RESUMEN
We report a case of Klebsiella pneumoniae bacteraemia in an 80-year-old man in France with no history of travel to Asia, complicated by endogenous endophthalmitis, multiple cerebral microbleeds and hepatic microabscesses, associated with a Bentall endocarditis. Hypervirulence pathotype was suggested based on clinical picture, bacterial isolate genomic sequence and hypermucoidy. Interestingly, the isolate had the non-K1/K2-capsular serotype locus KL113-like, carried a KpVP-1-like virulence plasmid, and belonged to the emerging sublineage SL660 (comprising the sequence type ST660).
Asunto(s)
Bacteriemia , Infecciones por Klebsiella , Klebsiella pneumoniae , Humanos , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , Klebsiella pneumoniae/clasificación , Klebsiella pneumoniae/patogenicidad , Masculino , Anciano de 80 o más Años , Infecciones por Klebsiella/microbiología , Infecciones por Klebsiella/diagnóstico , Bacteriemia/microbiología , Endoftalmitis/microbiología , Endoftalmitis/diagnóstico , Francia , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/diagnóstico , Hemorragia Cerebral/microbiologíaRESUMEN
The diagnostic and prognostic values of blood cultures (BC) for 347 acute prostatitis inpatients were evaluated. BC were positive for 21% of patients and contributed to the microbiological diagnosis for 5%. Fever duration, length of hospitalization, use of an antibiotic combination, duration of antibiotic use, and urine bacterial titers increased when BC were positive.
Asunto(s)
Bacteriemia/diagnóstico , Bacterias/aislamiento & purificación , Sangre/microbiología , Prostatitis/complicaciones , Prostatitis/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bacteriemia/microbiología , Bacterias/clasificación , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Prostatitis/microbiología , Adulto JovenRESUMEN
Because Q fever is mostly diagnosed serologically, localizing a persistent focus of Coxiella burnetii infection can be challenging. F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) could be an interesting tool in this context.We performed a retrospective study on patients diagnosed with C burnetii infection, who had undergone F-FDG PET/CT between 2009 and 2015. When positive F-FDG PET/CT results were obtained, we tried to determine if it changed the previous diagnosis by discovering or confirming a suspected focus of C burnetii infection.One hundred sixty-seven patients benefited from F-FDG PET/CT. The most frequent clinical subgroup before F-FDG PET/CT was patients with no identified focus of infection, despite high IgG1 serological titers (34%). For 59% (nâ=â99) of patients, a hypermetabolic focus was identified. For 62 patients (62.6%), the positive F-FDG PET/CT allowed the diagnosis to be changed. For 24 of them, (38.7%), a previously unsuspected focus of infection was discovered. Forty-two (42%) positive patients had more than 1 hypermetabolic focus. We observed 21 valvular foci, 34 vascular foci, and a high proportion of osteoarticular localizations (nâ=â21). We also observed lymphadenitis (nâ=â27), bone marrow hypermetabolism (nâ=â11), and 9 pulmonary localizations.We confirmed thatF-FDG PET/CT is a central tool in the diagnosis of C burnetii focalized persistent infection. We proposed new diagnostic scores for 2 main clinical entities identified using F-FDG PET/CT: osteoarticular persistent infections and lymphadenitis.
Asunto(s)
Enfermedades Óseas Infecciosas/diagnóstico por imagen , Endocarditis/diagnóstico por imagen , Linfadenitis/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Fiebre Q/diagnóstico por imagen , Enfermedades Vasculares/diagnóstico por imagen , Adulto , Anciano , Enfermedades Óseas Infecciosas/microbiología , Coxiella burnetii , Endocarditis/microbiología , Femenino , Fluorodesoxiglucosa F18 , Humanos , Inmunoglobulinas/sangre , Linfadenitis/microbiología , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/diagnóstico por imagen , Neumonía Bacteriana/microbiología , Infecciones Relacionadas con Prótesis/microbiología , Fiebre Q/sangre , Radiofármacos , Estudios Retrospectivos , Enfermedades Vasculares/microbiologíaRESUMEN
We report the case of a multi-experienced patient, infected with an HIV-1 strain, with selected multiple resistance mutations. We designed a novel well-tolerated and effective rescue treatment including dolutegravir, rilpivirine, and foscarnet, allowing a 60-week sustained virological response for the first time in 23 years of HIV infection.