RESUMO
OBJECTIVES: We determined primary and secondary resistance rates of H. pylori in different regions of Austria and potential bacterial and host factors associated with resistance. METHODS: In a prospective multicentre study H. pylori was cultivated from biopsies and susceptibility testing was performed according to EUCAST. Resistance to clarithromycin and levofloxacin was determined by sequencing of the resistance-determining regions of 23S rRNA and gyrA genes. cagA, vacA and babA2 genotypes were determined. RESULTS: A total of 1266 patients were included. 178 isolates were cultured: 128 from patients without prior eradication therapy, 50 from patients after failed eradication. Primary resistance to clarithromycin, levofloxacin and metronidazole were 17.2%, 9.4% and 10.2%, respectively. Secondary resistance to clarithromycin, levofloxacin and metronidazole were 64%, 18% and 44%, respectively. Prior eradication was associated with a higher risk of clarithromycin as well as metronidazole resistance (OR=8.1; 95% CI 3.8-17.1 and OR 5.7; 95% CI 2.5-13, respectively). CONCLUSION: Primary resistance to both clarithromycin and levofloxacin was markedly lower in Southern Austria than recently reported.
Assuntos
Farmacorresistência Bacteriana , Infecções por Helicobacter/microbiologia , Helicobacter pylori/efeitos dos fármacos , Adulto , Idoso , Antibacterianos/farmacologia , Áustria/epidemiologia , Claritromicina/farmacologia , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Feminino , Genótipo , Infecções por Helicobacter/epidemiologia , Helicobacter pylori/genética , Helicobacter pylori/isolamento & purificação , Humanos , Levofloxacino/farmacologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , RNA Ribossômico 23S/genética , Análise de Sequência de DNA , Fatores de Virulência/genéticaRESUMO
Relapsing polychondritis (RP) is a relatively rare disorder, with a high death rate that affects cartilaginous structures. RP can be either primary or secondary as part of autoimmune syndromes. We present a case of RP in a 49-year-old man suffering from cytoplasmic antineurophil cytoplasmic antibodies (cANCA) positive vasculitis, admitted to our hospital with red swollen left ear and painful sternoclavicular joint and larynx. The patient was in remission from the vasculitis but manifested a high cANCA titre indicating vasculitis activity. With his high cANCA titre vasculitis, full manifestation of RP concomitantly occurred. After a successful cortisone treatment for RP, the patient received cyclophosphamide treatment for his vasculitis that resulted in a decrease in cANCA titre and full remission of his RP symptoms.
Assuntos
Anticorpos Anticitoplasma de Neutrófilos/sangue , Policondrite Recidivante/imunologia , Vasculite do Sistema Nervoso Central/complicações , Anticorpos Anticitoplasma de Neutrófilos/imunologia , Biópsia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Policondrite Recidivante/complicações , Policondrite Recidivante/diagnóstico , Recidiva , Tomografia Computadorizada por Raios X , Vasculite do Sistema Nervoso Central/sangue , Vasculite do Sistema Nervoso Central/diagnósticoRESUMO
Familial Mediterranean fever (FMF) is an autosomal recessive hereditary disease. FMF-related arthritis affects large joints, especially in the lower extremities. It starts with acute pain and swelling and affects one joint at a time. Fever is the most common symptom in FMF. Monoarthritis as the sole symptom is relatively rare and thus delayed diagnosis of the disease in a patient who had been suffering from monoarthritis for several years. Genetic analysis showing typical mutations in the patient eventually resulted in correct diagnosis, although classical clinical diagnostic criteria were not met. The patient received appropriate therapy with colchicine, which led to remission of the symptoms.