RESUMO
We described a MRSA bloodstream infection outbreak that was rapidly identified and controlled in a Neonatal Intensive Care Unit after implementation of a bundle of measures, including PCR-screening and HCW decolonization. We found 35% of healthcare workers(HCW) colonized with S. aureus by PCR, one of them that presented skin lesion positive for MSSA (same clone and spa type than two patients). Our findings raise the hypothesis that the outbreak could be related to HCW colonization.
Assuntos
Infecção Hospitalar , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Países Desenvolvidos , Surtos de Doenças/prevenção & controle , Humanos , Recém-Nascido , Controle de Infecções , Unidades de Terapia Intensiva Neonatal , Staphylococcus aureus Resistente à Meticilina/genética , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureusRESUMO
Radon and progeny are potentially relevant in radioecological studies, as they contribute more than half of the exposure to environmental radiation. The investigation of 222Rn in internal environments of municipalities of Paraíba and Rio Grande do Norte in Brazil was carried out using passive dosimetry with α Espec-222, installed in environments selected by the history of natural radiative occurrences. The monitoring time was eight months to consider seasonal influence. Concentrations from 26.91 to 316.35 Bq m-3 were obtained, with a maximum effective dose of almost 8 mSv y-1. The influence on households exceeds, by almost 31%, the average obtained for occupational environments. The municipalities of Paraíba presented higher results for Rn, with an average of almost 176 Bq m-3 and an effective dose greater than 4 mSv y-1. The application of individual occupancy factors for home and work environments made it possible to combine the dosimetric models, making the scenario closer to the real exposure of individuals who work and reside in the same municipality, with a dosimetric response of 21.45% lower than the model used worldwide. The different scenarios applied allowed expanding the radiometry of the environments, generating a database that precedes studies of environmental and radioecological impacts, strengthening security and enabling new works to interpret public health problems in search of joint and shared solutions.
Assuntos
Poluentes Radioativos do Ar , Poluição do Ar em Ambientes Fechados , Monitoramento de Radiação , Radônio , Poluentes Radioativos do Ar/análise , Poluição do Ar em Ambientes Fechados/análise , Radiação de Fundo , Brasil , Humanos , Monitoramento de Radiação/métodos , Radônio/análiseRESUMO
ABSTRACT We described a MRSA bloodstream infection outbreak that was rapidly identified and controlled in a Neonatal Intensive Care Unit after implementation of a bundle of measures, including PCR-screening and HCW decolonization. We found 35% of healthcare workers(HCW) colonized with S. aureus by PCR, one of them that presented skin lesion positive for MSSA (same clone and spa type than two patients). Our findings raise the hypothesis that the outbreak could be related to HCW colonization.
RESUMO
BACKGROUND: Corynebacterium diphtheriae (C. diphtheriae) infections, usually related to upper airways involvement, could be highly invasive. Especially in developing countries, non-toxigenic C. diphtheriae strains are now emerging as cause of invasive disease like endocarditis. The present case stands out for reinforcing the high virulence of this pathogen, demonstrated by the multiple systemic embolism and severe valve deterioration. It also emphasizes the importance of a coordinated interdisciplinary work to address all these challenges related to infectious endocarditis. CASE PRESENTATION: A 21-year-old male cocaine drug abuser presented to the emergency department with a 1-week history of fever, asthenia and dyspnea. His physical examination revealed a mitral systolic murmur, signs of acute arterial occlusion of the left lower limb, severe arterial hypotension and acute respiratory failure, with need of vasoactive drugs, orotracheal intubation/mechanical ventilation, empiric antimicrobial therapy and emergent endovascular treatment. The clinical suspicion of acute infective endocarditis was confirmed by transesophageal echocardiography, demonstrating a large vegetation on the mitral valve associated with severe valvular regurgitation. Abdominal ultrasound was normal with no hepatic, renal, or spleen abscess. Serial blood cultures and thrombus culture, obtained in the vascular procedure, identified non-toxigenic C. diphtheriae, with antibiotic therapy adjustment to monotherapy with ampicillin. Since the patient had a severe septic shock with sustained fever, despite antimicrobial therapy, urgent cardiac surgical intervention was planned. Anatomical findings were compatible with an aggressive endocarditis, requiring mitral valve replacement for a biological prosthesis. During the postoperative period, despite an initial clinical recovery and successfully weaning from mechanical ventilation, the patient presented with a recrudescent daily fever. Computed tomography of the abdomen revealed a hypoattenuating and extensive splenic lesion suggestive of abscess. After sonographically guided bridging percutaneous catheter drainage, surgical splenectomy was performed. Despite left limb revascularization, a forefoot amputation was required due to gangrene. The patient had a good clinical recovery, fulfilling 4-weeks of antimicrobial treatment. CONCLUSION: Despite the effectiveness of toxoid-based vaccines, recent global outbreaks of invasive C. diphtheriae infectious related to non-toxigenic strains have been described. These infectious could be highly invasive as demonstrated in this case. Interdisciplinary work with an institutional "endocarditis team" is essential to achieve favorable clinical outcomes in such defiant scenarios.
Assuntos
Abscesso Abdominal/complicações , Infecções por Corynebacterium/complicações , Infecções por Corynebacterium/diagnóstico , Corynebacterium diphtheriae/isolamento & purificação , Embolia/complicações , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/cirurgia , Ampicilina/uso terapêutico , Amputação Cirúrgica , Antibacterianos/uso terapêutico , Infecções por Corynebacterium/microbiologia , Ecocardiografia Transesofagiana , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/cirurgia , Febre , Pé/patologia , Pé/cirurgia , Gangrena , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Valva Mitral/patologia , Valva Mitral/cirurgia , Esplenectomia , Esplenopatias/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
Abstract The mechanisms involved in the uncommon resistance phenotype, carbapenem resistance and broad-spectrum cephalosporin susceptibility, were investigated in 25 Pseudomonas aeruginosa clinical isolates that exhibited this phenotype, which were recovered from three different hospitals located in São Paulo, Brazil. The antimicrobial susceptibility profile was determined by CLSI broth microdilution. β-lactamase-encoding genes were investigated by PCR followed by DNA sequencing. Carbapenem hydrolysis activity was investigated by spectrophotometer and MALDI-TOF assays. The mRNA transcription level of oprD was assessed by qRT-PCR and the outer membrane proteins profile was evaluated by SDS-PAGE. Genetic relationship among P. aeruginosa isolates was assessed by PFGE. Carbapenems hydrolysis was not detected by carbapenemase assay in the carbapenem-resistant and cephalosporin-susceptible P. aueruginosa clinical isolates. OprD decreased expression was observed in all P. aeruginosa isolates by qRT-PCR. The outer membrane protein profile by SDS-PAGE suggested a change in the expression of the 46 kDa porin that could correspond to OprD porin. The isolates were clustered into 17 genotypes without predominance of a specific PFGE pattern. These results emphasize the involvement of multiple chromosomal mechanisms in carbapenem-resistance among clinical isolates of P. aeruginosa, alert for adaptation of P. aeruginosa clinical isolates under antimicrobial selective pressure and make aware of the emergence of an uncommon phenotype among P. aeruginosa clinical isolates.
Assuntos
Humanos , Pseudomonas aeruginosa/efeitos dos fármacos , Carbapenêmicos/farmacologia , Cefalosporinas/farmacologia , Resistência beta-Lactâmica/genética , Antibacterianos/farmacologia , Fenótipo , Pseudomonas aeruginosa/enzimologia , Pseudomonas aeruginosa/genética , Espectrofotometria Ultravioleta , Proteínas da Membrana Bacteriana Externa , Proteínas de Bactérias/metabolismo , beta-Lactamases/metabolismo , Brasil , DNA Bacteriano , Testes de Sensibilidade Microbiana , Eletroforese em Gel de Campo Pulsado , Análise de Sequência de DNA , Porinas/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
The mechanisms involved in the uncommon resistance phenotype, carbapenem resistance and broad-spectrum cephalosporin susceptibility, were investigated in 25 Pseudomonas aeruginosa clinical isolates that exhibited this phenotype, which were recovered from three different hospitals located in São Paulo, Brazil. The antimicrobial susceptibility profile was determined by CLSI broth microdilution. ß-lactamase-encoding genes were investigated by PCR followed by DNA sequencing. Carbapenem hydrolysis activity was investigated by spectrophotometer and MALDI-TOF assays. The mRNA transcription level of oprD was assessed by qRT-PCR and the outer membrane proteins profile was evaluated by SDS-PAGE. Genetic relationship among P. aeruginosa isolates was assessed by PFGE. Carbapenems hydrolysis was not detected by carbapenemase assay in the carbapenem-resistant and cephalosporin-susceptible P. aueruginosa clinical isolates. OprD decreased expression was observed in all P. aeruginosa isolates by qRT-PCR. The outer membrane protein profile by SDS-PAGE suggested a change in the expression of the 46kDa porin that could correspond to OprD porin. The isolates were clustered into 17 genotypes without predominance of a specific PFGE pattern. These results emphasize the involvement of multiple chromosomal mechanisms in carbapenem-resistance among clinical isolates of P. aeruginosa, alert for adaptation of P. aeruginosa clinical isolates under antimicrobial selective pressure and make aware of the emergence of an uncommon phenotype among P. aeruginosa clinical isolates.
Assuntos
Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Cefalosporinas/farmacologia , Pseudomonas aeruginosa/efeitos dos fármacos , Resistência beta-Lactâmica , Proteínas da Membrana Bacteriana Externa , Proteínas de Bactérias/metabolismo , Brasil , DNA Bacteriano , Eletroforese em Gel de Campo Pulsado , Humanos , Testes de Sensibilidade Microbiana , Fenótipo , Porinas/metabolismo , Pseudomonas aeruginosa/enzimologia , Pseudomonas aeruginosa/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Análise de Sequência de DNA , Espectrofotometria Ultravioleta , Resistência beta-Lactâmica/genética , beta-Lactamases/metabolismoRESUMO
Abstract Background: Marfan's Syndrome (MFS) is a disorder of connective tissue, mainly involving the cardiovascular, musculoskeletal, and ocular systems. The most severe problems include aortic root dilatation and dissection. Anesthetic management is vital for the improvement on perioperative morbidity. Case report: 61-year-old male with MFS, presenting mainly with pectus carinatum, scoliosis, ectopia lens, previous spontaneous pneumothorax and aortal aneurysm and dissection submitted to thoracoabdominal aortic prosthesis placement. Underwent routine laparoscopic cholecystectomy due to lithiasis. Important findings on preoperative examination were thoracolumbar kyphoscoliosis, metallic murmur on cardiac exam. Chest radiograph revealed Cobb angle of 70°. Echocardiogram showed evidence of aortic mechanical prosthesis with no deficits. Discussion: Preoperative evaluation should focus on cardiopulmonary abnormalities. The anesthesiologist should be prepared for a potentially difficult intubation. Proper positioning and limb support prior to induction is crucial in order to avoid joint injuries. Consider antibiotic prophylaxis for subacute bacterial endocarditis. The patient should be carefully positioned to avoid joint injuries. Intraoperatively cardiovascular monitoring is mandatory: avoid maneuvers that can lead to tachycardia or hypertension, control airway pressure to prevent pneumothorax and maintain an adequate volemia to decrease chances of prolapse, especially if considering laparoscopic surgery. No single intraoperative anesthetic agent or technique has demonstrated superiority. Adequate postoperative pain management is vitally important to avoid the detrimental effects of hypertension and tachycardia.
Resumo Justificativa: A síndrome de Marfan (SMF) é uma doença do tecido conjuntivo que envolve principalmente os sistemas cardiovascular, musculoesquelético e visual. Os problemas mais graves incluem dilatação da raiz da aorta e dissecção. O manejo anestésico é vital para a melhoria da morbidade perioperatória. Relato de caso: Homem de 61 anos com SMF, apresentou-se principalmente com pectus carinatum, escoliose, ectopia da lente, pneumotórax espontâneo anterior e aneurisma da aorta e dissecção, submetido à colocação de prótese aórtica toracoabdominal. O paciente foi submetido à colecistectomia videolaparoscópica de rotina devido à litíase. Os achados importantes ao exame pré-operatório foram cifoescoliose toracolombar e murmúrio metálico em exame cardíaco. A radiografia de tórax revelou ângulo de Cobb de 70° e o ecocardiograma mostrou evidência de prótese mecânica aórtica sem alterações. Discussão: A avaliação pré-operatória deve ter como foco as anormalidades cardiopulmonares. O anestesiologista deve estar preparado para uma intubação potencialmente difícil. O posicionamento adequado e o apoio para o membro antes da indução são fundamentais para evitar lesões nas articulações. Profilaxia antibiótica deve ser considerada para endocardite bacteriana subaguda. O paciente deve ser cuidadosamente posicionado para evitar lesões das articulações. O monitoramento cardiovascular é obrigatório no período intraoperatório: evitar manobras que podem levar à taquicardia ou hipertensão; controlar a pressão das vias aéreas para evitar pneumotórax e manter uma volemia adequada para diminuir as chances de prolapso, especialmente em caso de laparoscopia. Nenhum agente anestésico ou técnica demonstrou superioridade no período intraoperatório. O tratamento adequado da dor no pós-operatório é de vital importância para evitar os efeitos deletérios da hipertensão e da taquicardia.
Assuntos
Humanos , Masculino , Assistência Perioperatória/métodos , Anestesia/métodos , Síndrome de Marfan/cirurgia , Síndrome de Marfan/diagnóstico , Dor Pós-Operatória/prevenção & controle , Testes de Função Respiratória , Diagnóstico por Imagem , Coração/fisiopatologia , Coração/diagnóstico por imagem , Pulmão/fisiopatologia , Pulmão/diagnóstico por imagem , Síndrome de Marfan/fisiopatologia , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Marfan's Syndrome (MFS) is a disorder of connective tissue, mainly involving the cardiovascular, musculoskeletal, and ocular systems. The most severe problems include aortic root dilatation and dissection. Anesthetic management is vital for the improvement on perioperative morbidity. CASE REPORT: 61-year-old male with MFS, presenting mainly with pectus carinatum, scoliosis, ectopia lens, previous spontaneous pneumothorax and aortal aneurysm and dissection submitted to thoracoabdominal aortic prosthesis placement. Underwent routine laparoscopic cholecystectomy due to lithiasis. Important findings on preoperative examination were thoracolumbar kyphoscoliosis, metallic murmur on cardiac exam. Chest radiograph revealed Cobb angle of 70°. Echocardiogram showed evidence of aortic mechanical prosthesis with no deficits. DISCUSSION: Preoperative evaluation should focus on cardiopulmonary abnormalities. The anesthesiologist should be prepared for a potentially difficult intubation. Proper positioning and limb support prior to induction is crucial in order to avoid joint injuries. Consider antibiotic prophylaxis for subacute bacterial endocarditis. The patient should be carefully positioned to avoid joint injuries. Intraoperatively cardiovascular monitoring is mandatory: avoid maneuvers that can lead to tachycardia or hypertension, control airway pressure to prevent pneumothorax and maintain an adequate volemia to decrease chances of prolapse, especially if considering laparoscopic surgery. No single intraoperative anesthetic agent or technique has demonstrated superiority. Adequate postoperative pain management is vitally important to avoid the detrimental effects of hypertension and tachycardia.
Assuntos
Anestesia/métodos , Síndrome de Marfan/diagnóstico , Síndrome de Marfan/cirurgia , Assistência Perioperatória/métodos , Diagnóstico por Imagem , Coração/diagnóstico por imagem , Coração/fisiopatologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Síndrome de Marfan/fisiopatologia , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Testes de Função RespiratóriaRESUMO
BACKGROUND: Marfan's Syndrome (MFS) is a disorder of connective tissue, mainly involving the cardiovascular, musculoskeletal, and ocular systems. The most severe problems include aortic root dilatation and dissection. Anesthetic management is vital for the improvement on perioperative morbidity. CASE REPORT: 61-year-old male with MFS, presenting mainly with pectus carinatum, scoliosis, ectopia lens, previous spontaneous pneumothorax and aortal aneurysm and dissection submitted to thoracoabdominal aortic prosthesis placement. Underwent routine laparoscopic cholecystectomy due to lithiasis. Important findings on preoperative examination were thoracolumbar kyphoscoliosis, metallic murmur on cardiac exam. Chest radiograph revealed Cobb angle of 70°. Echocardiogram showed evidence of aortic mechanical prosthesis with no deficits. DISCUSSION: Preoperative evaluation should focus on cardiopulmonary abnormalities. The anesthesiologist should be prepared for a potentially difficult intubation. Proper positioning and limb support prior to induction is crucial in order to avoid joint injuries. Consider antibiotic prophylaxis for subacute bacterial endocarditis. The patient should be carefully positioned to avoid joint injuries. Intraoperatively cardiovascular monitoring is mandatory: avoid maneuvers that can lead to tachycardia or hypertension, control airway pressure to prevent pneumothorax and maintain an adequate volemia to decrease chances of prolapse, especially if considering laparoscopic surgery. No single intraoperative anesthetic agent or technique has demonstrated superiority. Adequate postoperative pain management is vitally important to avoid the detrimental effects of hypertension and tachycardia.
RESUMO
Infections due to multidrug-resistant organisms continue to increase, and therapeutic options remain scarce. Given this challenge, it has become necessary to use older antimicrobials for treatment of these pathogens. We report three patients with lower urinary tract infections caused by Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae who were successfully treated with a seven-day course of oral fosfomycin monotherapy.
Assuntos
Antibacterianos/uso terapêutico , Fosfomicina/uso terapêutico , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/efeitos dos fármacos , Infecções Urinárias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Feminino , Humanos , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Infecções Urinárias/microbiologia , beta-Lactamases/metabolismoRESUMO
Infections due to multidrug-resistant organisms continue to increase, and therapeutic options remain scarce. Given this challenge, it has become necessary to use older antimicrobials for treatment of these pathogens. We report three patients with lower urinary tract infections caused by Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae who were successfully treated with a seven-day course of oral fosfomycin monotherapy.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Fosfomicina/uso terapêutico , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/efeitos dos fármacos , Infecções Urinárias/tratamento farmacológico , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , Resultado do Tratamento , Infecções Urinárias/microbiologia , beta-LactamasesRESUMO
We report the whole-genome sequence (WGS) of an in vitro susceptible derivative revertant mutant from a bloodstream isolate involved in a nosocomial outbreak in Brazil. The WGS comprises 2.5 Mb with 2,500 protein-coding sequences, 16rRNA genes, and 60 tRNA genes.
Assuntos
Acetamidas/farmacologia , Proteínas de Bactérias/metabolismo , Mutação , Oxazolidinonas/farmacologia , RNA Ribossômico 23S/metabolismo , Proteínas Ribossômicas/metabolismo , Staphylococcus hominis/efeitos dos fármacos , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Brasil , Farmacorresistência Bacteriana Múltipla , Genes Bacterianos , Humanos , Unidades de Terapia Intensiva , Linezolida , Testes de Sensibilidade Microbiana , RNA Ribossômico 23S/genética , Proteínas Ribossômicas/genética , Ribossomos/genética , Ribossomos/metabolismo , Infecções Estafilocócicas/diagnóstico , Staphylococcus hominis/genética , Staphylococcus hominis/isolamento & purificação , Centros de Atenção TerciáriaAssuntos
Acetamidas/farmacologia , Antibacterianos/farmacologia , Infecção Hospitalar/microbiologia , Mutação , Oxazolidinonas/farmacologia , RNA Ribossômico 23S/genética , Infecções Estafilocócicas/microbiologia , Staphylococcus haemolyticus/efeitos dos fármacos , Brasil , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/transmissão , Catéteres/microbiologia , Infecção Hospitalar/transmissão , Farmacorresistência Bacteriana Múltipla , Eletroforese em Gel de Campo Pulsado , Humanos , Linezolida , Testes de Sensibilidade Microbiana , Análise de Sequência de DNA , Infecções Estafilocócicas/transmissão , Staphylococcus haemolyticus/genéticaAssuntos
Acetamidas/farmacologia , Antibacterianos/farmacologia , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana , Oxazolidinonas/farmacologia , RNA Ribossômico 23S/genética , Infecções Estafilocócicas/epidemiologia , Staphylococcus epidermidis/efeitos dos fármacos , Brasil , Infecção Hospitalar/microbiologia , Surtos de Doenças , Eletroforese em Gel de Campo Pulsado , Hospitais , Humanos , Linezolida , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Tipagem Molecular , Mutação Puntual , Infecções Estafilocócicas/microbiologia , Staphylococcus epidermidis/isolamento & purificaçãoRESUMO
Lactococcus garvieae, an emerging zoonotic pathogen, is responsible for mastitis in rodents and sepsis in fish. Although deemed opportunistic and hardly ever causing infections in humans, its incidence is probably underestimated due to the difficulty in diagnosis. There are very few reports of osteomyelitis, liver abscess, and peritonitis, and only nine cases of endocarditis described in worldwide literature. We describe the first case of Lactococcus garvieae endocarditis in Latin America, in a female patient with metallic prosthetic heart valve who presented with daily fever, chills, Osler nodes and six positive blood cultures for Lactococcus garvieae, which met Duke's criteria for the diagnosis of "definitive infective endocarditis"
Assuntos
Endocardite Bacteriana/microbiologia , Próteses Valvulares Cardíacas , Lactococcus/isolamento & purificação , Diagnóstico Diferencial , Feminino , Febre/etiologia , Infecções por Bactérias Gram-Positivas/diagnóstico , Humanos , Lactococcus/classificação , América Latina , Pessoa de Meia-IdadeRESUMO
Lactococcus garvieae, patógeno zoonótico emergente, é responsável por mastite em ruminantes e septicemia em peixes. Embora seja considerado oportunista e raramente causar infecções em humanos, sua incidência deve estar subestimada devido à dificuldade do diagnóstico. Há pouquíssimos relatos de osteomielite, abscesso hepático e peritonite, e apenas nove casos descritos na literatura mundial de endocardite. Relatamos o primeiro caso de endocardite por Lactococcus garvieae da América Latina em paciente portadora de prótese valvar metálica, com quadro de febre diária, calafrios, nodos de Osler e seis hemoculturas positivas para Lactococcus garvieae, que preenchiam os critérios de Duke para o diagnóstico de "endocardite infecciosa definitiva".
Lactococcus garvieae, an emerging zoonotic pathogen, is responsible for mastitis in rodents and sepsis in fish. Although deemed opportunistic and hardly ever causing infections in humans, its incidence is probably underestimated due to the difficulty in diagnosis. There are very few reports of osteomyelitis, liver abscess, and peritonitis, and only nine cases of endocarditis described in worldwide literature. We describe the first case of Lactococcus garvieae endocarditis in Latin America, in a female patient with metallic prosthetic heart valve who presented with daily fever, chills, Osler nodes and six positive blood cultures for Lactococcus garvieae, which met Duke's criteria for the diagnosis of "definitive infective endocarditis".
Lactococcus garvieae, patógeno zoonótico emergente, es responsable por mastitis en rumiantes y septicemia en peces. Aunque sea considerado oportunista y raramente cause infecciones en humanos, su incidencia debe estar subestimada debido a la dificultad del diagnóstico. Hay poquísimos relatos de osteomielitis, absceso hepático y peritonitis, y apenas nueve casos descriptos en la literatura mundial de endocarditis. Relatamos el primer caso de endocarditis por Lactococcus garvieae de América Latina en paciente portadora de prótesis valvar metálica, con cuadro de fiebre diaria, escalofríos, nódulos de Osler y seis hemocultivos positivos para Lactococcus garvieae, que llenaban los criterios de Duke para el diagnóstico de "endocarditis infecciosa definitiva".
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Endocardite Bacteriana/microbiologia , Próteses Valvulares Cardíacas , Lactococcus/isolamento & purificação , Diagnóstico Diferencial , Febre/etiologia , Infecções por Bactérias Gram-Positivas/diagnóstico , América Latina , Lactococcus/classificaçãoRESUMO
The objective of this study was to describe a pseudo-outbreak of C. difficile in a hospital, following a change in the method used to detect the toxin. In February 2002, there were two cases of CDAD and in March 7 occurred, coinciding with a change of the test (from detection of toxin A to toxin A/B). An outbreak was suspected. Active surveillance and education of staff were started. A CDAD case was defined as a patient with acute onset of diarrhea (> or = three episodes of liquid stools) and a positive stool test. They were classified as hospital or community-acquired. Stool samples were also collected for C. difficile culture and isolates were typed using AP-PCR. From March 2002 through December 2003 there were 138 cases of CDAD: 70% were hospital-acquired and among the 30% with CDAD present on admission, most (81%) came directly from the community (50% had no history of hospitalization). Fifty-two percent of hospital-acquired CDAD and 94% of cases on admission had already used antibiotics. The incidence of CDAD in hospitalized patients during surveillance was 3.3 per 1000 patient-admissions. The incidence of CDAD present on admission was 6.1/1000 patients. Sixteen isolates were typed and presented 13 different profiles. In conclusion, the CDAD increase in our study occurred due to change in diagnostic methods and not due to an outbreak, as suspected initially. The incidence in hospitalized patients was much lower than in reported outbreaks. There were 13 molecular types suggesting that an outbreak did not occur. CDAD was largely community-acquired.
Assuntos
Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/epidemiologia , Infecção Hospitalar/epidemiologia , Diarreia/epidemiologia , Surtos de Doenças , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Toxinas Bacterianas/análise , Brasil/epidemiologia , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/microbiologia , Diarreia/microbiologia , Fezes/microbiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Adulto JovemRESUMO
The objective of this study was to describe a pseudo-outbreak of C. difficile in a hospital, following a change in the method used to detect the toxin. In February 2002, there were two cases of CDAD and in March 7 occurred, coinciding with a change of the test (from detection of toxin A to toxin A/B). An outbreak was suspected. Active surveillance and education of staff were started. A CDAD case was defined as a patient with acute onset of diarrhea (³ three episodes of liquid stools) and a positive stool test. They were classified as hospital or community-acquired. Stool samples were also collected for C. difficile culture and isolates were typed using AP-PCR. From March 2002 through December 2003 there were 138 cases of CDAD: 70 percent were hospital-acquired and among the 30 percent with CDAD present on admission, most (81 percent) came directly from the community (50 percent had no history of hospitalization). Fifty-two percent of hospital-acquired CDAD and 94 percent of cases on admission had already used antibiotics. The incidence of CDAD in hospitalized patients during surveillance was 3.3 per 1000 patient-admissions. The incidence of CDAD present on admission was 6.1/1000 patients. Sixteen isolates were typed and presented 13 different profiles. In conclusion, the CDAD increase in our study occurred due to change in diagnostic methods and not due to an outbreak, as suspected initially. The incidence in hospitalized patients was much lower than in reported outbreaks. There were 13 molecular types suggesting that an outbreak did not occur. CDAD was largely community-acquired.
O objetivo deste estudo foi descrever um pseudo-surto de C. difficile em um hospital após a troca do método de detecção de toxina. Em fevereiro de 2002 houve dois casos de DACD e em março ocorreram sete casos, que coincidiram com a mudança de teste (que detectava apenas toxina A e passou a detectar toxinas A e B). Foi suspeitado que houvesse um surto e vigilância ativa e reforço educacional para os profissionais de saúde foi implantado. Um caso de DACD foi definido como um paciente com início abrupto de diarréia (> 3 episódios de fezes líquidas) e um teste positivo. Os casos foram classificados como de aquisição comunitária ou hospitalar. Foram colhidas fezes para cultura para C. difficile e os isolados foram tipados por AP-PCR. De março de 2002 a dezembro de 2003 houve 138 casos de DACD: 70 por cento foram hospitalares e, entre os 30 por cento de casos comunitários, a maioria (81 por cento) foi de pacientes provenientes diretamente da comunidade (50 por cento não tinham histórico de internação). Cinquenta e dois por cento dos casos de DCAD hospitalar e 94 por cento de casos na admissão haviam utilizado antimicrobianos. A incidência de DCAD em pacientes internados foi de 3,3/100 pacientes e na admissão foi 6,1/1000 pacientes. Dezesseis isolados foram tipados e apresentaram 13 perfis diferentes. Em conclusão, o aumento de DACD no nosso estudo ocorreu por uma mudança de método diagnóstico e não devido a um surto como foi suspeitado inicialmente. A incidência em pacientes internados foi muito inferior ao que já foi relatado em surtos. Houve 13 perfis moleculares sugerindo que não ocorreu um surto. DACD foi, em grande parte, de aquisição comunitária.