RESUMO
OBJECTIVE: To get a clear view of the current state of treatment for esophageal perforation in Japan. Esophagus perforations are the most serious gastrointestinal tract perforations and are associated with high morbidity and mortality. The optimal treatment choice remains unknown. METHODS: We conducted a retrospective clinical review of 182 esophageal perforation cases at 108 hospitals accredited by the Japanese Esophageal Society between January 2010 and December 2015. RESULTS: We found that 20.9% of patients were incorrectly diagnosed initially. We observed mediastinum emphysema in 83.5% of patients, and serious abscess formations of the mediastinum and intrathoracic cavity in 38.6% and 29.6%, respectively. The lower esophagus was the most commonly perforated site (77.7%). Management of esophageal perforations included nonoperative treatment in 20 patients (11%) and operative treatment in 162 patients (89%). The overall mortality rate was 6.9%. The survivors had significantly shorter times from symptom appearance to visit (p = 0.0016), and from time to visit to diagnosis confirmation (p = 0.0011). Moreover, patients older than 65 years, white blood cells less than 3000/mm3, C-reactive protein > 10 mg/L, or abscesses in the thoracic cavity showed significantly higher mortality than others. CONCLUSION: Shortening the time from onset to the start of treatment contributes to reduce mortality in patients with esophageal perforation. Moreover, strict medical treatment is necessary to lower the mortality rate of elderly patients with strong inflammation and abscesses in the thoracic cavity.
Assuntos
Perfuração Esofágica/diagnóstico , Perfuração Esofágica/etiologia , Perfuração Esofágica/cirurgia , Sociedades Médicas/organização & administração , Abscesso/diagnóstico , Abscesso/epidemiologia , Idoso , Tratamento Conservador/métodos , Tratamento Conservador/estatística & dados numéricos , Perfuração Esofágica/mortalidade , Feminino , Humanos , Japão/epidemiologia , Masculino , Enfisema Mediastínico/diagnóstico , Enfisema Mediastínico/epidemiologia , Mediastino/microbiologia , Mediastino/patologia , Pessoa de Meia-Idade , Mortalidade/tendências , Estudos Retrospectivos , Inquéritos e Questionários , Cavidade Torácica/microbiologia , Cavidade Torácica/patologia , Tempo para o Tratamento/estatística & dados numéricosRESUMO
BACKGROUND/AIMS: Postsurgical gastroesophageal intrathoracic leakage is a potentially life-threatening condition that is frequently accompanied by mediastinitis and subsequent sepsis. Aspiration of fluids from intrathoracic leaks during endoscopy for microbiological analysis is rarely performed in clinical routine. The aim was to evaluate the role of routine microbiological analysis of intrathoracic leaks via endoscopy and its impact on antibiotic therapy. METHODS: This is a prospective, observational single-center study. Seventeen consecutive patients who presented for endoscopic treatment of intrathoracic leaks were included. Concomitantly, fluids from intrathoracic leaks during endoscopic intervention and blood cultures were obtained and a microbiological analysis was performed. RESULTS: Bacteria and/or fungi were detected by culture of fluid aspirated from intrathoracic leaks in 88% cases, but in none of the blood cultures. In 15 patients, microbial colonization of the leakage was detected despite previous empiric antibiotic therapy; treatment had to be adjusted in all patients according to the observed antibiotic susceptibility profile. CONCLUSIONS: The microbiological colonization of postsurgical gastroesophageal intrathoracic leaks in patients is frequent. Only the direct microbiological analysis of fluids from intrathoracic leaks, but not of blood cultures, is effective for optimizing an antibiotic therapy in such patients.
Assuntos
Fístula Anastomótica/microbiologia , Líquidos Corporais/microbiologia , Esôfago/cirurgia , Exsudatos e Transudatos/microbiologia , Estômago/cirurgia , Cavidade Torácica/microbiologia , Idoso , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Antibacterianos/uso terapêutico , Endoscopia Gastrointestinal , Esofagectomia/efeitos adversos , Feminino , Gastrectomia/efeitos adversos , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Sangue Oculto , Estudos ProspectivosRESUMO
We report the first two proven cases of cavitary pulmonary zygomycosis caused by Rhizopus homothallicus. The diagnosis in each case was based on histology, culture of the causal agent, and the nucleotide sequence of the D1/D2 region of the 28S ribosomal DNA.
Assuntos
Pneumopatias/diagnóstico , Rhizopus/isolamento & purificação , Cavidade Torácica/microbiologia , Cavidade Torácica/patologia , Zigomicose/diagnóstico , Análise por Conglomerados , DNA Fúngico/química , DNA Fúngico/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Genes de RNAr , Histocitoquímica , Humanos , Pneumopatias/microbiologia , Pneumopatias/patologia , Masculino , Microscopia , Pessoa de Meia-Idade , Dados de Sequência Molecular , Filogenia , RNA Fúngico/genética , RNA Ribossômico 28S/genética , Radiografia Torácica , Rhizopus/genética , Rhizopus/crescimento & desenvolvimento , Análise de Sequência de DNA , Tomografia , Zigomicose/microbiologia , Zigomicose/patologiaRESUMO
We report a case of a previously fit middle-aged man presenting to the outpatient setting with unilateral pleural effusion, with minimal symptoms. On subsequent investigations, he was diagnosed with empyema thoracis secondary to Panton-Valentine leukocidin (PVL)-toxin positive community-acquired methicillin-resistant Staphylococcus aureus (MRSA). The patient was treated with prolonged antibiotics and pleural drainage, and he remained haemodynamically stable throughout hospital admission. PVL is a cytolytic exotoxin produced by some strains of S. aureus Such strains often cause recurrent skin and soft tissue infections, usually in previously fit and healthy individuals. Less commonly, invasive infections occur; these carry a high mortality rate if associated with necrotising pneumonia or septic shock. PVL genes are present in approximately 2% of clinical isolates of S. aureus in the UK. PVL-producing MRSA infections are on the rise and present significant clinical and public health challenges.
Assuntos
Toxinas Bacterianas , Empiema Pleural/microbiologia , Exotoxinas , Leucocidinas , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/microbiologia , Cavidade Torácica/microbiologia , Infecções Comunitárias Adquiridas/microbiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Environmental persistence of Mycobacterium tuberculosis is subject to speculation. However, the reality that infected postmortem tissues can be a danger to pathologists and embalmers has worrisome implications. A few experimental studies have demonstrated the organism's ability to withstand exposure to embalming fluid and formalin. Recently, a failure was reported in an attempt to resuscitate an original isolate of Robert Koch to determine the lifetime of the tubercle bacillus. The present study also considers a historical approach to determine persistence under favorable environmental conditions. It asks whether acid-fast forms observed in tissues of 300-year-old Hungarian mummies can be resuscitated. Finding organisms before the advent of antibiotics and pasteurization may yield valuable genetic information. Using various media modifications, as well as guinea pig inoculation, an attempt was made to culture these tissues for M. tuberculosis. In addition, a resuscitation-promoting factor, known to increase colony counts in high G+C bacteria, was applied to the cultures. Although an occasional PCR-positive sample was detected, no colonies of M. tuberculosis were obtained. Our results may indicate that the life span of the tubercle bacillus is less than a few hundred years, even though in the short run it can survive harsh chemical treatment.
Assuntos
Viabilidade Microbiana , Múmias/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Animais , Proteínas de Bactérias/análise , Técnicas de Tipagem Bacteriana , Técnicas de Cocultura , Meios de Cultivo Condicionados , Citocinas/análise , Feminino , Cobaias , Humanos , Mycobacterium tuberculosis/classificação , Cavidade Torácica/anatomia & histologia , Cavidade Torácica/microbiologiaRESUMO
We determined the prevalence of lung and mammary gland lesions associated with maedi-visna (MV) infection, the prevalence of paratuberculosis (PTB), and the prevalence and lesions distribution of caseous lymphadenitis (CL) in culled sheep. Total of 451 ewes and 34 rams were selected randomly from two slaughterhouses in Quebec, Canada. MV serostatus was determined by recombinant ELISA test. PTB diagnosis was based on characteristic histological lesions in the terminal ileum, ileocecal lymph node and/or ileocecal valve and CL by gross detection of abscesses and isolation of Corynebacterium pseudotuberculosis. Seroprevalence of MV was 44% (95% CI: 40, 48). Seropositivity increased with age and was higher in ewes than in rams. The percentages of lung and mammary gland lesions in seropositive sheep were 14 and 40%, respectively, but mammary gland lesions lack specificity. The prevalence of PTB was 3% (95% CI: 2, 5). PTB increased with age and was lower among sheep with abscesses. The prevalence of CL was >/=21% (95% CI: 17, 24). The most-prevalent site of caseous lymphadenitis lesions was the thoracic cavity. The risk of carcass condemnation was significantly associated with region, body score and abscesses. Only the presence of abscesses was associated with an increase in trimming of carcasses.
Assuntos
Matadouros , Linfadenite/veterinária , Paratuberculose/epidemiologia , Pneumonia Intersticial Progressiva dos Ovinos/epidemiologia , Doenças dos Ovinos/epidemiologia , Abscesso/microbiologia , Fatores Etários , Animais , Anticorpos Antivirais/sangue , Corynebacterium pseudotuberculosis , Ensaio de Imunoadsorção Enzimática/veterinária , Modelos Logísticos , Pulmão/virologia , Linfadenite/epidemiologia , Glândulas Mamárias Animais/virologia , Pneumonia Intersticial Progressiva dos Ovinos/sangue , Prevalência , Quebeque/epidemiologia , Ovinos , Cavidade Torácica/microbiologia , Vírus Visna-Maedi/isolamento & purificaçãoAssuntos
Coccidioides/isolamento & purificação , Coccidioidomicose/diagnóstico , Pneumonia/microbiologia , Cavidade Torácica/microbiologia , Adulto , Anticorpos Antifúngicos/sangue , Arizona , Biópsia , Coccidioidomicose/tratamento farmacológico , Fluconazol/uso terapêutico , Humanos , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/tratamento farmacológico , Masculino , Pele/patologia , Tórax/diagnóstico por imagem , Tórax/microbiologia , Tórax/patologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The air crescent sign is a well-known important diagnostic finding in invasive pulmonary aspergillosis. Herein we report a distinctive but rare ultrasonographic appearance in a patient with myositis secondary to Aspergillus flavus infection, which can be considered as the soft tissue counterpart of the air crescent sign.
Assuntos
Abdome/diagnóstico por imagem , Aspergilose/diagnóstico por imagem , Miosite/diagnóstico por imagem , Cavidade Torácica/diagnóstico por imagem , Abdome/microbiologia , Adulto , Antifúngicos/uso terapêutico , Aspergilose/complicações , Aspergilose/tratamento farmacológico , Diagnóstico Diferencial , Humanos , Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/tratamento farmacológico , Miosite/complicações , Miosite/tratamento farmacológico , Cavidade Torácica/microbiologia , UltrassonografiaRESUMO
We report a fatal case of community-acquired empyema thoracis and candidemia caused by Candida albicans. The patient responded poorly to human recombinant activated protein C and intravenous fluconazole treatment and died of profound shock with multiple organ failure 8 days after admission.
Assuntos
Candida albicans/patogenicidade , Candidemia/microbiologia , Infecções Comunitárias Adquiridas/microbiologia , Empiema/microbiologia , Cavidade Torácica/microbiologia , Antifúngicos/uso terapêutico , Candidemia/complicações , Candidemia/tratamento farmacológico , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/tratamento farmacológico , Empiema/complicações , Fluconazol/uso terapêutico , Seguimentos , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Proteína C/uso terapêutico , Proteínas Recombinantes/uso terapêutico , Cavidade Torácica/patologiaAssuntos
Antituberculosos/administração & dosagem , Mycobacterium tuberculosis/isolamento & purificação , Cavidade Torácica/microbiologia , Tuberculose dos Linfonodos/diagnóstico , Idoso , Biópsia por Agulha Fina , Diagnóstico Diferencial , Feminino , Humanos , Achados Incidentais , Tomografia por Emissão de Pósitrons , Radiografia Torácica , Cavidade Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Traqueia , Tuberculose dos Linfonodos/tratamento farmacológico , Tuberculose dos Linfonodos/fisiopatologiaRESUMO
There are few systems available for studying the genetics of the important avian respiratory pathogen, Mycoplasma gallisepticum. These techniques are needed to develop a mechanism to study the molecular pathogenesis of M. gallisepticum. Tn916 has the ability to transpose into the M. gallisepticum genome by both transformation and conjugation. In this study, PEG-mediated transformation was employed for the transfer of Tn916 into M. gallisepticum and create a transposon mutant library. Transformants were obtained at a frequency of approximately 5 x 10(-8) per recipient CFU. A total of 424 MG/Tn916 mutants were constructed and sequence data from the transposon junctions of 71 mutants was obtained and used to identify transposon insertion sites. Insertions were found throughout the genome in nearly all of the major gene categories, making this the first extensive characterization of a transposon mutant library of M. gallisepticum. Transposon stability was also examined, and it was determined that for two mutants the element was stably maintained in vivo in the absence of selective pressure.