RESUMO
We report a case of a renal transplant recipient who presented with oral lesions associated with cytomegalovirus (CMV) and herpes simplex virus (HSV). This female patient, who underwent a living donor renal transplant 26 months prior, presented with a painful buccal lesion after an episode of leukopenia. The search for CMV antigen was negative. A biopsy incision was made in the mucous membrane and the material collected by scarification was sent for polymerase chain reaction PCR, anatomic, pathological, and cytological exams. The lab results showed infections with CMV, HSV, and Candida albicans. Thus, the treatment involved the use of acyclovir (1 g a day for 10 days), topical Nystatin gargles (six times a day), and an aqueous solution of chlorexidine (0.12%), as well as laser therapy. After the adoption of these therapeutic modalities, there was complete remission of the buccal lesions. The odontological routine follow-up and early treatment of oral complications deriving from the immunosuppressive therapy contributed to a significant outcome.
Assuntos
Infecções por Citomegalovirus/complicações , Herpes Simples/complicações , Transplante de Rim/efeitos adversos , Doenças da Boca/virologia , Adulto , Candida albicans/isolamento & purificação , Citomegalovirus/isolamento & purificação , Feminino , Humanos , Doenças da Boca/microbiologia , Complicações Pós-Operatórias/virologia , Simplexvirus/isolamento & purificaçãoRESUMO
We evaluated the performance of several methods for the detection of methicillin resistance in Staphylococcus aureus using 101 clinical S. aureus isolates from pediatric patients in a tertiary hospital in Brazil; 50 isolates were mecA-positive and 51 were mecA-negative. The Etest and oxacillin agar screening plates were 100% sensitive and specific for mecA presence. Oxacillin and cefoxitin disks gave sensitivities of 96 and 92%, respectively, and 98% specificity. Alterations of CLSI cefoxitin breakpoints increased sensitivity to 98%, without decreasing specificity. Our results highlight the importance of a continuing evaluation of the recommended microbiological methods by different laboratories and in different settings. If necessary, laboratories should use a second test before reporting a strain as susceptible, especially when testing strains isolated from invasive or serious infections. With the new (2007) CLSI breakpoints, the cefoxitin-disk test appears to be a good option for the detection of methicillin resistance in S. aureus.
Assuntos
Antibacterianos/farmacologia , Cefoxitina/farmacologia , Resistência a Meticilina , Oxacilina/farmacologia , Staphylococcus aureus/efeitos dos fármacos , Proteínas de Bactérias/análise , Criança , Difusão , Humanos , Testes de Sensibilidade Microbiana/métodos , Proteínas de Ligação às Penicilinas , Reprodutibilidade dos Testes , Staphylococcus aureus/isolamento & purificaçãoRESUMO
Treatment of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae infections (KPC-EI) remains a challenge. Combined therapy has been proposed as the best choice, but there are no clear data showing which combination therapy is superior. Our aim was to evaluate the effectiveness of antimicrobial regimens for treating KPC-EI. This was a retrospective cohort study of KPC-EI nosocomial infections (based on CDC criteria) between October 2009 and June 2013 at three tertiary Brazilian hospitals. The primary outcomes were the 30-day mortality for all infections and the 30-day mortality for patients with bacteraemia. Risk factors for mortality were evaluated by comparing clinical variables of survivors and nonsurvivors. In this study, 118 patients were included, of whom 78 had bacteraemia. Catheter-related bloodstream infections were the most frequent (43%), followed by urinary tract infections (n = 27, 23%). Monotherapy was used in 57 patients and combined treatment in 61 patients. The most common therapeutic combination was polymyxin plus carbapenem 20 (33%). Multivariate analysis for all infections (n = 118) and for bacteremic infections (n = 78) revealed that renal failure at the end of treatment, use of polymyxin and older age were prognostic factors for mortality. In conclusion, polymyxins showed suboptimal efficacy and combination therapy was not superior to monotherapy.
Assuntos
Antibacterianos/uso terapêutico , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/enzimologia , Polimixinas/uso terapêutico , beta-Lactamases/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Brasil , Criança , Pré-Escolar , Estudos de Coortes , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/mortalidade , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Centros de Atenção Terciária , Resultado do Tratamento , Adulto JovemRESUMO
From June 1989 to March 1990 there were eight cases of Legionnaires' disease caused by Legionella pneumophila serogroup 1 in a renal transplant unit. There were seven cases of pneumonia and one case of pleural effusion. A study was conducted to identify the source of the outbreak. Legionella anisa was cultured from tap water. Twenty-seven staff members of the unit were serologically tested and antibody titres were positive in two. The probable source of infection was the potable water system. Control measures were hyperchlorination and heating of the water, after which there were no further cases during 5 months' follow up. We believe this is the first reported Legionnaires' disease outbreak in Latin America.
Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Unidades Hospitalares/normas , Transplante de Rim , Doença dos Legionários/epidemiologia , Brasil/epidemiologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Humanos , Doença dos Legionários/etiologia , Doença dos Legionários/prevenção & controle , Microbiologia da Água , Abastecimento de Água/normasRESUMO
Vancomycin-resistant enterococci strains (VRE) is an important pathogen related with hospital infections in many countries, presenting limited or no therapeutic options for treating serious infections. VRE has presented some different genotypes been VanA and VanB considered to be the most important in hospital environments. In the present study the authors investigated the prevalence of van genes (A, B an C) among clinical isolates of VRE in a five month period at a large tertiary hospital in Sao Paulo, Brazil. The results showed the presence of vanA, but not vanB or vanC in all 43 strains of E. faecalis and five E. faecium studied. The results bring an important issue, due to the possibility of resistance spread of vanA genes, to be monitored and solved by the hospital infection control team and the microbiology and molecular biology laboratories at tertiary Hospitals.
Assuntos
Enterococcus faecalis/genética , Enterococcus faecium/genética , Resistência a Vancomicina/genética , Proteínas de Bactérias/genética , Brasil , Carbono-Oxigênio Ligases/genética , Infecção Hospitalar/microbiologia , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecium/efeitos dos fármacos , Humanos , Reação em Cadeia da PolimeraseRESUMO
Members of the genera Staphylococcus are the most common pathogens found in the hospital environment and they are acquiring resistance to multiple drugs. PURPOSE--To evaluate the in vitro activity of teicoplanin and vancomycin against 195 strains of staphylococci isolated from in-patients. METHODS--One hundred strains of Staphylococcus aureus (50% methicillin-resistant) and 95 strains of coagulase-negative staphylococci (46.3% strains methicillin-resistant) were tested by the agar dilution and the disk diffusion techniques. RESULTS--All strains (100%) were susceptible to vancomycin, S. aureus strains presented MIC90 of 0.5 microgram/mL whereas strains of coagulase-negative staphylococci showed MIC90 of 1.0 microgram/mL. For teicoplanin, 98.5% of the strains were susceptible. MIC90 values were 0.5 microgram/mL for S. aureus strains, 2.0 micrograms/mL for coagulase-negative methicillin-susceptible staphylococci strains and 8.0 micrograms/mL for coagulase-negative methicillin-resistant staphylococci strains. CONCLUSION--From the microbiological point of view, the results showed a high potential for both drugs as therapeutic agents in staphylococcal infections due to multiresistant strains of hospital origin.
Assuntos
Staphylococcus aureus/efeitos dos fármacos , Teicoplanina/farmacologia , Vancomicina/farmacologia , Infecção Hospitalar/microbiologia , Resistência Microbiana a Medicamentos , Humanos , Testes de Sensibilidade Microbiana , Staphylococcus aureus/enzimologiaAssuntos
Meningite Pneumocócica/microbiologia , Resistência às Penicilinas , Brasil , Humanos , Lactente , Masculino , Meningite Pneumocócica/líquido cefalorraquidiano , Meningite Pneumocócica/tratamento farmacológico , Penicilina G/líquido cefalorraquidiano , Penicilina G/uso terapêutico , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
We report the unusual simultaneous occurrence of lymphoepithelial cysts, cytomegalovirus (CMV) and mycobacterial infections in the intraparotid lymph nodes of a 52-year-old AIDS patient who died of disseminated mycobacteriosis. Although cytomegalovirosis is a common finding in the salivary glands of HIV patients, the association of CMV inclusions with lymphoepithelial cyst (LC) has not been previously reported. Parotid mycobacterial infection is an uncommon finding, despite its usual disseminated presentation in HIV patients. These data emphasize that in immunosuppressed patients, simultaneous diseases of the parotid gland may occur and should be considered for diagnosis and treatment.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Cistos/patologia , Infecções por Citomegalovirus/complicações , Doenças Linfáticas/complicações , Doenças Parotídeas/complicações , Tuberculose dos Linfonodos/complicações , Tuberculose Bucal/complicações , Evolução Fatal , Humanos , Doenças Linfáticas/microbiologia , Doenças Linfáticas/virologia , Masculino , Pessoa de Meia-Idade , Doenças Parotídeas/microbiologia , Doenças Parotídeas/virologiaRESUMO
We evaluated the performance of several methods for the detection of methicillin resistance in Staphylococcus aureus using 101 clinical S. aureus isolates from pediatric patients in a tertiary hospital in Brazil; 50 isolates were mecA-positive and 51 were mecA-negative. The Etest and oxacillin agar screening plates were 100 percent sensitive and specific for mecA presence. Oxacillin and cefoxitin disks gave sensitivities of 96 and 92 percent, respectively, and 98 percent specificity. Alterations of CLSI cefoxitin breakpoints increased sensitivity to 98 percent, without decreasing specificity. Our results highlight the importance of a continuing evaluation of the recommended microbiological methods by different laboratories and in different settings. If necessary, laboratories should use a second test before reporting a strain as susceptible, especially when testing strains isolated from invasive or serious infections. With the new (2007) CLSI breakpoints, the cefoxitin-disk test appears to be a good option for the detection of methicillin resistance in S. aureus.
Assuntos
Criança , Humanos , Antibacterianos/farmacologia , Cefoxitina/farmacologia , Resistência a Meticilina , Oxacilina/farmacologia , Staphylococcus aureus/efeitos dos fármacos , Proteínas de Bactérias/análise , Difusão , Testes de Sensibilidade Microbiana/métodos , Reprodutibilidade dos Testes , Staphylococcus aureus/isolamento & purificaçãoAssuntos
Ciprofloxacina/farmacologia , Infecção Hospitalar/microbiologia , Acinetobacter/efeitos dos fármacos , Resistência Microbiana a Medicamentos , Técnicas In Vitro , Klebsiella pneumoniae/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Pseudomonas aeruginosa/efeitos dos fármacos , Serratia marcescens/efeitos dos fármacos , Staphylococcus aureus/efeitos dos fármacosRESUMO
Vancomycin-resistant enterococci strains (VRE) is an important pathogen related with hospital infections in many countries, presenting limited or no therapeutic options for treating serious infections. VRE has presented some different genotypes been VanA and VanB considered to be the most important in hospital environments. In the present study the authors investigated the prevalence of van genes (A, B an C) among clinical isolates of VRE in a five month period at a large tertiary hospital in Sao Paulo, Brazil. The results showed the presence of vanA, but not vanB or vanC in all 43 strains of E. faecalis and five E. faecium studied. The results bring an important issue, due to the possibility of resistance spread of vanA genes, to be monitored and solved by the hospital infection control team and the microbiology and molecular biology laboratories at tertiary Hospitals