RESUMO
We report the case of a 55 year-old man presenting with a double aortic and mitral endocarditis for which resected valve culture was repeatedly negative. Specific PCR made on valves because of highly positive blood tests for Bartonella henselae remained negative. A molecular approach was made with 16S rDNA PCR, followed by sequencing. Bartonella quintana was identified as the etiology of endocarditis. B. quintana, "fastidious" bacteria, even if hard to identify in a laboratory, is often reported as a blood culture negative endocarditis (BCNE) agent. Molecular biology methods have strongly improved the diagnosis of BCNE. We propose a review of the literature focusing on the interest of broad-spectrum PCR on valve for the etiological diagnosis of BCNE.
Assuntos
Bartonella quintana/isolamento & purificação , DNA Bacteriano/análise , Endocardite Bacteriana/etiologia , Reação em Cadeia da Polimerase/métodos , RNA Ribossômico 16S/genética , Ribotipagem , Febre das Trincheiras/diagnóstico , Doenças dos Trabalhadores Agrícolas/sangue , Doenças dos Trabalhadores Agrícolas/diagnóstico , Doenças dos Trabalhadores Agrícolas/etiologia , Doenças dos Trabalhadores Agrícolas/microbiologia , Valva Aórtica/microbiologia , Valva Aórtica/cirurgia , Bartonella quintana/genética , Sangue/microbiologia , Endocardite Bacteriana/sangue , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Reações Falso-Negativas , Jardinagem , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/microbiologia , Valva Mitral/cirurgia , Filogenia , Homologia de Sequência do Ácido Nucleico , Febre das Trincheiras/complicaçõesRESUMO
The CTX-M type extended spectrum beta-lactamases constitute a rapidly growing cluster of enzymes that have disseminated geographically. This study evaluates the prevalence of these enzymes in the university hospital in Tours, in 2007. Twenty-eight strains were studied: 21 Escherichia coli and seven Klebsiella pneumoniae. The gene bla(CTX-M) was detected by real-time PCR for 27 strains. The CTX-M-1 group, including CTX-M-15, was the most frequent CTX-M-type enzyme.
Assuntos
Proteínas de Bactérias/isolamento & purificação , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Escherichia coli/microbiologia , Escherichia coli/enzimologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , Resistência beta-Lactâmica/genética , beta-Lactamases/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Proteínas de Bactérias/classificação , Proteínas de Bactérias/genética , Bacteriúria/epidemiologia , Bacteriúria/microbiologia , Infecção Hospitalar/epidemiologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/epidemiologia , Feminino , França/epidemiologia , Hospitais Universitários/estatística & dados numéricos , Humanos , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Prevalência , Especificidade por Substrato , beta-Lactamases/classificação , beta-Lactamases/genéticaRESUMO
A case of hepatitis B virus reactivation leading to the diagnosis of a T cell lymphoma is reported. A 66-year-old woman with a past history (10 years before) of spontaneously recovered acute hepatitis B (with disappearance of serum hepatitis B surface antigen and appearance of anti-HBs), has been referred for hepatologic consultation for acute hepatitis. The patient was found positive again for hepatitis B surface antigen as well HBeAg and hepatitis B virus DNA. No other cause of liver disease was identified and a diagnosis of spontaneous hepatitis B virus reactivation was made. Five months later a peripheral T cell lymphoma was diagnosed. This unusual case confirms that natural immunity is not protective against hepatitis B virus reactivation and shows that such hepatitis B virus reactivation may precede the usual clinical manifestations of a peripheral T cell lymphoma.
Assuntos
Hepatite B/complicações , Linfoma de Células T/complicações , Linfoma de Células T/diagnóstico , Recidiva Local de Neoplasia/complicações , Idoso , Antivirais/uso terapêutico , DNA Viral/sangue , Evolução Fatal , Feminino , Hepatite B/tratamento farmacológico , Antígenos E da Hepatite B/sangue , Humanos , Lamivudina/uso terapêutico , Linfoma de Células T/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva , Remissão EspontâneaRESUMO
Use of molecular biology shows that Kingella kingae is a pathogen frequently involved in osteoarticular infections in young children. This study describes the cases of osteoarticular infections due to K. kingae which happened from 1995 to 2006 in the CHRU of Tours. The description is based on clinical and biological features. A K. kingae specific polymerase chain reaction was performed in our laboratory in order to improve K. kingae osteoarticular infections diagnosis, and is detailed here.