RESUMO
We report a case of Klebsiella pneumoniae bacteraemia in an 80-year-old man in France with no history of travel to Asia, complicated by endogenous endophthalmitis, multiple cerebral microbleeds and hepatic microabscesses, associated with a Bentall endocarditis. Hypervirulence pathotype was suggested based on clinical picture, bacterial isolate genomic sequence and hypermucoidy. Interestingly, the isolate had the non-K1/K2-capsular serotype locus KL113-like, carried a KpVP-1-like virulence plasmid, and belonged to the emerging sublineage SL660 (comprising the sequence type ST660).
RESUMO
The diagnostic and prognostic values of blood cultures (BC) for 347 acute prostatitis inpatients were evaluated. BC were positive for 21% of patients and contributed to the microbiological diagnosis for 5%. Fever duration, length of hospitalization, use of an antibiotic combination, duration of antibiotic use, and urine bacterial titers increased when BC were positive.
Assuntos
Bacteriemia/diagnóstico , Bactérias/isolamento & purificação , Sangue/microbiologia , Prostatite/complicações , Prostatite/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Bactérias/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Prostatite/microbiologia , Adulto JovemRESUMO
Because Q fever is mostly diagnosed serologically, localizing a persistent focus of Coxiella burnetii infection can be challenging. F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) could be an interesting tool in this context.We performed a retrospective study on patients diagnosed with C burnetii infection, who had undergone F-FDG PET/CT between 2009 and 2015. When positive F-FDG PET/CT results were obtained, we tried to determine if it changed the previous diagnosis by discovering or confirming a suspected focus of C burnetii infection.One hundred sixty-seven patients benefited from F-FDG PET/CT. The most frequent clinical subgroup before F-FDG PET/CT was patients with no identified focus of infection, despite high IgG1 serological titers (34%). For 59% (nâ=â99) of patients, a hypermetabolic focus was identified. For 62 patients (62.6%), the positive F-FDG PET/CT allowed the diagnosis to be changed. For 24 of them, (38.7%), a previously unsuspected focus of infection was discovered. Forty-two (42%) positive patients had more than 1 hypermetabolic focus. We observed 21 valvular foci, 34 vascular foci, and a high proportion of osteoarticular localizations (nâ=â21). We also observed lymphadenitis (nâ=â27), bone marrow hypermetabolism (nâ=â11), and 9 pulmonary localizations.We confirmed thatF-FDG PET/CT is a central tool in the diagnosis of C burnetii focalized persistent infection. We proposed new diagnostic scores for 2 main clinical entities identified using F-FDG PET/CT: osteoarticular persistent infections and lymphadenitis.
Assuntos
Doenças Ósseas Infecciosas/diagnóstico por imagem , Endocardite/diagnóstico por imagem , Linfadenite/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Infecções Relacionadas à Prótese/diagnóstico por imagem , Febre Q/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem , Adulto , Idoso , Doenças Ósseas Infecciosas/microbiologia , Coxiella burnetii , Endocardite/microbiologia , Feminino , Fluordesoxiglucose F18 , Humanos , Imunoglobulinas/sangue , Linfadenite/microbiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/diagnóstico por imagem , Pneumonia Bacteriana/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Febre Q/sangue , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Doenças Vasculares/microbiologiaRESUMO
We report the case of a multi-experienced patient, infected with an HIV-1 strain, with selected multiple resistance mutations. We designed a novel well-tolerated and effective rescue treatment including dolutegravir, rilpivirine, and foscarnet, allowing a 60-week sustained virological response for the first time in 23 years of HIV infection.