Bio prospecting of Riboflavin producing bacteria from different riboflavin enriched food sources

Riboflavin is an essential, water-soluble vitamin (B2) and a component of basic cellular metabolism. The aim of the present study is to isolate and characterize riboflavin producing bacteria from different food sources. Ten different riboflavin enriched food sources were collected from Vellore district. Totally 72 bacterial strains were isolated and cultured on nutrient agar plates. Out of these, 43 strains were identified as riboflavin producers. Isolated bacterial strains HDS27, HDS07, HDS14, HDS18, HDS38 and HDS54 isolated from milk, mushroom, spinach, lamb kidney, beef liver and mackerel fish were found to be potent riboflavin producers. Based on morphological, biochemical and molecular characterization, the potent strains were identified as Lactobacillus plantarum (HDS27), Bacillus cereus (HDS07), Delftia tsuruhatensis (HDS14), Citrobacter freundii (HDS18), Enterobacter cloacae (HDS38) and Bacillus cereus (HDS54). The selected potent isolates HDS27 from milk and HDS07 from mushroom showed a maximum riboflavin production of 3.69 mg/L and 2.9mg/L respectively. The present study explores the riboflavin producing novel bacteria from different food sources. This is the first report that the Enterobacter cloacae isolated from beef liver, Delftia tsuruhatensis from spinach and Citrobacter freundii from lamb kidney has the ability to produce riboflavin. These potent strains could be a better starter for substituting the conventional bacteria for large scale production of riboflavin in industry.

Novel repellents for the blood-sucking insects Rhodnius prolixus and Triatoma infestans, vectors of Chagas disease

Background: Studying the behavioral response of blood-sucking disease-vector insects to potentially repellent volatile compounds could shed light on the development of new control strategies. Volatiles released by human facial skin microbiota play diferent roles in the host-seeking behavior of triatomines. We assessed the repellency efect of such compounds of bacterial origin on Triatoma infestans and Rhodnius prolixus, two important vectors of Chagas disease in Latin America. Methods: Using an exposure device, insects were presented to human odor alone (control) and in the presence of three individual test compounds (2-mercaptoethanol, dimethyl sulfde and 2-phenylethanol, the latter only tested in R. prolixus) and the gold-standard repellent NN-diethyl-3-methylbenzamide (DEET). We quantifed the time the insects spent in the proximity of the host and determined if any of the compounds evaluated afected the behavior of the insects. Results: We found volatiles that signifcantly reduced the time spent in the proximity of the host. These were 2-phenylethanol and 2-mercaptoethanol for R. prolixus, and dimethyl sulfde and 2-mercaptoethanol for T. infestans. Such an efect was also observed in both species when DEET was presented, although only at the higher doses tested. Conclusions: The new repellents modulated the behavior of two Chagas disease vectors belonging to two diferent triatomine tribes, and this was achieved using a dose up to three orders of magnitude lower than that needed to evoke the same efect with DEET. Future eforts in understanding the mechanism of action of repellent compounds such as 2-mercaptoethanol, as well as an assessment of their temporal and spatial repellent properties, could lead to the development of novel control strategies for these insect vectors, refractory to DEET.

Citrobacter freundii multirresistente como agente etiológico de infección de vías urinarias / Multiresistant Citrobacter freundii as an etiological agent of urinary tract infection

Citrobacter freundii, en ocasiones puede actuar como patógeno oportunista, se presenta un caso de este microorganismo aislado como agente etiológico de infección del tracto urinario, en un paciente con enfermedad pulmonar obstructiva crónica. El aislado fue multirresistente, mostrando resistencia a gentamicina, amikacina, trimetoprim sulfametoxazole, ciprofloxacino, ceftriaxona, ceftazidima, cefepime, imipenem, meropenem y doripenem y, susceptibilidad a tigeciclina y colistina, el estudio molecular demostró la presencia del gen blaKPC.

Citrobacter freundii, sometimes it can act as opportunistic pathogen, a case of this isolated microorganism is presented as an etiological agent of urinary tract infection, in a patient with chronic obstructive pulmonary disease. The isolate was multiresistant to gentamicin, amikacin, trimetoprim sulfamethoxazole, ciprofloxacin, ceftriaxone, ceftazidime, cefepime, imipenem, meropenem and doripenem and it was susceptible to tigecycline and colistin, the molecular analysis showed the presence of the blaKPC gene.

Primer aislamiento de enterobacteria productora de carbapenemasa tipo-NDM en un hospital público de Rosario, Argentina PDF / First isolation of a NDM-like carbapenemase-producing Enterobacteriaceae in a public hospital in Rosario, Argentina

Introducción: La emergencia de enterobacterias productoras de carbapenemasas en el ámbito hospitalario representa un verdadero problema de salud pública mundial. Las carbapenemasas son enzimas que producen resistencia a los antibióticos carbapenémicos, teniendo un directo impacto en la disponibilidad de alternativas terapéuticas. En Argentina, a partir de 2013 han emergido carbapenemasas tipo-NDM (Nueva Delhi Metalo-ß-lactamasa, MßL), que constituyen una resistencia emergente a nivel global. Objetivo: Reportar el primer aislamiento clínico de enterobacteria portadora de NDM en nuestra institución. Materiales y métodos: El aislamiento estudiado fue recuperado de una muestra ósea de un paciente adulto. La identificación bacteriana y los ensayos de susceptibilidad antibiótica se realizaron mediante metodología manual y sistema automatizado Vitek 2C (Biomérieux). La detección y caracterización de carbapenemasas se efectuó por ensayos fenotípicos y moleculares. Resultados: Los ensayos revelaron que el aislamiento, tipificado como Citrobacter freundii, es productor de carbapenemasa tipo NDM. Resultó sensible a aztreonam, colistina y fosfomicina. No se detectó fenotípicamente la presencia de beta lactamasas de espectro extendido. Discusión: Se reporta el primer aislamiento de enterobacteria productor de MßL tipo-NDM en nuestro nosocomio, siendo multirresistente, con escasas alternativas terapéuticas. Dado que la presencia de este tipo de aislamiento es considerado de alto riesgo, se requiere un monitoreo activo de este mecanismo de resistencia y la instauración de medidas de control adecuadas para hacer frente a la amenaza que suponen

Introduction: the emergence of carbapenemase-producing Enterobaceriaceae in the hospital environment represents a major challenge for health care worldwide. Carbapene-mases are carbapenem-hydrolysing enzymes that confer resistance to these "last-line" antibiotics having a direct im-pact on the limited treatment options available. In Argentina, carbapenemases NDM-like (New DelhiMetallo-ß-lactamase, MßL) have emerged in 2013. This resistance has increased in frequency and it has disseminated around the world at unprecedented levels.Objective:report the first isolation of a NDM-producing En-terobacteriaceae in our hospital.Materials and methods: the isolate analysed in this study was recovered from a bone biopsy belonging to an adult patient. The bacterial identification and antimicrobial sus-ceptibility testings were performed using conventional methods and the automated system Vitek 2C (Biomérieux). Phenotypic and molecular techniques were carried out for the detection and characterization of carbapenemases.Results: it was confirmed that the isolate, identified as Citro-bacter freundii, produces the NDM enzyme. It showed sensi-bility to aztreonam, colistin and fosfomicyn. Extended-spec-trum beta-lactamases were not detected.Discussion: in this study we report the first isolation of NDM-like MßL in our institution, a multirresistant pathogen associ-ated with a lack of effective antimicrobial treatment options. Given the high risk of these infections, an active search of mechanisms of resistance is mandatory. In addition, the establishment of accurate control measures is a must to attempt to overcome this formidable threat

Empyema necessitatis due to Citrobacter freundii: Case report / Empiema necessitatis por Citrobacter freundii. Reporte de caso

Abstract Introduction: This paper presents the first case of empyema necessitatis secondary to infection with Citrobacter freundii (according to the databases consulted), and one of the few reports of this pathology in Colombia. Case presentation: This is the case of a 26-year-old patient from a rural area, with a history of severe cognitive deficit, who was taken to the emergency department due to a clinical picture of 15 days of evolution consisting of neurological deterioration associated with asthenia, adynamia, fever and cough with purulent expectoration. On admission, a chest x-ray was taken, finding pneumonia of the middle lobe with associated pleural effusion, for which empirical antibiotic management was initiated. The patient presented clinical deterioration and appearance of right pectoral mass, so a computed tomography of the thorax was performed, revealing empyema necessitatis. Close drainage and culture of the collection were made, with negative mycobacteria culture and positive report for C. freundii. The patient received specific antibiotic treatment for 8 weeks, with complete improvement of his clinical condition. Conclusion: Besides being the first case of empyema necessitatis by C. freundii that has been reported, this case is important because of the low amount of reports on this pathology in Colombia, considering that its main cause is tuberculosis, which is endemic in the country.

Resumen Introducción. Según lo encontrado en las bases de datos consultadas, el presente es el primer caso de empiema necessitatis secundario a Citrobacter freundii. Además, constituye uno de los pocos reportes de esta patología en Colombia. Presentación del caso. Se trata de un paciente de 26 años procedente de área rural, con antecedente de déficit cognitivo severo, quien fue llevado al servicio de urgencias por cuadro clínico de 15 días de evolución consistente en deterioro neurológico asociado a astenia, adinamia, fiebre y tos con expectoración purulenta. Al ingreso se tomó radiografía de tórax, encontrando neumonía del lóbulo medio con derrame pleural asociado, por lo que se inició cubrimiento antibiótico empírico. El paciente presentó deterioro clínico y aparición de masa pectoral derecha, por lo que se realizó tomografía computarizada de tórax, evidenciando empiema necessitatis. Luego, se hizo drenaje de la colección, con cultivo negativo para micobacterias y aislamiento de C. freundii. Se dio tratamiento guiado por antibiograma durante ocho semanas, con posterior recuperación completa del cuadro clínico. Conclusión. Además de ser el primer caso de empiema necessitatis por C. freundii, este es importante por la escasa cantidad de reportes en Colombia, considerando que su principal causa es la tuberculosis, la cual es endémica en el país.

Cristaluria masiva asociada a infección urinaria ureolítica: un caso exepcional / Massive crystalluria associated whit ureolitic urynary infection: an exceptional

Introducción y Objetivos. Las infecciones urinarias por gérmenes ureolíticos se asocian generalmente con la eliminación y/o formación de cálculos infectivos de estruvita (fosfato amónico magnésico, fosfato triple). Sin embargo no tenemos conocimiento de que se haya comunicado ningún caso de emisión masiva de cristales con visualización macroscópica y recuperación de las arenillas en el "poso seco" del sedimento de la orina. El objetivo de este breve artículo es comunicar un infrecuente caso de cristaluria masiva de fosfato amónico magnésico secundaria a infección urinaria por la asociación de dos gérmenes: Citrobacter freundii (no ureolítico) y Morganella morgagnii (ureolítica). Caso Clínico. Mujer de 72 años sin antecedentes urológicos previos que consultó por presentar desde hace 1 año expulsión de gran cantidad de arenillas en las micciones, hasta el punto de que en alguna ocasión le ocluían momentáneamente la uretra. La paciente aportó una muestra de la cristaluria (arenilla) recuperada del poso seco del sedimento de su orina, donde se aprecia un gran volumen de polvo y arena (microcristales). El estudio del sedimento urinario mostró PH 8, densidad de 1035 (n 1005-1030), nitritos (+), bacteriuria y abundante cantidad de cristales incoloros en forma de prisma o "ataúd" sugestivos de corresponder a cristales de fosfato amónico magnésico. En el urinocultivo existían 500.000 UFC/ml y se aislaron 2 gérmenes uno no ureolítico (Citrobacter freundii) y otro ureolítico (Morganella morgagnii). Radiografía simple de aparato urinario y ecografía normales. El análisis químico de la arenilla mostró una composición de 80 por ciento fosfato amónico magnésico y 20 por ciento oxalato cálcico. Se instauró tratamiento según antibiograma con ciprofloxacino 500 mg cada 12 horas 7 días y se acidificó la orina con vitamina C (ácido ascórbico) 500 mg día 20 días, consiguiendo erradicar la infección urinaria, normalizar el PH urinario a 5, y frenar definitivamente la expulsión de cristales. En un control a los 6 meses permanecía asintomática y con urinocultivo estéril. Conclusiónes. Este caso es una forma de presentación excepcional de una infección urinaria ureolítica, sin los síntomas clásicos habituales. Su única manifestación clínica fue la expulsión de gran cantidad de cristales (arenilla) en las micciones que en ocasiones provocaban obstrucciones intermitentes de uretra de resolución espontánea. Este singular caso demuestra que escuchando a los pacientes, a veces nos cuentan hechos casi imposibles y la mayoría de las veces son verídicos (AU)

Background and Objetives. Ureolytic urinary tract infections are generally associated with the elimination and / or formation of struvite infective stones (magnesium ammonium phosphate, triple phosphate). However, we are not aware of any reports of massive emission of crystals with macroscopic visualization and recovery of the sand in the "dry" sediment of the urine. The objective of this brief article is to report an infrequent case of massive crystalluria of magnesium ammonium phosphate secondary to urinary infection due to the association of two germs: Citrobacter freundii (non ureolytic) and Morganella morgagnii (ureolytic). Clinical Case. A 72-year-old woman with no prior urological history who consulted for the past 1 year of expulsion of a large amount of sand in the micturition, to the point that she had occasion ally occluded the urethra. The patient provided a sample of the crystalluria (sand) recovered from the dry sediment of her urine, where a large volume of dust and sand (microcrystals) was seen. The study of the urine sediment showed PH 8, density of 1035 (n 1005-1030), nitrites (+), bacteriuria and abundant amount of colorless crystals in the form of prism or "coffin" suggestive of corresponding magnesium ammonium phosphate crystals. In the urinoculture there were 500,000 CFU / ml and two non-ureolytic (Citrobacter freundii) and one ureolytic (Morganella morgagnii) were isolated. Simple x-ray of normal urinary system and ultrasound. The chemical analysis of the grit showed a composition of 80 pertcent magnesium ammonium phosphate and 20 pertcent calcium oxalate. Therapy was initiated according to antibiogram with ciprofloxacin 500 mg every 12 hours 7 days and the urine was acidified with vitamin C (ascorbic acid) 500 mg day 20, succeeding in eradicating the urinary tract infection, normalizing the urinary pH to 5, and finally stopping expulsion Of crystals. In a control at 6 months, he remained asymptomatic and with sterile urine culture. Conclusions. This case is an exceptional presentation of a urethritic urinary infection, without the usual classic symptoms. Its only clinical manifestation was the expulsion of large amounts of crystals (sand) in micturitions that occasionally caused intermittent urethral obstructions of spontaneous resolution. This unique case demonstrates that listening to patients, sometimes tell us almost impossible facts and most of the time are true.(AU)

Estudo genotípico e fenotípico de bacilos Gram-negativos produtores de carbapenemase do tipo New Delhi metalo-ß-lactamase / Genotypic and fenotypic study of Gram-negative bacilli producers carbapenemase type New Delhi metallo--ß-lactamase

Os carbapenêmicos são os antimicrobianos mais amplamente utilizados no tratamento empírico de infecções graves por bacilos Gram-negativos. A pressão seletiva gerada pelo uso desses antimicrobianos ao longo das últimas três décadas contribuiu para a disseminação de enterobactérias e Gram-negativos não fermentadores produtores de carbapenemases, particularmente as do tipo KPC e NDM. Os genes que codificam essas enzimas usualmente estão localizados em plasmídeos e/ou transpósons. A hipótese atualmente mais aceita é que o gene blaNDM-1 seja uma quimera criada em Acinetobacter baumannii. A NDM-1 foi descrita em paciente proveniente da Índia e subsequentemente evidenciou-se sua ampla disseminação nesse país. A epidemiologia que tem sido observada nos casos detectados na Europa e Estados Unidos tem sido viagem à Índia, ou seja, sem casos autóctones. No Brasil, os primeiros casos foram identificados no Rio Grande do Sul, e a seguir no Rio de Janeiro e em São Paulo. Diferentemente dos casos da Europa e América do Norte, os casos do Brasil não tem relação epidemiológica com a Índia. O sequenciamento integral dos plasmídeos e cromossomos albergando o gene blaNDM permitirá entender como ocorre a disseminação desse mecanismo de resistência no Brasil. Para isso, foi avaliado o perfil de susceptibilidade dos isolados, bem como a capacidade conjugativa e clonalidade. Das vinte e oito amostras utilizadas neste trabalho, treze delas pertencem à espécie Enterobacter hormaechei, uma à espécie Citrobacter freundii, sete à espécie Escherichia coli, quatro à Klebsiella pneumoniae e três ao gênero Acinetobacter spp. Os primeiros isolados incluídos neste estudo (Escherichia coli e Enterobacter hormaechei produzindo NDM-1) foram isolados em agosto de 2013, de uma mesma amostra de swab retal de um paciente do Rio de Janeiro que nunca viajou para o exterior. O sequenciamento completo do DNA plasmidial utilizando a plataforma Illumina e a anotação de ambos os plasmídeos albergando o gene blaNDM-1 revelou que estes pertencem a grupos de incompatibilidade diferentes, IncFIIK (E. hormaechei) e IncX3 (E. coli), e abrigam um novo transpóson composto designado Tn3000. A comparação da sequência nucleotídica do Tn3000 com aquelas disponíveis no GenBank evidencia que a mesma estrutura está presente em plasmídeos de isolados da cidade de Porto Alegre e também em diferentes continentes. As espécies de Acinetobacter (A. radioresistens, A. ursingii e A. guillouiae) isoladas em São Paulo e Porto Alegre, possuem o gene blaNDM-1 albergados em um mesmo plasmídeo não tipável de 41.087 pb. A avaliação da clonalidade dos isolados de Enterobacter hormaechei "subsp. oharae" mostrou dois perfis diferentes através da técnica de PFGE, sendo que todos os microrganismos foram isolados de um surto no mesmo hospital no Rio de Janeiro. Isolados de Klebsiella pneumoniae de uma mesma paciente internada em hospital em Salvador, de sítios distintos - swab retal, hemocultura e urina, em ordem cronológica - obtiveram o mesmo perfil clonal pela técnica de PFGE. O mesmo ocorreu com três isolados de Escherichia coli, de um mesmo paciente do Rio de Janeiro, em amostras de swab retal. Os achados deste estudo evidenciam que no Brasil, Nepal, Marrocos e Índia há uma disseminação do gene blaNDM-1 mediada por um novo elemento móvel designado Tn3000 em enterobactérias. A detecção de um mesmo plasmídeo em diferentes espécies de Acinetobacter evidencia que neste gênero bacteriano, no Brasil, a disseminação do gene blaNDM-1 ocorre por conjugação.

Carbapenems are the antimicrobials most widely used in the empirical treatment of severe infections caused by Gram-negative bacilli. The selective pressure generated by the use of these antibiotics over the last three decades has contributed to the spread of enterobacteria and Gram-negative non-fermenting producing carbapenemases, mainly KPC and NDM. Genes encoding these enzymes are usually located in plasmids and/or transposons. Currently the most accepted hypothesis is that the blaNDM-1 gene is a chimera created in Acinetobacter baumannii. The NDM-1 was described in a patient from India and subsequently was reported to be broadly disseminate in this country. The epidemiology that has been observed in cases detected in Europe and United States is traveling to India, but no autochthonous cases. In Brazil, the first cases were identified in Rio Grande do Sul, and then in Rio de Janeiro and São Paulo. Differently from the cases described in Europe and North America, the cases from Brazil have no epidemiological link with India. The complete sequencing of plasmids and chromosomes harboring blaNDM gene will understanding how the dissemination of this resistance mechanism in Brazil occurs. In this work we will be evaluate the susceptibility profile of the isolates, and their conjugal capacity and clonality. Of the twenty-eight samples used in this study, thirteen of them belong to the species Enterobacter hormaechei, one to Citrobacter freundii, seven to Escherichia coli, four to Klebsiella pneumoniae and three to the genus Acinetobacter sp. The first two isolates included in this study (Escherichia coli and Enterobacter hormaechei) were isolated in August 2013, from the same rectal swab sample from a patient from Rio de Janeiro that never traveled abroad. Complete sequencing of plasmid DNA using Illumina platform and annotation of both plasmids harboring the blaNDM-1 gene revealed that they belong to different incompatibility groups, IncFIIK (E. hormaechei) and IncX3 (E. coli), and are harbor to a new transposon designated Tn3000. The comparison of the Tn3000 nucleotide sequence with those available at GenBank shows that the same structure is present in plasmids from other Porto Alegre and also in different continents. The Acinetobacter species (A. radioresistens, A. ursingii and A. guillouiae) isolated in São Paulo and Porto Alegre, have the blaNDM-1 gene harbored in a single non-typing plasmid of 41,087 bp. The evaluation of clonal relationship of Enterobacter hormaechei "subsp. oharae" showed two different profiles by PFGE technique; of note all microorganisms were isolated from an outbreak in the same hospital in Rio de Janeiro. Isolates of Klebsiella pneumoniae from a single patient hospitalized in Salvador, from different anatomical sites - rectal swab, blood culture and urine, in chronological order - obtained the same clonal profile by the PFGE technique. The same occurred with three Escherichia coli isolates, from the same patient from Rio de Janeiro, in swab rectal strains. Our findings suggest that in Brazil, Nepal, Morocco and India there is a spread of blaNDM-1 gene mediated by Tn3000 in enterobacteria. The detection of a same plasmid in different species of Acinetobacter shows that in this bacterial genus, in Brazil, the dissemination of the blaNDM-1 gene occurs by conjugation.

Celulitis facia odontogénica severa infrecuent causada por citrobacter freunddii productora de ampc en un paciente con diabetes mellitus 2. reporte de caso / Uncmmon severe oodontogenic facial cellulitis caused by ampcproducing citrobacter freundii in a patient with type 2 diabetes mellitus. case report / Celulite facial odontogênica sevea infrequente causada por citrobacter freundii produtora de ampc em um paciente com diabetes mellitus 2. relatório e caso

El manejo de la celulitis facial odontogénica no deja de ser un tema controversial en el campo de la cirugía oral y maxilofacial; los principios quirúrgicos y terapéuticos han sido sometidos a modificacio nes basadas en los hallazgos clínicos, imagenológicos y microbiológicos a través del tiempo. En pacientes con diabetes mellitus 2 se incrementa el riesgo a sufrir infecciones bacterianas oportunistas con tiempos de hospitalización más prolongados que la población no diabética. La literatura es clara estableciendo las diferencias clínicas y microbiológicas de la celulitis facial odontogénica en este grupo de pacientes, sin embargo, no existe un protocolo médico quirúrgico destinado a ellos. El microorganismo comúnmente aislado es Klebsiella pneumoniae, mientras Citrobacter freundii es inusual en las infecciones odontogénicas, su capacidad para producir betalactamasas de amplio espectro (AmpC) le permite bloquear la acción de los antibióticos de uso empírico en Cirugía Oral y Maxilofacial. A continuación, presentamos el caso de una paciente de 61 años con diabetes Mellitus tipo 2 y celulitis facial odontogénica por Citrobacter freundii productora de AmpC.

The management of odontogenic facial cellulitis is still a controversial issue in the field of Oral and Maxillofacial Surgery. Surgical and therapeutic principles have undergone modifications based on clinical findings, imaging and microbiological over time. In patients with type 2 Diabetes Mellitus the risk of opportunistic bacterial infections is increased thus suffering longer hospitalization periods than the nondiabetic population. The literature is clear by setting the clinical and microbiological differences of odontogenic facial cellulitis in this group of patients, but there is no surgical medical protocol for them. Klebsiella pneumoniae is the most common microorganism isolated while Citrobacter freundii is unusual in relation to oral infections; their ability to produce ESBLs (AmpC) allows them to block the action of empirical antibiotics used in Maxillofacial Surgery. We present the case of a 61 year old patient with type 2 Diabetes Mellitus and odontogenic facial cellulitis caused by AmpCproducing Citrobacter freundii.

O tratamento da celulite facial odontogênica não deixa de ser um tema controverso no campo da Cirurgia Oral e Maxilofacial; os princípios cirúrgicos e terapêuticos foram submetidos a modificações baseadas nos descobrimentos clínicos, imagenológicos e microbiológicos através do tempo. Em pacientes com Diabetes Mellitus 2 aumenta o risco de sofrer infecções bacterianas oportunistas com tempos de hospitalização mais prolongados que na população não diabética. A literatura é clara estabelecendo as diferenças clínicas e microbiológicas da Celulite Facial Odontogênica neste grupo de pacientes; porém, não existe um protocolo médico cirúrgico destinado a eles. O microrganismo comunmente isolado é o Klebsiella pneumoniae, enquanto que o Citrobacter freundii é inusual nas infecções odontogênicas, sua capacidade para produzir betalactamases de amplo espectro (AmpC) lhe permite bloquear a ação dos antibióticos de uso empírico em Cirurgia Oral e Maxilofacial. A seguir apresentamos o caso de uma paciente de 61 anos com Diabetes Mellitus tipo 2 e celulite facial odontogênica por Citrobacter freundii produtora de AmpC.

Absceso esplénico por citrobacter diversus / Splenic abscess citrobacter diversus

Se reporta un inusual caso de absceso esplénico en un paciente pedriátrico. Se trata de una niña de 10 años portadora heterocigoto de Hb S, con bronconeumonía y derrame pericárdico asociado. El diagnóstico incial se realizó por los hallazgos clínicos característicos y se confirmó con estudios ecográficos y de tomografía computada abdominal. El tratamiento incluyó antibióticos de amplio espectro y laparotomía con esplenectomía. Se aisló Citrobacter diversus en el cultivo del material purulento obtenido preoperatoriamente. La evolución ulterior fue satisfactoria.