RESUMO
Antituberculous (anti-TB) drug resistance has become a major tuberculosis control issue in the United States, where this situation has closely paralleled the current acquired immunodeficiency syndrome epidemic associated with human immunodeficiency virus type-1 (HIV-1) infections. In less developed countries, especially those like Nicaragua with an apparently low prevalence of known HIV-1 infections, less is known about the epidemiology of antituberculous drug resistance. To understand the potential extent of this problem in Nicaragua, we conducted a cross-sectional prevalence study at Nicaragua's only inpatient tuberculosis treatment facility, located in Leon, Nicaragua. A radiometric method was used during recovery, purification, and drug susceptibility testing of clinical Mycobacterium tuberculosis isolates. Resistance to at least one of the major anti-TB medications was found in 15 (40.5%) of 37 sputum isolates, of which seven (19%) were resistant to either isoniazid alone, or to isoniazid plus another agent other than rifampin. Five were resistant to at least isoniazid and rifampin (i.e., 13.5% demonstrated multidrug resistance). Two isolates were resistant to pyrazinamide alone, and one was resistant to streptomycin alone. These initial results suggest that anti-TB drug resistance is a defined problem for tuberculosis control programs in Nicaragua, a problem that is largely related to individual noncompliance, lack of extensive drug susceptibility testing facilities, and a general unavailability of expensive anti-TB medications for re-treatment. Ongoing surveillance for drug resistance, using the methodology presented here, might assist Nicaraguan public health officials in their tuberculosis control programs.
Assuntos
Antituberculosos/farmacologia , Resistência a Múltiplos Medicamentos , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Isoniazida/farmacologia , Masculino , Testes de Sensibilidade Microbiana/métodos , Pessoa de Meia-Idade , Nicarágua/epidemiologia , Prevalência , Pirazinamida/farmacologia , Radiometria , Rifampina/farmacologia , Escarro/microbiologia , Estreptomicina/farmacologia , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/microbiologiaRESUMO
Serum samples were obtained from 340 healthy individuals without evidence of neurologic disease living in rural Haiti. Sera were screened for antibodies to human T-cell lymphotropic virus type I (HTLV-I) using two commercially available enzyme immunoassays (EIA) and by an indirect immunofluorescence assay (IFA) using a mixture of uninfected H9 cells and HTLV-I-infected MT-2 cells. Repeatedly positive samples were confirmed by Western blot (WB). Results with the two EIA systems were concordant and detected 13 positive samples, each of which was confirmed by WB. Only 9 (69%) of 13 WB-positive sera were detected by IFA, and four additional samples, positive by IFA, could not be confirmed by WB. The prevalence of HTLV-I seropositivity in this selected rural Haitian population was 3.8% (13 of 340).
Assuntos
Ensaio de Imunoadsorção Enzimática , Imunofluorescência , Anticorpos Anti-HTLV-I/sangue , Infecções por HTLV-I/epidemiologia , Adolescente , Adulto , Idoso , Western Blotting , Reações Cruzadas , Feminino , Haiti/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , População RuralRESUMO
Infections associated with marine activities, particularly work or recreation in salt water, present unique diagnostic challenges for the infectious disease practitioner. Those caused by halophilic, non-cholera Vibrio species are increasingly being recognized in clinical practice. They typically follow saltwater injuries, especially those associated with coral. Because these infections can be both severe and life-threatening, a consideration of halophilic Vibrio species in the differential diagnosis of marine-acquired infections is important. In this case report, we discuss the diagnosis and treatment of cellulitis in a patient with a Caribbean coral injury associated with Vibrio alginolyticus cellulitis.
Assuntos
Celulite (Flegmão)/microbiologia , Traumatismos da Perna/microbiologia , Vibrioses/microbiologia , Infecção dos Ferimentos/microbiologia , Idoso , Corpos Estranhos/microbiologia , Humanos , Masculino , Viagem , Ilhas Virgens Americanas , Vibrio/patogenicidade , Microbiologia da ÁguaRESUMO
The diagnostic considerations raised by immunocompromised patients with opportunistic infection continue to expand. When such patients harbor latent or persistent infection acquired in a tropical environment, the diagnostic challenge is even greater. The Infectious Disease Service at Yale-New Haven Hospital was asked to see a middle-aged man from Peru with known T-cell lymphoma who had recently completed a course of chemotherapy. He presented to the hospital with fever, petechial skin rash, pulmonary infiltrates, and neutropenia. Ultimately this case illustrated the necessity for careful evaluation of such patients, looking, in particular, for evidence of opportunistic parasitic infection.