RESUMO
Peripheral tuberculous lymphadenitis accounts for ~10% of tuberculosis cases in the United States. Epidemiologic characteristics include a 1.4:1 female-to-male ratio, a peak age range of 30-40 years, and dominant foreign birth, especially East Asian. Patients present with a 1-2 month history of painless swelling of a single group of cervical lymph nodes. Definitive diagnosis is by culture or nucleic amplification of Mycobacterium tuberculosis; demonstration of acid fast bacilli and granulomatous inflammation may be helpful. Excisional biopsy has the highest sensitivity at 80%, but fine-needle aspiration is less invasive and may be useful, especially in immunocompromised hosts and in resource-limited settings. Antimycobacterial therapy remains the cornerstone of treatment, but response is slower than with pulmonary tuberculosis; persistent pain and swelling are common, and paradoxical upgrading reactions may occur in 20% of patients. The role of steroids is controversial. Initial excisional biopsy deserves consideration for both optimal diagnosis and management of the otherwise slow response to therapy.
Assuntos
Tuberculose dos Linfonodos/diagnóstico , Tuberculose dos Linfonodos/tratamento farmacológico , Adulto , Antituberculosos/uso terapêutico , Gerenciamento Clínico , Feminino , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose dos Linfonodos/microbiologia , Tuberculose dos Linfonodos/patologia , Estados Unidos/epidemiologiaRESUMO
We report a skin and soft-tissue infection outbreak among football team members due to a USA300 methicillin-susceptible Staphylococcus aureus (MRSA) strain with genes coding for Panton-Valentine leukocidin and the arginine catabolic mobile element. We postulate that the strain is a community-associated USA300 MRSA strain that lost methicillin resistance but retained important virulence factors.
Assuntos
Atletas , Infecções Comunitárias Adquiridas/epidemiologia , Surtos de Doenças , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Cutâneas Estafilocócicas/epidemiologia , Estudantes , Proteínas de Bactérias/genética , Toxinas Bacterianas/genética , Técnicas de Tipagem Bacteriana , Infecções Comunitárias Adquiridas/microbiologia , Impressões Digitais de DNA , Eletroforese em Gel de Campo Pulsado , Exotoxinas/genética , Humanos , Sequências Repetitivas Dispersas , Leucocidinas/genética , Masculino , Resistência a Meticilina , Staphylococcus aureus Resistente à Meticilina/classificação , Staphylococcus aureus Resistente à Meticilina/genética , Infecções Cutâneas Estafilocócicas/microbiologia , Fatores de Virulência/genética , Adulto JovemRESUMO
Vaccination of healthcare workers (HCWs) is an important strategy in the control and prevention of hospital outbreaks. The decision to vaccinate is often based on self-report of vaccination status. Self-report of previous receipt of tetanus-diphtheria or tetanus toxin vaccination was validated using an electronic medical record. Results showed that HCWs' self-report is reliable during a vaccination campaign.