Florizina/farmacología , Neumonía Bacteriana/complicaciones , Neumonía Bacteriana/genética , Neumonía Bacteriana/patología , Infecciones por Pseudomonas/complicaciones , Infecciones por Pseudomonas/genética , Infecciones por Pseudomonas/patología , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/crecimiento & desarrollo , Ratas , Ratas Wistar , Transportador 1 de Sodio-Glucosa/agonistas , Transportador 1 de Sodio-Glucosa/antagonistas & inhibidores , Transportador 1 de Sodio-Glucosa/metabolismo , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/genética , Infecciones Estafilocócicas/patología

RESUMEN

OBJECTIVE: To investigate the relationship between abdominal ultrasound findings and demographic, historical, and clinical features in children with cystic fibrosis (CF). STUDY DESIGN: Children age 3-12 years with CF without known cirrhosis, were enrolled in a prospective, multicenter study of ultrasound to predict hepatic fibrosis. Consensus ultrasound patterns were assigned by 3 radiologists as normal, heterogeneous, homogeneous, or cirrhosis. Data were derived from direct collection and US or Toronto CF registries. χ(2) or ANOVA were used to compare variables among ultrasound groups and between normal and abnormal. Logistic regression was used to study risk factors for having abnormal ultrasound. RESULTS: Findings in 719 subjects were normal (n = 590, 82.1%), heterogeneous (64, 8.9%), homogeneous (41, 5.7%), and cirrhosis (24, 3.3%). Cirrhosis (P = .0004), homogeneous (P < .0001), and heterogeneous (P = .03) were older than normal. More males were heterogeneous (P = .001). More heterogeneous (15.0%, P = .009) and cirrhosis (25.0%, P = .005) had CF-related diabetes or impaired glucose tolerance vs normal (5.4%). Early infection with Pseudomonas aeruginosa (<2 years old) was associated with a lower risk (OR 0.42, P = .0007) of abnormal. Ursodeoxycholic acid use (OR 3.69, P < .0001) and CF-related diabetes (OR 2.21, P = .019) were associated with increased risk of abnormal. CONCLUSIONS: Unsuspected cirrhosis is seen in 3.3% of young patients with CF, heterogeneous in 8.9%. Abnormal ultrasound is associated with CF-related diabetes, and early P aeruginosa is associated with normal ultrasound. Prospective assessment of these risk factors may identify potential interventional targets. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01144507.

Asunto(s)

Fibrosis Quística/diagnóstico por imagen , Cirrosis Hepática/diagnóstico por imagen , Análisis de Varianza , Índice de Masa Corporal , Niño , Preescolar , Fibrosis Quística/complicaciones , Femenino , Humanos , Cirrosis Hepática/complicaciones , Masculino , Estado Nutricional , Estudios Prospectivos , Infecciones por Pseudomonas/complicaciones , Pseudomonas aeruginosa , Factores de Riesgo , Ultrasonografía , Ácido Ursodesoxicólico/química

Asunto(s)

Compuestos de Magnesio/orina , Fosfatos/orina , Infecciones por Pseudomonas/orina , Pseudomonas aeruginosa , Anciano , Humanos , Dolor de la Región Lumbar/microbiología , Masculino , Infecciones por Pseudomonas/complicaciones , Estruvita , Urinálisis , Trastornos Urinarios/microbiología

RESUMEN

BACKGROUND: The Forced Oscillation Technique (FOT) has the potential to increase our knowledge about the biomechanical changes that occur in Cystic Fibrosis (CF). Thus, the aims of this study were to investigate changes in the resistive and reactive properties of the respiratory systems of adults with CF. METHODS: The study was conducted in a group of 27 adults with CF over 18 years old and a control group of 23 healthy individuals, both of which were assessed by the FOT, plethysmography and spirometry. An equivalent electrical circuit model was also used to quantify biomechanical changes and to gain physiological insight. RESULTS AND DISCUSSION: The CF adults presented an increased total respiratory resistance (p < 0.0001), increased resistance curve slope (p<0.0006) and reduced dynamic compliance (p<0.0001). In close agreement with the physiology of CF, the model analysis showed increased peripheral resistance (p<0.0005) and reduced compliance (p < 0.0004) and inertance (p<0.005). Significant reasonable to good correlations were observed between the resistive parameters and spirometric and plethysmographic indexes. Similar associations were observed for the reactive parameters. Peripheral resistance, obtained by the model analysis, presented reasonable (R=0.35) to good (R=0.64) relationships with plethysmographic parameters. CONCLUSIONS: The FOT adequately assessed the biomechanical changes associated with CF. The model used provides sensitive indicators of lung function and has the capacity to differentiate between obstructed and non-obstructed airway conditions. The FOT shows great potential for the clinical assessment of respiratory mechanics in adults with CF.

Asunto(s)

Simulación por Computador , Fibrosis Quística/fisiopatología , Impedancia Eléctrica , Manometría/métodos , Modelos Biológicos , Pruebas de Función Respiratoria/métodos , Mecánica Respiratoria , Adulto , Infecciones por Burkholderia/complicaciones , Infecciones por Burkholderia/fisiopatología , Burkholderia cenocepacia , Estudios Transversales , Fibrosis Quística/complicaciones , Femenino , Humanos , Modelos Lineales , Masculino , Manometría/instrumentación , Pletismografía , Neumonía Bacteriana/complicaciones , Neumonía Bacteriana/fisiopatología , Infecciones por Pseudomonas/complicaciones , Infecciones por Pseudomonas/fisiopatología , Ventilación Pulmonar , Pruebas de Función Respiratoria/instrumentación , Espirometría , Transductores de Presión , Adulto Joven

RESUMEN

OBJECTIVE: To examine patterns of microbial colonization of the respiratory and intestinal tracts in early life in infants with cystic fibrosis (CF) and their associations with breastfeeding and clinical outcomes. STUDY DESIGN: A comprehensive, prospective longitudinal analysis of the upper respiratory and intestinal microbiota in a cohort of infants and young children with CF followed from birth was performed. Genus-level microbial community composition was characterized using 16S-targeted pyrosequencing, and relationships with exposures and outcomes were assessed using linear mixed-effects models, time-to-event analysis, and principal components analysis. RESULTS: Sequencing of 120 samples from 13 subjects collected from birth to 34 months revealed relationships between breastfeeding, microbial diversity in the respiratory and intestinal tracts, and the timing of onset of respiratory complications, including exacerbations and colonization with Pseudomonas aeruginosa. Fluctuations in the abundance of specific bacterial taxa preceded clinical outcomes, including a significant decrease in bacteria of the genus Parabacteroides within the intestinal tract prior to the onset of chronic P aeruginosa colonization. Specific assemblages of bacteria in intestinal samples, but not respiratory samples, were associated with CF exacerbation in early life, indicating that the intestinal microbiome may play a role in lung health. CONCLUSIONS: Our findings relating breastfeeding to respiratory outcomes, gut diversity to prolonged periods of health, and specific bacterial communities in the gut prior to respiratory complications in CF highlight a connection between the intestinal microbiome and health and point to potential opportunities for antibiotic or probiotic interventions. Further studies in larger cohorts validating these findings are needed.

Asunto(s)

Fibrosis Quística/microbiología , Intestinos/microbiología , Microbiota , Sistema Respiratorio/microbiología , Lactancia Materna , Preescolar , Progresión de la Enfermedad , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Estudios Prospectivos , Infecciones por Pseudomonas/complicaciones , Pseudomonas aeruginosa

RESUMEN

BACKGROUND: Patients with cystic fibrosis (CF) exhibit a wide range of disease severity, and can be broadly stratified into high-risk and low-risk groups based on cystic fibrosis transmembrane conductance regulator (CFTR) mutation class. Patients with a low-risk genotype are often diagnosed as adults, with milder disease and lower sweat chloride values. The aim of the current study was to better understand radiographic and clinical characteristics of sinus disease in adult CF patients within this risk category. METHODS: Adult CF patients were retrospectively compared to a control group of patients with chronic rhinosinusitis. CF diagnostic testing and pulmonary characteristics were compared between high-risk and low-risk CF groups, and sinus CT findings were compared among all 3 groups. RESULTS: When comparing CF cohorts (n = 25 and 30, respectively), earlier age at diagnosis (p < 0.001), higher sweat chloride values (p < 0.001), lower forced expiratory volume in 1 second (FEV1 ) values (p < 0.001), and a higher prevalence of pulmonary infection with Pseudomonas aeruginosa (p = 0.001) were found in the high-risk genotype group. A significantly increased incidence of sinus hypoplasia/aplasia and bony sclerosis was seen when comparing both CF groups to the control cohort (n = 30), as well as when comparing the high-risk and low-risk CF genotype cohorts. CONCLUSION: The current study describes clinicopathologic findings of sinus disease in adult CF patients in the context of genotype severity. Our data demonstrate that while patients within a low-risk genotype cohort have generally milder lung disease, they retain classic radiographic findings of CF sinus disease that can help raise the index of suspicion for undiagnosed CF.

Asunto(s)

Regulador de Conductancia de Transmembrana de Fibrosis Quística/genética , Fibrosis Quística/genética , Mutación/genética , Adulto , Estudios de Casos y Controles , Cloruros/metabolismo , Enfermedad Crónica , Fibrosis Quística/diagnóstico por imagen , Femenino , Volumen Espiratorio Forzado/fisiología , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Senos Paranasales/anomalías , Senos Paranasales/diagnóstico por imagen , Infecciones por Pseudomonas/complicaciones , Pseudomonas aeruginosa , Estudios Retrospectivos , Rinitis/diagnóstico por imagen , Factores de Riesgo , Sinusitis/diagnóstico por imagen , Sudor/química , Tomografía Computarizada por Rayos X