RESUMEN
Apart from causing various dermatological disorders, ticks, which also widespread in our part of the world, can transmit diseases that affect the nervous system. The difficulty of carrying out differential diagnosis and the possibility of administering causal treatment in cases of meningopolyneuritis Garin-Bujadoux-Bannwarth and progressive Borrelian encephalomyelitis are giving rise to demands for an improvement in immunodiagnosis.
Asunto(s)
Enfermedades del Sistema Nervioso/transmisión , Garrapatas/microbiología , Animales , Borrelia/aislamiento & purificación , Infecciones por Borrelia/transmisión , Virus de la Encefalitis Transmitidos por Garrapatas/aislamiento & purificación , Encefalitis Transmitida por Garrapatas/transmisión , Encefalomielitis/transmisión , Humanos , Meningitis/transmisión , Polineuropatías/transmisiónRESUMEN
Between February and June, 1983, four cases of Citrobacter diversus neonatal meningitis were identified at a suburban Baltimore hospital. One of the 4 infants died at age 13 months, 2 (both of whom had brain abscesses) have evidence of developmental delay and 1 appears to be normal after 33 months of follow-up. A review of microbiology records revealed that C. diversus had been present in the hospital nursery prior to identification of the first infant with meningitis, with isolation from infants born 7 months, 4 months and 4 days, respectively, before the first meningitis case. C. diversus was isolated from 21 infants born during the outbreak period and from hand or rectal cultures of 5 nursing personnel. All isolates were biotype E, with two distinct clusters of cases identified on the basis of plasmid profile and serotype. In a case-control study isolation of C. diversus was significantly associated with male sex, low birth weight and care by house pediatricians. The outbreak was controlled by stringent infection control measures and exclusion of personnel carriers. During the 24 months following the outbreak 3431 babies discharged from the nursery were cultured for C. diversus; 3 were colonized with the organism.
Asunto(s)
Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Infecciones por Enterobacteriaceae/epidemiología , Meningitis/epidemiología , Citrobacter/aislamiento & purificación , Infección Hospitalaria/transmisión , Infecciones por Enterobacteriaceae/transmisión , Femenino , Humanos , Recién Nacido , Masculino , Maryland , Meningitis/transmisión , Personal de Enfermería en HospitalRESUMEN
After the successful identification of Borrelia burgdorferi as the cause of Lyme disease, a new tick-borne infection occurring in the United States, almost identical spirochaetes have been isolated from the tick Ixodes ricinus in Europe. As a result, the spirochaetal aetiology of skin diseases, which had long been recognized as tick-borne infections, namely erythema chronicum migrans with its neurological complications of the tick-borne meningopolyneuritis of Garin-Bujadoux-Bannwarth, acrodermatitis chronica atrophicans and lymphadenosis cutis benigna, could be confirmed by means of microbiological, histological and serological methods. On the basis of case histories it had already been assumed for some time that anetodermia maculosa and the localised sclerodermas might also be caused by a tick-borne agent. The results of serological investigations have now strengthened this assumption, although microbiological confirmation is still lacking.
Asunto(s)
Mordeduras y Picaduras/complicaciones , Infecciones por Spirochaetales/transmisión , Garrapatas , Acrodermatitis/transmisión , Dermatitis/transmisión , Humanos , Enfermedad de Lyme/transmisión , Linfadenitis/transmisión , Meningitis/transmisión , Polineuropatías/transmisión , Esclerodermia Localizada/transmisiónRESUMEN
The etiology of pyogenic infections of the brain and meninges varies principally by age, predisposing causes or conditions, and anatomic site of the infection. An appreciation of these factors, plus the prudent use of noninvasive anatomic diagnostic techniques (such as CT) and examination of the CSF, will provide a basis for the empiric use of appropriate antibiotics. The beta-lactam antibiotics remain the preferred drugs whenever possible because of their broad spectrum on antimicrobial activity, efficacy in CNS infections, low cost, and low toxicity.
Asunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Enfermedades del Sistema Nervioso Central/tratamiento farmacológico , Adulto , Antibacterianos/uso terapéutico , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/diagnóstico por imagen , Infecciones Bacterianas/etiología , Sangre/microbiología , Absceso Encefálico/tratamiento farmacológico , Absceso Encefálico/etiología , Edema Encefálico/etiología , Edema Encefálico/terapia , Enfermedades del Sistema Nervioso Central/complicaciones , Enfermedades del Sistema Nervioso Central/diagnóstico por imagen , Enfermedades del Sistema Nervioso Central/etiología , Ventrículos Cerebrales , Líquido Cefalorraquídeo/citología , Niño , Preescolar , Medicina Comunitaria , Encefalitis/etiología , Fiebre/etiología , Bacterias Gramnegativas , Humanos , Lactante , Recién Nacido , Enfermedades del Recién Nacido/etiología , Meningitis/complicaciones , Meningitis/etiología , Meningitis/fisiopatología , Meningitis/transmisión , Enfermedades del Sistema Nervioso/etiología , Efusión Subdural/etiología , Tomografía Computarizada por Rayos XRESUMEN
Two cases of neonatal listeriosis occurred in a hospital within a two-week period. Both infants were infected with the same organism, Listeria monocytogenes, type 1a, bacteriophage type 6 (lysotype 1652). Both infants were born in the same delivery room, 17 hours apart. The index patient became septic shortly after birth and died after 48 hours despite antibiotic therapy. The mother of the index patient was febrile and had chorioamnionitis. The second infant became ill with meningitis at 13 days of age. Neither infants nor mothers were attended by the same medical or nursing staff nor were they in the same labor or postpartum areas or nurseries. However, both infants were resuscitated in the same delivery room after birth by means of laryngoscope, suction catheter, and emergency resuscitation (Ambu) bag. Although it was hospital policy to clean and sterilize resuscitation equipment after use, the equipment had only been wiped with alcohol between patients in this instance, since sterile replacement equipment was not available during the early-morning hours when the index birth occurred. Therefore, we believe the contaminated resuscitation equipment was the source of infection in the second infant. This episode emphasizes the importance of appropriate disinfection of respiratory resuscitation equipment to prevent nosocomial infection due to L monocytogenes, an unusual but important pathogen in neonates.
Asunto(s)
Salas de Parto , Contaminación de Equipos , Listeriosis/transmisión , Quirófanos , Infección Hospitalaria/transmisión , Femenino , Humanos , Recién Nacido , Masculino , Meningitis/transmisión , Embarazo , Resucitación/instrumentaciónRESUMEN
The clinical spectrum of this remarkable non-syphilitic spirochaetosis (spirochaeta infection) of the nervous system is described in light of 53 further cases with reference to our earlier description of 47 cases. As the etiological diagnosis is not possible in all cases the knowledge of clinical courses is especially important. Males are affected almost twice as often as women. The disease is especially prevalent in the sixth decade. Usually, the syndrome begins in the warm season with exquisite pain and other sensory irritations in combination with marked malaise. Initial signs during the winter as well as painless clinical courses were also noted. About one half of the patients remembered contact with arthropodes or a chronic migrating erythema. In most cases (95%), asymmetrical peripheral signs followed the painful stage. More than two thirds of the patients showed affection of cranial nerves, usually facial palsy. Twenty percent demonstrated paresis of the extremities alone, the combination of involvement of cranial nerves and extremities was noted in one third of the cases. The sensory signs were usually only mild. Occasionally, the neurological impairment was limited to isolated sensory impairment. In contrast to the closely related Lyme disease, central nervous affection as well as cardiac and arthritic involvement is rare: 34 percent demonstrated mild psychopathological impairment; in one case a Babinski-phenomenon was elicited. Knee joint pain and gonarthritis were found in one case each. Even though meningeal signs were usually absent, the CSF showed alterations suggestive of chronic lymphocytic meningitis in all cases. At the same time, local synthesis of all three immune globulins was documented, especially of IgM (85%).
Asunto(s)
Mordeduras y Picaduras/complicaciones , Eritema/transmisión , Meningitis/transmisión , Polineuropatías/transmisión , Infecciones por Spirochaetales/complicaciones , Garrapatas , Adolescente , Adulto , Anciano , Animales , Formación de Anticuerpos , Mordeduras y Picaduras/inmunología , Niño , Eritema/inmunología , Femenino , Técnica del Anticuerpo Fluorescente , Humanos , Inmunoglobulina G/metabolismo , Inmunoglobulina M/metabolismo , Masculino , Meningitis/inmunología , Persona de Mediana Edad , Polineuropatías/inmunología , Infecciones por Spirochaetales/inmunología , Parálisis por Garrapatas/transmisiónRESUMEN
Spirochetes were cultivated from 17% of 114 Ixodes ricinus ticks in the Stockholm area. Three strains of these spirochetes were selected for studies by electron microscopy. These three strains had definite morphological similarities to spirochetes of the genus Borrelia, as judged by the number of flagella, absence of cytoplasmic tubules, and dimensions. The three strains were not identical, but seemed to consist of two different kinds of cells, one with eight and one with eleven flagella. The three strains were also shown to react with a monoclonal antibody that reacts with Lyme disease spirochetes (Borrelia burgdorferi), but not with strains of other Borreliae, Treponemes, or Leptospiras. These results indicate the possibility of transmission of Borrelia spirochetes from ticks to humans in Sweden. The antibody response to one of the spirochetal strains isolated from Swedish I. ricinus was studied in 37 patients with the typical clinical picture of erythema chronicum migrans (ECM), in 45 patients with chronic meningitis (CMe) cured by high-dose intravenous penicillin, in 298 patients with post-infectious arthritis, and in controls. The antibody response was estimated by indirect immunofluorescence assay (IFA) enzyme-linked immunosorbent assay (ELISA). The antibody levels differed significantly between patients with CMe and healthy individuals (p less than 0.001), both with respect to serum antibody levels and CSF-antibody levels. The antibody levels also differed significantly between patients with ECM and healthy controls as measured by ELISA (p less than 0.05), whereas the difference was not significant as measured by IFA. Five of 298 patients with post-infectious arthritis had higher titers than any of the controls, and two of these five patients had titers higher than any patient with CMe or ECM. These results indicate spirochetal aetiology of ECM, and in some patents with CMe or postinfectious arthritis. As a diagnostic test for ECM, both IFA and ELISA were of limited value, since only 5/37 (14%) ECM patients were positive by IFA, and 14/37 (38%) by ELISA. Regarding patients with CMe, 23/45 (51%) were seropositive by IFA and 30/45 (67%) by ELISA. However, measurement of CSF-antibodies were found to be a more sensitive method than measurement of serum antibodies both by IFA and ELISA, since 38/45 (84%) CMe patients were positive by IFA, and 41/45 (91%) by ELISA. In addition, estimation of CSF antibodies was also found to be a more specific method than estimation of serum antibodies.(ABSTRACT TRUNCATED AT 400 WORDS)
Asunto(s)
Vectores Arácnidos , Infecciones por Borrelia/transmisión , Eritema/transmisión , Enfermedad de Lyme/transmisión , Meningitis/transmisión , Animales , Anticuerpos Antibacterianos/análisis , Anticuerpos Monoclonales/inmunología , Artritis/etiología , Artritis/microbiología , Artritis/fisiopatología , Borrelia/inmunología , Borrelia/aislamiento & purificación , Eritema/inmunología , Eritema/microbiología , Eritema/terapia , Humanos , Enfermedad de Lyme/inmunología , Enfermedad de Lyme/microbiología , Enfermedad de Lyme/terapia , Meningitis/inmunología , Meningitis/microbiología , Meningitis/terapia , Suecia , Toxicosis por Garrapatas/transmisión , Garrapatas/microbiologíaRESUMEN
Antibodies against Borrelia duttoni using indirect immunofluorescence could be demonstrated in 6 patients with erythema chronicum migrans and in 8 persons with tick-borne meningopolyneuritis. Significant increases of IgG and IgM antibody titres in the course of the disease and IgG antibodies in the CSF indicate recent contact with Borrelia duttoni or a closely related agent. Demonstration by fluorescence serology of spirochaetaceae in Ixodes ricinus in two sites of infection equally indicate such an aetiology. The immunofluorescence test for patient sera used here improves the diagnosis of erythema chronicum migrans infection and of its various organ manifestations. Results are similar to those in Lyme disease in the United States.
Asunto(s)
Infecciones por Borrelia , Eritema/microbiología , Meningitis/microbiología , Polineuropatías/microbiología , Adolescente , Adulto , Anciano , Anticuerpos Antibacterianos/inmunología , Vectores Arácnidos , Borrelia/inmunología , Infecciones por Borrelia/inmunología , Niño , Femenino , Humanos , Masculino , Meningitis/transmisión , Persona de Mediana Edad , Polineuropatías/transmisión , GarrapatasAsunto(s)
Meningitis/prevención & control , Niño , Humanos , Meningitis/transmisión , Meningitis por Haemophilus/epidemiología , Meningitis por Haemophilus/prevención & control , Meningitis Meningocócica/epidemiología , Meningitis Meningocócica/prevención & control , Meningitis Neumocócica/epidemiología , Meningitis Neumocócica/prevención & control , Instituciones Académicas , Estados UnidosAsunto(s)
Anestesiología/instrumentación , Infección Hospitalaria/transmisión , Síndrome de Creutzfeldt-Jakob/transmisión , Desinfectantes/administración & dosificación , Equipos Desechables , Óxido de Etileno/toxicidad , Hepatitis B/transmisión , Humanos , Meningitis/transmisión , Terapia Respiratoria/instrumentación , Esterilización , Ventiladores MecánicosRESUMEN
During an outbreak of neonatal meningitis caused by kanamycin-resistant Citrobacter diversus, a field procedure for presumptive identification of the organism was evaluated, and using it resulted in the early recognition of patients colonized by the epidemic strain of C. diversus. Rectal and nasopharyngeal specimens were plated and incubated on MacConkey agar containing 10 micrograms of kanamycin per ml. After 18 h of incubation, lactose-nonfermenting colonies present on the selective medium were picked and identified 8 h later with the following biochemical tests: indole, adonitol, dulcitol, citrate, and triple sugar iron agar. This presumptive identification of C. diversus was later confirmed for all cases by conventional testing with a complete set of biochemicals. In 1 week, 253 specimens from patients were processed with this technique, and 49 strains of C. diversus were identified. The rapid identification of C. diversus and transfer of carriers into appropriate cohorts resulted in a 64% reduction in the prevalence of colonization.
Asunto(s)
Técnicas Bacteriológicas , Citrobacter/aislamiento & purificación , Infecciones por Enterobacteriaceae/transmisión , Enfermedades del Recién Nacido/transmisión , Meningitis/transmisión , Citrobacter/clasificación , Citrobacter/crecimiento & desarrollo , Citrobacter/metabolismo , Medios de Cultivo , Humanos , Recién NacidoRESUMEN
After an outbreak of flavobacterium meningitis in the newborn nursery of the University Hospital, an investigation was carried out to determine the possible sources of this organisms in the nursery. Various serotypes of the organism were recovered from a variety of sources such as wash basins, sinks, suction apparatus, and disinfectants in the nursery as well as the neighbouring wards. Colonisation of the pharynx with this organism was demonstrated in several clinically healthy babies in the nursery. The possible role of fomites, hospital staff, newborn babies, and their mothers in the transmission of the organism is considered together with the measures taken to reduce environmental contamination.