RESUMO
We present the case of an actinomycotic mycetoma of the foot due to Actinomycetes viscosus. It evolved for nine years on the foot of a 26-year-old patient from a rural environment: Douar Inezgane (city in southern Morocco). Bacteriological study of the skin and grains confirmed the diagnosis. It showed positive bacilli on direct examination and on Gram staining and in positive culture. Histological study showed a polymorphous granulomatous inflammation without signs of malignancy with actinomycotic grains. Then we retained the diagnosis of primary cutaneous actinomycosis without visceral locations. The treatment was based on antibiotics: penicillin G by intravenous infusion for five weeks, relayed orally by amoxicillin associated with trimethoprim-sulfamethoxazole for long periods. After six months of treatment, we observed a favorable outcome with reduction of the swelling, nodules, lymphadenopathy, fistula's number and extension of time of issue of grains. The current follow up is 15 months. The primary cutaneous actinomycosis is still relevant in Morocco.
Assuntos
Actinomyces viscosus/isolamento & purificação , Actinomicose/microbiologia , Dermatoses do Pé/microbiologia , Micetoma/microbiologia , Actinomicose/tratamento farmacológico , Actinomicose/patologia , Adulto , Antibacterianos/uso terapêutico , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/patologia , Humanos , Masculino , Marrocos , Micetoma/tratamento farmacológico , Micetoma/patologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
The aim of this prospective study in Morocco was to investigate the causes of invasive bacterial diseases in children in order to inform antibiotic therapy and vaccine choices. Of 238 children aged < or = 5 years admitted to the Children's Hospital of Casablanca for invasive diseases over a 12-month period, 185 were diagnosed with bacterial infection: 76 had chest-X-ray-confirmed pneumonia, 59 had meningitis and 50 had sepsis. Streptococcus pneumoniae was the most common pathogen identified (n = 24), followed by Neisseria meningitidis (n = 18, all group B) and Haemophilus influenzae (n = 11). The rate of penicillin non-susceptibility was 62.5% among Str. pneumoniae isolates and 11.1% among N. meningitidis and all isolates were ceftriaxone-susceptible. Of the 11 H. influenzae isolates, only 1 produced a beta-lactamase. The 5 predominant Str. pneumoniae serotypes were 19F, 14, 23F, 6B and 19A and the theoretical coverage of the 7, 10 and 13-valent pneumococcal conjugate vaccines was 60%, 78% and 91% respectively.
Assuntos
Antibacterianos/farmacologia , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Resistência Microbiana a Medicamentos , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Pré-Escolar , Feminino , Haemophilus influenzae tipo b/efeitos dos fármacos , Haemophilus influenzae tipo b/genética , Humanos , Lactente , Recém-Nascido , Masculino , Marrocos/epidemiologia , Neisseria meningitidis/efeitos dos fármacos , Neisseria meningitidis/genética , Vacinas Pneumocócicas/imunologia , Estudos Prospectivos , Sorotipagem , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/genéticaRESUMO
OBJECTIVE: The aim of this study was to identify the clinical presentations and the current antimicrobial susceptibility of Acinetobacter baumannii. RESULTS: We identified 754 strains especially from intensive care units (50.53%) between January 2003 and December 2005. Bronchial swabs and blood culture were prevalent. High-level resistance to betalactamines was noted: 91% to cefotaxime, 50.3% to ceftazidime, and 42.6% to imipenem. Aminoside resistance varied from 17.9% for netilmicine to 72.1% for gentamycin. The resistance rate to ciprofloxacine was 65.8%, and to trimethoprime-sulfamethoxazole 75.8%. In intensive care units, the antimicrobial resistance rate of A. baumannii was higher (p<0.05). CONCLUSION: The resistance of A. baumannii to current antibiotics is alarming especially in intensive care units. An effective strategy against nosocomial infection is still necessary.
Assuntos
Acinetobacter baumannii/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Infecções Oportunistas/microbiologia , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Hospitais Universitários , Humanos , Unidades de Terapia Intensiva , Marrocos , Infecções Oportunistas/tratamento farmacológicoRESUMO
A previous study showed that B:4:P1.15 was the most frequent phenotype of Neisseria meningitidis isolated in Casablanca (Morocco). To determine if there was an epidemic clone, MLST and PFGE were used to compare 13 B:4:P1.15 strains isolated from September 1999 to December 2000. MLST showed 4 Sequence Types (ST): ST-33 was the most frequent ST (9/13 strains) and 4 strains belonged to 3 newly described STs. Twelve stains belonged to ST-32 complex, and one strain presenting a new ST (ST-2502) did not belong to any known ST complex. The analysis by PFGE showed that the strains were subdivided into 7 clusters, and that there was no epidemic clone. MLST is useful for long-term epidemiological studies on N. meningitidis strains from varied geographical origins. PFGE seemed to be well adapted to the comparison of a small number of strains isolated during a short period within a defined community.
Assuntos
Meningite Meningocócica/epidemiologia , Neisseria meningitidis Sorogrupo B/genética , Técnicas de Tipagem Bacteriana , Humanos , Marrocos , Neisseria meningitidis Sorogrupo B/classificação , Neisseria meningitidis Sorogrupo B/isolamento & purificação , Fenótipo , Mapeamento por Restrição , Pele/microbiologiaRESUMO
During 1994, 10 isolates of extended-spectrum beta-lactamase-producing Salmonella typhimurium were recovered from children transferred to our hospital from two different centers. Two additional isolates were recovered from two nurses from one of these centers. The aim of this study was to determine if there is any relationship between these isolates. The characterization was done by phenotypic and genotypic methods: biotyping, phage typing, antibiotic susceptibility pattern determination, plasmid analysis, ribotyping (by the four endonucleases EcoRI, SmaI, BglII, and PvuII), pulsed-field gel electrophoresis (PFGE) of genome macrorestriction patterns with XbaI, and randomly amplified polymorphic DNA (RAPD) pattern determination (with the three primers 217 d2, B1, and A3). The same biotype, the same serotype, and an identical antibiotype were found. All isolates were resistant to oxyimino-beta-lactams, gentamicin, tobramycin, and sulfamethoxazole-trimethoprim. All isolates showed an indistinguishable pattern by ribotyping and very similar patterns by PFGE and RAPD. The overall results indicated the spread of a closely related strain of S. typhimurium in children and nurses.
Assuntos
Técnicas de Tipagem Bacteriana , Salmonella typhimurium/classificação , Salmonella typhimurium/enzimologia , beta-Lactamases/biossíntese , Sequência de Bases , Criança , Primers do DNA/genética , Genótipo , Humanos , Fenótipo , Técnica de Amplificação ao Acaso de DNA Polimórfico , Infecções por Salmonella/microbiologia , Salmonella typhimurium/genéticaRESUMO
Pefloxacin, which has been shown to have a high in vitro activity against Salmonella spp., was compared to cotrimoxazole in the treatment of typhoid fever in adults. In a prospective, randomized trial, 42 patients with bacteriologically documented typhoid fever received either 400 mg pefloxacin b.i.d. or 160/800 mg cotrimoxazole b.i.d. Duration of treatment was 14 days in both groups. All patients were cured without experiencing a relapse or becoming a salmonella carrier. Apyrexia and resolution of digestive and neurological symptoms were obtained in a significantly shorter time with pefloxacin than with cotrimoxazole. Pefloxacin was well tolerated and more effective than cotrimoxazole in the treatment of typhoid fever.
Assuntos
Norfloxacino/análogos & derivados , Febre Paratifoide/tratamento farmacológico , Sulfametoxazol/uso terapêutico , Trimetoprima/uso terapêutico , Febre Tifoide/tratamento farmacológico , Adulto , Combinação de Medicamentos/farmacologia , Combinação de Medicamentos/uso terapêutico , Feminino , Humanos , Masculino , Norfloxacino/farmacologia , Norfloxacino/uso terapêutico , Pefloxacina , Estudos Prospectivos , Distribuição Aleatória , Salmonella paratyphi A/efeitos dos fármacos , Salmonella paratyphi A/isolamento & purificação , Salmonella paratyphi B/efeitos dos fármacos , Salmonella paratyphi B/isolamento & purificação , Salmonella typhi/efeitos dos fármacos , Salmonella typhi/isolamento & purificação , Sulfametoxazol/farmacologia , Trimetoprima/farmacologia , Combinação Trimetoprima e SulfametoxazolRESUMO
Measurement of cerebrospinal fluid lactic acid by an enzymatic test has been evaluated in 164 patients. The upper limit of normal CSF lactate was 300 mg/l. The CSF lactate level is useful for differential diagnosis between partially treated pyogenic meningitis and tuberculous meningitis. The increase of CSF lactate is not specific for meningitis and must be interpreted taking into account the clinical situation.
Assuntos
Lactatos/líquido cefalorraquidiano , Meningite/diagnóstico , Adulto , Pré-Escolar , Diagnóstico Diferencial , Humanos , Meningite/líquido cefalorraquidiano , Meningite Meningocócica/líquido cefalorraquidiano , Meningite Meningocócica/diagnóstico , Meningite Pneumocócica/líquido cefalorraquidiano , Meningite Pneumocócica/diagnóstico , Meningite Viral/líquido cefalorraquidiano , Meningite Viral/diagnóstico , Tuberculose Meníngea/líquido cefalorraquidiano , Tuberculose Meníngea/diagnósticoRESUMO
The pharmacokinetics of amoxycillin in the CSF following intravenous and oral administration at a 150 mg/kg per day or 250 mg/kg per day dosage in the treatment of purulent meningitis is described. A significant correlation between meningeal inflammation and CSF levels of amoxycillin were observed, including a correlation between the initial neurological state and the outcome of the illness. Despite the early introduction of oral therapy and the reduction in dosage following meningeal and pneumococcal meningitis, no treatment failures could be attributed to this therapeutic regime. Such a treatment schedule, moreover, reduces the risk of superinfection in hospital as well as the cost of treatment and aids the comfort to the patient.
Assuntos
Amoxicilina/uso terapêutico , Meningite Meningocócica/tratamento farmacológico , Meningite Pneumocócica/tratamento farmacológico , Administração Oral , Amoxicilina/administração & dosagem , Amoxicilina/líquido cefalorraquidiano , Criança , Pré-Escolar , Custos e Análise de Custo , Humanos , Lactente , Injeções Intravenosas , CinéticaRESUMO
A prospective study of pediatric diarrhea was conducted in Casablanca. An etiologic agent was found in 67,8% of 87 ill participants. Rotavirus was the most common cause while Campylobacter jejuni, reported as Rotavirus for the first time in Morocco, was isolated in 11% of the patients.