RESUMO
BACKGROUND: Kingella kingae (Kk) is frequently responsible for invasive skeletal infections in children aged 3-36months. However, few outbreaks of invasive Kk infections in day care centers have been reported. The objective of the present study was to describe (a) the clinical and laboratory data recorded during an outbreak of invasive Kk skeletal infections, and (b) the management of the outbreak. METHOD: Four children from the same day care center were included in the study May and June 2019. We retrospectively analyzed the children's clinical presentation and their radiological and laboratory data. We also identified all the disease control measures taken in the day care center. RESULTS: We observed cases of septic arthritis of the wrist (case #1), shoulder arthritis (case #2), knee arthritis (case #3) ans cervical spondylodiscitis (case #4). All cases presented with an oropharyngeal infection and concomitant fever prior to diagnosis of the skeletal infection. All cases were misdiagnosed at the initial presentation. The mean (range) age at diagnosis was 10.75months (9-12). The three patients with arthritis received surgical treatment. All patients received intravenous and then oral antibiotics. In cases 1 and 2, Kk was detected using real-time PCR and a ST25-rtxA1 clone was identified. The outcome was good in all four cases. Four other children in the day care center presented with scabies during this period and were treated with systemic ivermectin. The Regional Health Agency was informed, and all the parents of children attending the day care center received an information letter. The day care center was cleaned extensively. CONCLUSION: Our results highlight the variety of features of invasive skeletal Kk infections in children and (given the high risk of transmission in day care centers) the importance of diagnosing cases as soon as possible.
Assuntos
Artrite Infecciosa/epidemiologia , Creches , Discite/epidemiologia , Surtos de Doenças/prevenção & controle , Kingella kingae/isolamento & purificação , Infecções por Neisseriaceae/epidemiologia , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/terapia , Artrite Infecciosa/transmissão , Vértebras Cervicais/microbiologia , Pré-Escolar , Terapia Combinada , Diagnóstico Diferencial , Discite/diagnóstico , Discite/microbiologia , Discite/terapia , Feminino , França/epidemiologia , Humanos , Articulação do Joelho/microbiologia , Masculino , Infecções por Neisseriaceae/diagnóstico , Infecções por Neisseriaceae/terapia , Infecções por Neisseriaceae/transmissão , Estudos Retrospectivos , Articulação do Ombro/microbiologia , Articulação do Punho/microbiologiaRESUMO
PURPOSE: Multidrug-resistant Klebsiella pneumoniae strains are regularly involved in hospital outbreaks. This study describes an ESBL-producing K. pneumoniae clone (ST607-K25) responsible for a nosocomial outbreak in a neonatal intensive care unit. METHODOLOGY: Fourteen strains isolated from 13 patients were included. Antimicrobial susceptibility testing was performed by the agar diffusion method. A clonal link was first investigated by fingerprinting (ERIC-PCR and REP-PCR) then confirmed by MLST. Characterization was performed by molecular detection and identification of several drug resistance and virulence determinants. RESULTS: All strains expressed the same antibiotype, combining ESBL production, fluoroquinolones and aminoglycoside resistance, except for one which remained susceptible to fluoroquinolones. Fingerprinting methods confirmed the clonal link and MLST identified a ST607 clone. Molecular investigations revealed: (I) genes encoding for two narrow-spectrum beta-lactamases (SHV-1 and TEM-1) and an ESBL (CTX-M-15); (II) absence of any chromosomal mutation in quinolone resistance-determining- regions (QRDR) of gyrA/gyrB and parC/parE genes; (III) genes encoding for three plasmid-mediated quinolone-resistance (PMQR) determinants: oqxAB (14/14), aac(6')-Ib-cr (14/14) and qnrB (13/14); (IV) production of a K25 capsule; and (V) carriage of three genes encoding for virulence factors: mrkD (type 3 fimbriae) (14/14), ybts (yersiniabactin) (12/14) and entB (enterobactin) (14/14). CONCLUSION: We described a multidrug-resistant Kp ST607 clone responsible for a nosocomial outbreak in vulnerable and premature newborns. Molecular investigations allowed us to identify several resistance factors responsible for ESBL production (CTX-M-15) and quinolone resistance (three PMQR determinants). The detection of a gene (ybtS) belonging to the high-pathogenicity island yersiniabactin could partly explain its high colonization and diffusion potential.
Assuntos
Antibacterianos/farmacologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/isolamento & purificação , Aminoglicosídeos/farmacologia , Proteínas de Bactérias/genética , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Fluoroquinolonas/farmacologia , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/genética , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Fatores R/genética , beta-Lactamases/efeitos dos fármacosRESUMO
Klebsiella pneumoniae is an opportunistic pathogen in neonates. A 23-day-old newborn developed septic arthritis of the right hip due to an ESBL-producing strain. A recurrence on the knee was observed at 4 years of age. A molecular investigation confirmed the clonal link of the strains responsible for the two infections and allowed us to identify virulence factors.
Assuntos
Artrite Infecciosa/complicações , Infecções por Klebsiella/complicações , Osteomielite/complicações , Abscesso/complicações , Abscesso/microbiologia , Antibacterianos/uso terapêutico , Artrite Infecciosa/microbiologia , Artrite Infecciosa/terapia , Artrocentese/métodos , Pré-Escolar , Desbridamento/métodos , Fêmur/microbiologia , Fêmur/patologia , Articulação do Quadril/microbiologia , Articulação do Quadril/patologia , Humanos , Recém-Nascido , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/terapia , Klebsiella pneumoniae/genética , Imageamento por Ressonância Magnética , Masculino , Osteomielite/microbiologia , Osteomielite/terapia , Recidiva , Fatores de VirulênciaRESUMO
We report a case history of a woman of 66 years of age who had a granulocytic sarcoma of the cervix which presented as metrorrhagia and which at first was thought to be an anaplastic cancer. The poor general state of the patient made it impossible to start any anti-leukaemic treatment and the patient died two months after the diagnosis was made. A review of the literature shows that 62 cases of granulocytic sarcoma have been reported of which 22 were in the breast, 19 in the ovary, 13 in the cervix or the uterus, 6 in the vagina and 2 in the vulva. The cells seem to invade the blood and the bone marrow in all occasions by the time of diagnosis or at the most a few weeks later and cases of granulocytic solitary sarcoma are very rare. It blood has not been attacked it is difficult to make a histological diagnosis unless immunological marking and Giemsa staining is carried out together with Leder's reaction. The treatment should be similar to those used for acute myeloid leukaemia.
Assuntos
Leucemia Mieloide , Neoplasias do Colo do Útero , Idoso , Anaplasia , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Feminino , Neoplasias dos Genitais Femininos/patologia , Humanos , Leucemia Mieloide/patologia , Neoplasias do Colo do Útero/patologiaAssuntos
Técnicas Projetivas , Psiquiatria/história , França , História do Século XX , Hungria , Psicometria , Estados UnidosRESUMO
Electron microscopic examination in a case of papular xanthoma revealed the presence of myelinlike laminated bodies in the cytoplasm of the foam cells. To our knowledge, similar bodies have been described in large numbers in only two cases of congenital self-healing histiocytosis and one case of generalized eruptive histiocytoma. The presence of laminated bodies may be a morphologic characteristic of papular xanthoma. However, this possibility should be confirmed by identification of the same inclusions in other cases of this disease.
Assuntos
Dermatopatias/patologia , Pele/ultraestrutura , Xantomatose/patologia , Adulto , Citoplasma/metabolismo , Citoplasma/ultraestrutura , Diagnóstico Diferencial , Células Espumosas/metabolismo , Células Espumosas/ultraestrutura , Humanos , Técnicas Imunoenzimáticas , Macrófagos/metabolismo , Macrófagos/ultraestrutura , Masculino , Muramidase/metabolismo , Pele/metabolismo , Dermatopatias/metabolismo , Xantomatose/metabolismoRESUMO
An unusual case of a mucin secreting benign microfollicular adenoma of the thyroid in a 30 year old euthyroid woman is reported. Histologically, the lesion was characterised by follicular cells with the appearance of signet ring cells. Histochemistry showed the mucin content of these cells to consist uniformly of sulphated acid mucins; positive thyroglobulin immunostaining was also shown. The published work on primary mucin secreting tumours of the thyroid gland is reviewed. Dual differentiation is thought to be responsible for combined mucin secretion and hormone production in this type of neoplasm.
Assuntos
Adenoma/metabolismo , Mucinas/metabolismo , Neoplasias da Glândula Tireoide/metabolismo , Adenoma/patologia , Adulto , Feminino , Histocitoquímica , Humanos , Neoplasias da Glândula Tireoide/patologiaRESUMO
A 32-week-old (gestational age) female infant with epidermolysis bullosa letalis (EBL) (confirmed by light and electron microscopy) had a gastric-outlet obstruction on routine roentgenographic examination. An autopsy showed a fibrous cord connecting the stomach and first part of the duodenum in the area of the pylorus. A review of the literature indicated 12 additional cases of epidermolysis bullosa (EBL where type was confirmed) associated with pyloric atresia. The possibility of coexistent pyloric atresia should be considered in a newborn who has suspected EBL.