RESUMO
INTRODUCTION: Salmonella foodborne disease during pregnancy causes a significant fetal loss in domestic livestock and preterm birth, chorioamnionitis and miscarriage in humans. These complications could be associated with alterations in placental structure. This study was aimed to determine how a low dose of Salmonella Enteritidis during late gestation affects placental histomorphometric in mice. METHODS: We used a self-limiting enterocolitis murine model. BALB/c pregnant animals received a low dose of Salmonella Enteritidis (3-4 x 102 CFU/mouse) on gestational day (GD) 15. At day 3 post infection bacterial loads, serum cytokines expression and placental histomorphometrics parameters were analyzed. RESULTS: We found that a sub-lethal infection with Salmonella induced a significant drop in fetal weight -to-placental weight-ratio and an increase in the placental coefficient. After bacterial inoculation maternal organs were colonized, inducing placental morphometric alterations, including increased placental thickness, reduced surface area, and diminished major and minor diameters. Also, foci of necrosis accompanied by acute leukocyte infiltration in decidual zone, reduction of vascular spaces and vascular congestion in labyrinth zone, were also evident in placentas from infected females on GD 18. Our data shows that placentas from infected mothers are phenotypically different from control ones. Furthermore, expression of IFN-gamma and IL-6 was up regulated in response to Salmonella in maternal serum. DISCUSSION: Our findings demonstrate that a low dose of Salmonella during late gestation alters the placental morphometry leading to negative consequences on pregnancy outcome such as significant reduction in fetal body weight.
Assuntos
Placenta/patologia , Complicações Infecciosas na Gravidez/patologia , Infecções por Salmonella/patologia , Salmonella enteritidis/fisiologia , Animais , Corioamnionite/microbiologia , Corioamnionite/patologia , Modelos Animais de Doenças , Feminino , Retardo do Crescimento Fetal/etiologia , Retardo do Crescimento Fetal/patologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Placenta/microbiologia , Doenças Placentárias/microbiologia , Doenças Placentárias/patologia , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Intoxicação Alimentar por Salmonella/complicações , Intoxicação Alimentar por Salmonella/patologia , Infecções por Salmonella/complicações , Síndrome de Resposta Inflamatória Sistêmica/complicações , Síndrome de Resposta Inflamatória Sistêmica/microbiologia , Síndrome de Resposta Inflamatória Sistêmica/patologiaRESUMO
OBJECTIVES: The main objective of this study was to derive cost estimates of five major foodborne illnesses (campylobacteriosis, salmonellosis, enterohemorrhagic Escherichia coli (EHEC), yersiniosis and shigellosis) in Sweden. These estimates provide a necessary contribution to perform future cost-benefit analyses aimed at reducing the burden of foodborne disease. A secondary aim was to obtain estimates of the true number of cases that occur in the community, thus providing necessary ground for calculating costs. METHODS: The true number of cases for each foodborne illness was simulated by multiplying the reported number of cases by sequential multipliers, one for each potential source of information loss about a case. This assessment of the true number of cases was then used to estimate the number of cases of sequelae for each illness. An incidence-based analysis was then used to calculate direct medical and non-medical costs, as well as indirect costs. Data for estimating the true number of cases for each illness were primarily based on an expert panel, while the derivation of costs mainly utilized national registries, databases and published literature. RESULTS: The estimated number of cases was between 7- and 11-fold higher than the reported number of cases, indicating the importance of taking information loss into account when calculating costs. By far the most common pathogen of the five was campylobacter, with an estimated 101,719 (90% credibility interval [CI] 59,640-158,025) human cases occurring annually. For salmonella, 19,678 (90% CI 8394-40,456) cases were estimated to occur each year, while the other three pathogens were less common, with a yearly incidence of approximately 2500-5500 cases each. The total cost for the five pathogens (including sequelae) amounted to 142 million annually. Campylobacter was the most costly pathogen, representing 69% of the total costs. Salmonellosis and EHEC constituted 18 and 9% of these costs, respectively, while yersiniosis and shigellosis represented approximately 2% each. Costs for sequelae were significant and accounted for approximately 50% of the total costs. CONCLUSIONS: Our simulations indicated that campylobacter infection was more common and more costly than salmonella, EHEC, yersinia and shigella combined. Estimated costs for all illnesses were highly influenced by (1) considering potential information losses about cases in the population (which increased costs 7- to 11-fold), and (2) taking account of post-infection sequelae (which doubled the costs).
Assuntos
Efeitos Psicossociais da Doença , Doenças Transmitidas por Alimentos/economia , Infecções por Campylobacter/complicações , Infecções por Campylobacter/economia , Infecções por Campylobacter/epidemiologia , Disenteria Bacilar/complicações , Disenteria Bacilar/economia , Disenteria Bacilar/epidemiologia , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/economia , Infecções por Escherichia coli/epidemiologia , Feminino , Doenças Transmitidas por Alimentos/complicações , Doenças Transmitidas por Alimentos/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Incidência , Masculino , Modelos Econômicos , Intoxicação Alimentar por Salmonella/complicações , Intoxicação Alimentar por Salmonella/economia , Intoxicação Alimentar por Salmonella/epidemiologia , Suécia/epidemiologia , Yersiniose/complicações , Yersiniose/economia , Yersiniose/epidemiologiaRESUMO
Intestinal inflammation is the central pathological feature of colitis and the inflammatory bowel diseases. These syndromes arise from unidentified environmental factors. We found that recurrent nonlethal gastric infections of Gram-negative Salmonella enterica Typhimurium (ST), a major source of human food poisoning, caused inflammation of murine intestinal tissue, predominantly the colon, which persisted after pathogen clearance and irreversibly escalated in severity with repeated infections. ST progressively disabled a host mechanism of protection by inducing endogenous neuraminidase activity, which accelerated the molecular aging and clearance of intestinal alkaline phosphatase (IAP). Disease was linked to a Toll-like receptor 4 (TLR4)-dependent mechanism of IAP desialylation with accumulation of the IAP substrate and TLR4 ligand, lipopolysaccharide-phosphate. The administration of IAP or the antiviral neuraminidase inhibitor zanamivir was therapeutic by maintaining IAP abundance and function.
Assuntos
Fosfatase Alcalina/deficiência , Colo/microbiologia , Doenças Inflamatórias Intestinais/microbiologia , Intoxicação Alimentar por Salmonella/complicações , Salmonella typhimurium , Receptor 4 Toll-Like/metabolismo , Fosfatase Alcalina/administração & dosagem , Animais , Colo/imunologia , Colo/patologia , Inibidores Enzimáticos/administração & dosagem , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/enzimologia , Doenças Inflamatórias Intestinais/patologia , Lipopolissacarídeos/imunologia , Camundongos , Camundongos Endogâmicos C57BL , Neuraminidase/antagonistas & inibidores , Recidiva , Sialiltransferases/genética , Sialiltransferases/metabolismo , Receptor 4 Toll-Like/genética , Zanamivir/administração & dosagem , beta-Galactosídeo alfa-2,3-SialiltransferaseAssuntos
Febre de Causa Desconhecida/etiologia , Microbiologia de Alimentos , Carne/microbiologia , Intoxicação Alimentar por Salmonella/microbiologia , Salmonella enterica/isolamento & purificação , Tartarugas/microbiologia , Adulto , Animais , Guiné Equatorial/etnologia , Fezes/microbiologia , Humanos , Malária Falciparum/complicações , Masculino , Intoxicação Alimentar por Salmonella/complicações , Salmonella enterica/classificação , Espanha , Sífilis/complicaçõesAssuntos
Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Dor no Peito/etiologia , Fluoroquinolonas/uso terapêutico , Intoxicação Alimentar por Salmonella/complicações , Intoxicação Alimentar por Salmonella/tratamento farmacológico , Doença Aguda , Adulto , Humanos , Masculino , Resultado do TratamentoAssuntos
Diarreia/complicações , Miocardite/etiologia , Intoxicação Alimentar por Salmonella/complicações , Salmonella enteritidis/isolamento & purificação , Doença Aguda , Adolescente , Técnicas de Diagnóstico Cardiovascular , Diarreia/microbiologia , Fezes/microbiologia , Humanos , Imunocompetência , Masculino , Miocardite/diagnóstico , Miocardite/microbiologia , Intoxicação Alimentar por Salmonella/microbiologiaRESUMO
BACKGROUND: In most patients, infection with a non-typhoid Salmonella species usually results in self-limiting gastroenteritis. Severe complications such as bacteraemia and extra-abdominal infections are most often attributed to typhoid subspecies like S. typhi and S. paratyphi. In this article, we present the case of a healthy patient with non-typhoid salmonellosis who nevertheless developed severe complications. CASE DESCRIPTION: A 63-year-old man with an unremarkable medical history presented at the emergency department with abdominal complaints suggestive of gastroenteritis. Cultures of faeces and blood yielded S. typhimurium. The infection was complicated by many intra-abdominal abscesses, abdominal sepsis and an intestinal perforation requiring multiple interventions. The patient has been symptom-free for half a year now. CONCLUSION: Severe complications related to infection with non-typhoid S. typhimurium are rare. The incidence of salmonellosis has risen over the past few years, however; the risk of severe complications has therefore also increased.
Assuntos
Perfuração Intestinal/diagnóstico , Infecções por Salmonella/complicações , Infecções por Salmonella/diagnóstico , Salmonella typhimurium/isolamento & purificação , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/microbiologia , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Diagnóstico Diferencial , Humanos , Perfuração Intestinal/microbiologia , Masculino , Pessoa de Meia-Idade , Intoxicação Alimentar por Salmonella/complicações , Intoxicação Alimentar por Salmonella/diagnósticoRESUMO
A 63-year-old woman presented with 24 hours of dysarthria, confusion, and appendicular ataxia preceded by watery diarrhea, without fever, nausea, vomiting, meningeal signs, recent travel, or antibiotic use. She had type II diabetes and gastroesophageal reflux disease (on proton pump inhibitor). She had consumed inadequately cooked beef stew left at room temperature for 24 hours. Blood cultures were positive for Salmonella typhimurium. CSF showed 15 nucleated cells, 72% monocytoid; remainder of CSF was normal. MRI was consistent with cerebellitis (figure). At 3 months, after 3 weeks of IV ceftriaxone, she remained dysarthric with bilateral dysmetria.
Assuntos
Doenças Cerebelares/diagnóstico , Doenças Cerebelares/microbiologia , Intoxicação Alimentar por Salmonella/diagnóstico , Salmonella typhimurium/isolamento & purificação , Doença Aguda , Doenças Cerebelares/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Intoxicação Alimentar por Salmonella/complicaçõesRESUMO
Myocarditis typically presents with non-specific clinical symptoms, and can easily be missed in the absence of a high index of clinical suspicion. Myocarditis caused by bacterial pathogens is rare in immunocompetent individuals, more commonly seen following viral infection. Although more classically associated with typhoid fever and gastroenteritis, Salmonella species are a rare cause of myocarditis. We report a case of Salmonella enteritidis-induced myocarditis after gastrointestinal infection in a 16 year-old girl, and discuss the diagnostic tools currently utilised to ascertain the diagnosis.
Assuntos
Miocardite/diagnóstico , Infecções por Salmonella/diagnóstico , Salmonella enteritidis , Adolescente , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Quimioterapia Combinada , Ecocardiografia , Eletrocardiografia , Feminino , Seguimentos , Gastroenterite/complicações , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Humanos , Miocardite/tratamento farmacológico , Edema Pulmonar/diagnóstico , Edema Pulmonar/tratamento farmacológico , Intoxicação Alimentar por Salmonella/complicações , Intoxicação Alimentar por Salmonella/diagnóstico , Intoxicação Alimentar por Salmonella/tratamento farmacológico , Infecções por Salmonella/tratamento farmacológico , Taquicardia/diagnóstico , Taquicardia/tratamento farmacológicoRESUMO
Salmonella is an important foodborne pathogen, with eggs and egg-containing foods being frequently implicated in causing outbreaks of disease. In April 2012, an investigation was commenced after a number of cases of salmonellosis were linked to a Canberra café. The investigation sought to identify the cause of illness and to introduce public health measures to prevent further disease. A case control study was undertaken using the café's booking list to identify potential cases and controls. A structured questionnaire was developed using the café's menu, with information collected via telephone interview or email. A case was defined as any person who ate at the implicated café on 25 April 2012 and subsequently developed gastroenteritis. A total of 20 cases and 22 controls were recruited into the study. All 20 cases had faecal cultures positive for Salmonella Typhimurium phage type 135a (STm 135a). Eating eggs Benedict (odds ratio 63.00, 95% confidence interval 6.08-2771.66 P > 0.001) was significantly associated with illness. While no microbiological evidence of STm 135a was obtained from foods sampled from the café, STm 135a was recovered from swabs taken from the kitchen environment. This report illustrates an ongoing trend in Australia, where raw and minimally cooked egg-containing foods are identified as the responsible vehicles in a high proportion of foodborne Salmonella outbreaks.
Assuntos
Surtos de Doenças , Gastroenterite/epidemiologia , Intoxicação Alimentar por Salmonella/epidemiologia , Salmonella typhimurium , Adulto , Austrália/epidemiologia , Estudos de Casos e Controles , Ovos/microbiologia , Feminino , Gastroenterite/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Intoxicação Alimentar por Salmonella/complicações , Intoxicação Alimentar por Salmonella/microbiologia , Adulto JovemRESUMO
Described case report speaks in favour of the relation between childhood sexual abuse with the development of conversion disorder. Following Salmonella poisoning, adolescent, at the age of 16, develops series of severe somatic symptoms. Results of diagnostic procedures excluded organic foundation of the symptoms; diagnosis of conversion disorder is established. Soon, patient's problems stop abruptly and spontaneously, and the aetiology of the mental disorder remains unexplained. Six years later, adolescent reveals for the first time data about the childhood sexual abuse during the forensic evaluation (within the court process related to the request for compensation for the complications which occurred following the Salmonella infection). During the forensic evaluation, we had insight into the previous medical history, while an interview, psychological and psychiatric exploration was conducted with the examinee. Data about the sexual abuse retrospectively explain the dynamics of the development of conversion disorder. The described case indicates that sexual abuse of children and adolescents frequently remains unrecognized, which has sequels for treatment and prevention of subsequent consequences for mental health. It is important to emphasize the significance of examining history of abuse during the diagnostic of certain mental disorders. Forensic implications of the case have not been discussed in details for the needs of this report.
Assuntos
Abuso Sexual na Infância/psicologia , Transtorno Conversivo/etiologia , Transtorno Conversivo/psicologia , Criança , Eletrocardiografia , Feminino , Humanos , Intoxicação Alimentar por Salmonella/complicações , Adulto JovemRESUMO
The authors propose to consider infectious diseases as mass clinical conditions in both normative-legal and medical contexts. Peculiarities of commission and comprehensive inspections carried out in situations of massive infectious morbidity among servicemen are illustrated by examples of the work of state forensic medical organizations and investigative authorities of the Russian Defense Ministry.
Assuntos
Transmissão de Doença Infecciosa/legislação & jurisprudência , Medicina Militar/legislação & jurisprudência , Militares , Infecções por Salmonella , Precauções Universais/legislação & jurisprudência , Prova Pericial/legislação & jurisprudência , Prova Pericial/métodos , Fômites/microbiologia , Medicina Legal , Humanos , Controle de Infecções/legislação & jurisprudência , Controle de Infecções/normas , Morbidade , Salmonella/patogenicidade , Intoxicação Alimentar por Salmonella/complicações , Infecções por Salmonella/epidemiologia , Infecções por Salmonella/etiologia , Infecções por Salmonella/prevenção & controle , Infecções por Salmonella/transmissãoRESUMO
Osteomyelitis is an inflammation of the bone caused by infecting organisms. We present here the first case of osteomyelitis of the distal femur caused by Salmonella typhimurium in a patient with Crohn's disease. The infection was successfully treated with a combination of antibiotics and surgical treatment.
Assuntos
Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Doença de Crohn/complicações , Doença de Crohn/tratamento farmacológico , Fêmur , Infecções Oportunistas/diagnóstico , Osteomielite/diagnóstico , Infecções por Salmonella/diagnóstico , Salmonella typhimurium , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Terapia Combinada , Fêmur/cirurgia , Humanos , Infusões Intravenosas , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteomielite/cirurgia , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/diagnóstico , Cintilografia , Intoxicação Alimentar por Salmonella/complicações , Intoxicação Alimentar por Salmonella/diagnóstico , Infecções por Salmonella/cirurgiaRESUMO
OBJECTIVE: In 2005 a large outbreak of Salmonella hadar occurred in Spain following the consumption of commercial precooked roast chicken. We estimated the incidence and risk factors for reactive arthritis (ReA) and other musculoskeletal sequelae in the patients of this outbreak in 2 health departments of Castellon province. METHODS: A prospective cohort study of the patients and their families was carried out. Clinical infection with Salmonella was considered as the exposure factor. The cohort was studied for ReA symptoms using a telephone questionnaire. Telephone interviews or medical examinations of subjects with musculoskeletal symptoms were conducted by a rheumatologist. Robust Poisson regression models were used in the analysis. RESULTS: From the cohort of 262 people, 248 (94.7%) participated in the telephone survey, 155 with clinical salmonellosis (infected), 78 noninfected, and 15 with some symptoms but not clinical salmonellosis. One hundred one infected patients (65%) reported musculoskeletal symptoms, compared to 19 noninfected (24%) (adjusted relative risk = 2.60, 95% CI 1.73-3.90). Of the infected group, 16 ReA (incidence 10%, 95% CI 6.0-16.2), 7 enthesopathies, and 2 arthralgias were detected, and zero in the noninfected group. The risk factors for ReA were age, weight loss, and duration of diarrhea. Antibiotic treatment for the infection protected against symptoms of peripheral or axial arthritis (adjusted relative risk = 0.73, 95% CI 0.55-0.98). CONCLUSION: The incidence of ReA and musculoskeletal symptoms after the infection was high. The use of antibiotics for S. hadar infection offered some protection against musculoskeletal symptoms.
Assuntos
Artrite Reativa/epidemiologia , Surtos de Doenças , Contaminação de Alimentos , Miosite/epidemiologia , Intoxicação Alimentar por Salmonella/epidemiologia , Salmonella enteritidis/isolamento & purificação , Animais , Antibacterianos/uso terapêutico , Artrite Reativa/microbiologia , Artrite Reativa/prevenção & controle , Galinhas , Estudos de Coortes , Culinária , Coleta de Dados , Microbiologia de Alimentos , Humanos , Masculino , Miosite/microbiologia , Miosite/prevenção & controle , Proibitinas , Estudos Prospectivos , Intoxicação Alimentar por Salmonella/complicações , Intoxicação Alimentar por Salmonella/tratamento farmacológico , Salmonella enteritidis/fisiologia , Espanha/epidemiologia , Inquéritos e Questionários , TelefoneAssuntos
Dor Abdominal/etiologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Intoxicação Alimentar por Salmonella/complicações , Adulto , Aneurisma Infectado/tratamento farmacológico , Antibacterianos/administração & dosagem , Hérnia Diafragmática/diagnóstico por imagem , Humanos , Masculino , Radiografia , Intoxicação Alimentar por Salmonella/tratamento farmacológico , Tomógrafos Computadorizados , Resultado do TratamentoRESUMO
Anaerobic gas-producing clostridial infection is one of most severe complications of mainly gunshot wound of war period, in peace time occurs very seldom. The rare clinical case of anaerobic gas-producing clostridial endogenic infection with fulminant course in patient with salmonellosis produced by group B salmonella typhimurium. The disease was finished with fatal outcome in 8.5 hours after appearance of pain syndrome in right thigh with consequent fulminant development of gas gangrene with arterial hypotension on 4th day after onset of gastroenteric form of medium severity salmonellosis. Clinical, microbiological and postmortem data are represented.
Assuntos
Infecções por Clostridium/complicações , Clostridium/isolamento & purificação , Intoxicação Alimentar por Salmonella/complicações , Salmonella typhimurium/isolamento & purificação , Idoso , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/microbiologia , Diagnóstico Diferencial , Evolução Fatal , Humanos , Intestino Delgado/microbiologia , Masculino , Intoxicação Alimentar por Salmonella/diagnóstico , Intoxicação Alimentar por Salmonella/microbiologiaRESUMO
OBJECTIVE: In 2005, 592 individuals in Ontario developed acute gastroenteritis, predominantly after consuming bean sprouts contaminated with Salmonella enteritidis. Salmonella is a known trigger of reactive arthritis (ReA). We describe the population affected by the Salmonella outbreak in terms of clinical presentation of self-reported arthritic symptoms and HLA-B27 genotyping. METHODS: Subjects were mailed a questionnaire, which assessed symptoms consistent with ReA. Subsequently, subjects were asked to submit saliva samples, which were analyzed for HLA-B27. Simple descriptive statistics were performed for analysis of survey responses, and the genetic component was analyzed by chi-square or Fisher's exact tests. RESULTS: Most respondents were female (71.3%), with a mean age of 46.0 years. The mean duration of diarrhea symptoms was 16.5 days. 62.5% of respondents reported extraintestinal symptoms that were consistent with ReA. The most commonly reported features were joint pain, swelling or stiffness (46.2%), stiffness > 30 min (35.6%), ocular symptoms (24.0%), and visibly swollen joints (19.2%). Subjects with Salmonella infection had a similar incidence of HLA-B27, regardless of whether they developed symptoms consistent with ReA or not. Notably, HLA-B27 was present more frequently in those who developed Salmonella infection than in healthy controls (OR 3.0). CONCLUSION: The study, one of the largest for a dysenteric outbreak, revealed a high event rate of self-reported symptoms consistent with ReA in those infected with Salmonella. Our results showed that HLA-B27 may have rendered individuals more susceptible to Salmonella infection, but did not contribute to the development of symptoms consistent with ReA after infection. We note that the methods used in this study, including self-report, are not ideal for diagnosis of inflammatory arthritis. However, given the rarity of large outbreaks of Salmonella, the study adds valuable knowledge about the course of ReA.
Assuntos
Artrite Reativa/epidemiologia , Surtos de Doenças , Intoxicação Alimentar por Salmonella/complicações , Salmonella enteritidis , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reativa/genética , Artrite Reativa/microbiologia , Notificação de Doenças , Feminino , Genótipo , Antígeno HLA-B27 , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Proibitinas , Intoxicação Alimentar por Salmonella/epidemiologia , Intoxicação Alimentar por Salmonella/genéticaAssuntos
Dor Lombar/etiologia , Abscesso do Psoas/microbiologia , Intoxicação Alimentar por Salmonella/complicações , Salmonella enteritidis/isolamento & purificação , Adulto , Animais , Bovinos , Culinária , Humanos , Masculino , Carne/efeitos adversos , Abscesso do Psoas/complicações , Abscesso do Psoas/diagnóstico por imagem , RadiografiaRESUMO
Se presenta el caso de un paciente masculino de 59 años de edad, con antecedentes de colitis ulcerosa, que luego de la ingesta de agua no potable se internó por diarrea de una semana de evolución con más de veinte deposiciones acuosas diarias. Al momento de la internación se realizó rectosigmoidoscopía que no reveló actividad de su enfermedad intestinal de base. Se solicitaron estudios para descartar diversas etiologías infecciosas, obteniéndose en coprocultivo desarrollo de Salmonella species por lo que se indicó tratamiento antibiótico con ciprofloxacina.