Abdomen agudo quirúrgico por Neisseria gonorrhoeae / Acute surgical abdomen due to Neisseria gonorrhoeae / Abdome agudo cirúrgico por Neisseria gonorrhoeae

Resumen El diagnóstico diferencial de enfermedad inflamatoria pélvica (EIP) representa un desafío, porque tiene un gran polimorfismo en su forma de presentación y, de ser sintomática, se confunde con numerosas patologías que ocasionan dolor abdominal agudo. Neisseria gonorrhoeae es uno de sus agentes etiológicos más frecuentes. Se presenta el caso de una paciente de sexo femenino con síndrome de abdomen agudo asociado a vómitos. Los estudios de imágenes (ecografía y tomografía axial computada) revelaron la presencia de líquido interasas y apéndice aumentado de tamaño. Se decidió conducta quirúrgica. Durante la misma se tomó muestra de líquido abdominal de cuyo análisis microbiológico se recuperó N. gonorrhoeae, sensible a ceftriaxona y a azitromicina. La paciente fue tratada con estos antibióticos en dosis de 1 g/día/endovenoso, con buena evolución clínica. Frente a una paciente en edad fértil con abdomen agudo es útil recordar, por sus implicancias, la posibilidad de una EIP por N. gonorrhoeae.

Abstract Differential diagnosis of pelvic inflammatory disease (PID) represents a challenge because it has a great polymorphism in its presentations and, if symptomatic, there are numerous pathologies that cause acute abdominal pain. Neisseria gonorrhoeae is one of the most frequent etiological agents. The case of a female patient with acute abdominal syndrome associated with vomiting is presented. Imaging studies (ultrasound and computed tomography) revealed the presence of fluid between the intestinal loops and an enlarged appendix. Surgical management was decided, during which a sample of abdominal liquid was taken and N. gonorrhoeae, susceptible to ceftriaxone and azithromycin, was recovered from its microbiological analysis. The patient was treated with these antibiotics at doses of 1 g/day/iv, with good clinical evolution. In the case of a patient of childbearing age suffering from acute abdomen, it is useful to remember, because of its implications, the possibility of PID due to N. gonorrhoeae.

Resumo O diagnóstico diferencial de doença inflamatória pélvica (DIP), representa um desafio, porque tem um amplo polimorfismo em sua forma de apresentação e, caso seja sintomática, confunde-se com numerosas patologias que causam dor abdominal aguda. Neisseria gonorrhoeae é um dos seus agentes etiológicos mais frequentes. É apresentado o caso de uma paciente de sexo feminino com síndrome de abdome agudo associado com vômitos. Os estudos das imagens (ultrassonografia e tomografía axial computadorizada) revelaram a existência de líquido ascítico e apêndice aumentado de tamanho. Decidiu-se o tratamento cirúrgico. Durante a prática cirúrgica foi obtida amostra do líquido abdominal de cuja análise microbiológica foi recuperada N. gonorrhoeae, sensível à ceftriaxona e à azitromicina. A paciente recebeu o tratamento com esses antibióticos em dose de 1 g/dia/intravenosa, obtendo boa evolução clínica. Diante de uma paciente em idade fértil com abdome agudo, é útil lembrar, pelas suas consequências, a possibilidade de uma DIP por N. gonorrhoeae.

Neumonía por Pasteurella multocida y Staphylococcus aureus en una paciente sin patología subyacente / Pneumonia by Pasteurella multocida and Staphylococcus aureus in a patient whithout underlying conditions / Pneumonia por Pasteurella multocida e Staphylococcus aureus em uma paciente sem patologia subjacente

Resumen Muchos microorganismos capaces de producir infecciones en el ser humano son de origen zoonótico. Entre éstos está Pasteurella multocida, la cual se encuentra como comensal y/o patógeno oportunista, colonizando el tracto gastrointestinal y respiratorio de gran cantidad de mamíferos y aves. Por otro lado, Staphylococcus aureus es un colonizante de piel y nasofaringe y un patógeno oportunista para seres humanos y animales y su transmisión podría ser bidireccional. Se presenta un caso de neumonía por P. multocida y S. aureus en una mujer sin enfermedad subyacente, que acogía perros y gatos abandonados e ingresó con politraumatismo por caída desde un quinto piso. Ambos microorganismos fueron recuperados en una muestra de aspirado traqueal e identificados por Vitek®2 Compact. La identificación de P. multocida fue confirmada por espectrometría de masas (MALDI-TOF-MS) y presentó sensibilidad a penicilina, cefotaxima, amoxicilina-ácido clavulánico, ciprofloxacina, tetraciclina y trimetoprima-sulfametoxazol. S. aureus era sensible a meticilina sin resistencia acompañante.

Abstract Many microorganisms capable of producing infections in humans are of zoonotic origin. Among them, Pasteurella multocida, is a commensal and/or opportunistic pathogen that colonises the gastrointestinal and the respiratory tract of a great number of mammals and birds. On the other hand, Staphylococcus aureus is a coloniser of skin and nasopharynx and an opportunistic pathogen in humans and animals, whose transmission might be bidirectional. A case of pneumonia by P. multocida and S. aureus was presented in a woman without an underlying condition, who sheltered stray dogs and cats and was admitted with multiple trauma due to a fall from a fifth floor. Both microorganisms were recovered from a tracheal aspirate sample and identified by Vitek®2 Compact. Identification of P. multocida was confirmed by mass spectrometry (MALDI-TOF MS) and was susceptible to penicillin, cefotaxime, amoxicillin-clavulanic acid, ciprofloxacin, tetracycline and trimethoprim-sulfamethoxazole. S. aureus was methicillin-susceptible without accompanying resistance.

Resumo Muitos dos microrganismos capazes de produzir infecções no ser humano têm origem zoonótico. Entre eles está a Pasteurella multocida, que se encontra como comensal e/ou patógeno oportunista, colonizando o trato gastrintestinal e respiratório de grande quantidade de mamíferos e aves. Por outro lado, Staphylococcus aureus é um colonizador de pele e nasofaringe e um patógeno oportunista para seres humanos e animais e sua transmissão poderia ser bidirecional. Apresenta-se um caso de pneumonia por P. multocida e S. aureus em uma mulher, sem doença subjacente, que abrigava cães e gatos abandonados e entrou com múltiplos traumatismos devido à queda desde o quinto andar. Ambos os microrganismos foram obtidos da amostra de aspiração traqueal e identificados por Vitek®2 Compact. A identificação de P. multocida foi validada por espectrometria de massas (MALDI-TOF MS) e apresentou sensibilidade à penicilina, cefotaxima, amoxicilina-ácido clavulânico, ciprofloxacina, tetraciclina e trimetoprim-sulfometoxazol. S. aureus era meticilino sensível sem resistência acompanhante.

[Identification of Candida yeasts: Conventional methods and MALDI-TOF MS]. / Identificación de levaduras del género Candida: los métodos convencionales frente a MALDI-TOF MS.

BACKGROUND: Invasive fungal infections are increasing, and Candida yeasts are the main cause. Species other than Candida albicans are becoming more frequent, and some of them may have variable patterns of susceptibility to antifungal agents, making it important to identify them correctly. Conventional identification methods used by most laboratories may present with drawbacks. Mass spectrometry (MALDI-TOF MS) has emerged as an alternative method. AIMS: The aim of this study was to evaluate the concordance of the identification, at species level, by conventional methods (API) and MALDI-TOF MS. METHODS: The following species and number of isolates were studied: Candida parapsilosis (28), Candida glabrata (34), Candida krusei (24), Candida tropicalis (45), Candida guilliermondii (30), C. albicans (28), Candida dubliniensis (6), Candida kefyr (1), and Candida lipolytica (1) from the strain collection of Autonomous City of Buenos Aires Mycology Network (RMCABA). The strains C. parapsilosis 22019, C. glabrata 90030, C. krusei 6258 and C. albicans 68548 from the American Type Culture Collection (ATCC) were also included. Discrepancies were resolved by genotyping. RESULTS AND CONCLUSIONS: The direct concordance between the conventional identification method and MALDI-TOF MS was 92.5% (186/201).

[Yeast urinary tract infections. Multicentre study in 14 hospitals belonging to the Buenos Aires City Mycology Network]. / Infecciones urinarias nosocomiales por levaduras. Estudio multicéntrico de 14 hospitales de la red de micología de la Ciudad Autónoma de Buenos Aires.

BACKGROUND: Urinary tract infections are a frequent ailment in patients in intensive care units. Candida and other yeasts cause 5-12% of these infections. The value of the finding of any yeast is controversial, and there is no consensus about which parameters are adequate for differentiating urinary infections from colonization or contamination. AIMS: To analyse the epidemiological characteristics of patients with funguria, to determine potential cut-off points in cultures (to distinguish an infection from other conditions), to identify the prevalent yeast species, and to determine the value of a second urine sample. METHODS: A multicentre study was conducted in intensive care units of 14 hospitals in the Buenos Aires City Mycology Network. The first and second samples of urine from every patient were cultured. The presence of white cells and yeasts in direct examination, colony counts, and the identification of the isolated species, were evaluated. RESULTS: Yeasts grew in 12.2% of the samples. There was no statistical correlation between the number of white cells and the fungal colony-forming units. Eighty five percent of the patients had indwelling catheters. Funguria was not prevalent in women or in patients over the age of 65. Candida albicans, followed by Candida tropicalis, were the most frequently isolated yeasts. Candida parapsilosis and Candida glabrata appeared less frequently. The same species were isolated in 70% of second samples, and in 23% of the cases the second culture was negative. CONCLUSIONS: It was not possible to determine a useful cut-off point for colony counts to help in the diagnosis of urinary infections. As in other publications, C. albicans, followed by C. tropicalis, were the most prevalent species.

Identificación de levaduras del género Candida: los métodos convencionales frente a MALDI-TOF MS / Identification of Candida yeasts: Conventional methods and MALDI-TOF MS

Antecedentes: Las infecciones fúngicas invasivas han ido aumentando y las levaduras del género Candida son la principal causa de las mismas. Las especies distintas de Candida albicans son cada vez más frecuentes y algunas pueden presentar patrones variables de sensibilidad a los antimicóticos, por lo que es importante la correcta identificación de la especie. Los métodos de identificación convencionales con los que cuentan la mayoría de los laboratorios pueden presentar inconvenientes. La espectrometría de masas (MALDI-TOF MS) surgió como una alternativa a los mismos. Objetivos: Evaluar la concordancia de los resultados de identificación de diferentes especies de Candida mediante dostécnicas: una convencional (galerías API) y MALDI-TOF MS. Métodos: Se analizaron las siguientes especies y número de aislamientos: Candida parapsilosis (28), Candida glabrata (34), Candida krusei (24), Candida tropicalis (45), Candida guilliermondii (30), C. albicans (28), Candida dubliniensis (6), Candida kefyr (1) y Candida lipolytica (1) del cepario de RMCABA; también se utilizaron las cepas C. parapsilosis 22019, C. glabrata 90030, C. krusei 6258 y C. albicans 68548, pertenecientes a la American Type Culture Collection (ATCC). Las discrepancias en la identificación se resolvieron mediante genotipificación. Resultados y conclusiones: La concordancia directa entre la identificación convencional y MALDI-TOF MS fue del 92,5% (186/201)

Background: Invasive fungal infections are increasing, and Candida yeasts are the main cause. Species other than Candida albicans are becoming more frequent, and some of them may have variable patterns of susceptibility to antifungal agents, making it important to identify them correctly. Conventional identification methods used by most laboratories may present with drawbacks. Mass spectrometry (MALDI-TOF MS) has emerged as an alternative method. Aims: The aim of this study was to evaluate the concordance of the identification, at species level, by conventional methods (API) and MALDI-TOF MS. Methods: The following species and number of isolates were studied: Candida parapsilosis (28), Candida glabrata (34), Candida krusei (24), Candida tropicalis (45), Candida guilliermondii (30), C. albicans (28), Candida dubliniensis (6), Candida kefyr (1), and Candida lipolytica (1) from the strain collection of Autonomous City of Buenos Aires Mycology Network (RMCABA). The strains C. parapsilosis 22019, C. glabrata 90030, C. krusei 6258 and C. albicans 68548 from the American Type Culture Collection (ATCC) were also included. Discrepancies were resolved by genotyping. Results and conclusions: The direct concordance between the conventional identification method and MALDI-TOF MS was 92.5% (186/201)

Infecciones urinarias nosocomiales por levaduras. Estudio multicéntrico de 14 hospitales de la red de micología de la Ciudad Autónoma de Buenos Aires / Yeast urinary tract infections. Multicentre study in 14 hospitals belonging to the Buenos Aires City Mycology Network

Antecedentes. Las infecciones del tracto urinario son una complicación en las unidades de cuidados intensivos. Las levaduras ocasionan el 5-12% de dichas infecciones. El valor del hallazgo de las levaduras es controvertido y no hay consenso acerca de qué parámetros son los adecuados para diferenciar entre contaminación, colonización e infección urinaria. Objetivos. Analizar las características epidemiológicas de pacientes con funguria, determinar potenciales puntos de corte en los cultivos para distinguir la infección urinaria de otras situaciones, identificar las especies de levaduras prevalentes y determinar el valor de la segunda muestra de orina. Métodos. Se realizó un estudio multicéntrico en unidades de cuidados intensivos de 14 hospitales. Se procesaron primeras y segundas muestras para urocultivo, se evaluaron la presencia de leucocitos y levaduras en el examen directo, se hizo un recuento de colonias y se identificaron las especies aisladas. Resultados. Hubo crecimiento de levaduras en el 12,2% de las muestras. No hubo correlación entre el número de leucocitos y el de unidades formadoras de colonias de levaduras. El 85% de los pacientes tenían catéteres vesicales. No se observó mayor prevalencia ni en mujeres ni en pacientes adultos mayores de 65 años. Candida albicans fue la especie más frecuente, seguida por Candida tropicalis y, en menor proporción, por Candida parapsilosis y Candida glabrata. En la segunda muestra se corroboró la presencia de la misma especie en el 70% de los casos, y en el 23% de ellos el segundo cultivo fue negativo. Conclusiones. No fue posible determinar un punto de corte en el recuento de colonias que oriente al diagnóstico de infección urinaria. Las dos especies prevalentes fueron C. albicans y C. tropicalis (AU)

Background. Urinary tract infections are a frequent ailment in patients in intensive care units. Candida and other yeasts cause 5-12% of these infections. The value of the finding of any yeast is controversial, and there is no consensus about which parameters are adequate for differentiating urinary infections from colonization or contamination. Aims. To analyse the epidemiological characteristics of patients with funguria, to determine potential cut-off points in cultures (to distinguish an infection from other conditions), to identify the prevalent yeast species, and to determine the value of a second urine sample. Methods. A multicentre study was conducted in intensive care units of 14 hospitals in the Buenos Aires City Mycology Network. The first and second samples of urine from every patient were cultured. The presence of white cells and yeasts in direct examination, colony counts, and the identification of the isolated species, were evaluated. Results. Yeasts grew in 12.2% of the samples. There was no statistical correlation between the number of white cells and the fungal colony-forming units. Eighty five percent of the patients had indwelling catheters. Funguria was not prevalent in women or in patients over the age of 65. Candida albicans, followed by Candida tropicalis, were the most frequently isolated yeasts. Candida parapsilosis and Candida glabrata appeared less frequently. The same species were isolated in 70% of second samples, and in 23% of the cases the second culture was negative. Conclusions. It was not possible to determine a useful cut-off point for colony counts to help in the diagnosis of urinary infections. As in other publications, C. albicans, followed by C. tropicalis, were the most prevalent species (AU)