Bacillus cereus bacteremia in a patient with an abdominal stab wound / Bacteriemia por Bacillus cereus en paciente con herida de arma blanca abdominal

Abstract Bacillus cereus is a gram positive microorganism commonly involved in gastrointestinal infection but capable of causing severe infections and bacteremia. We describe here a case of bacteremia caused by B. cereus in a previously healthy young woman admitted to the intensive care unit following emergency surgery due to a penetrating abdominal stab wound and subsequent hepatic lesion. She developed fever during admission and cultures were taken. B. cereus was isolated in blood and hepatic fluid collection cultures. Treatment was adjusted according to the isolate, with good clinical results. It is important to highlight the pathogenic potential of this microorganism and not underestimate it as a contaminant when it is isolated from blood samples.

Resumen Bacillus cereus es un microorganismo gram positivo comúnmente involucrado en infecciones gastrointestinales, pero capaz de causar infecciones graves y bacteriemia. Presentamos un caso de bacteriemia por B. cereus en una mujer joven previamente sana que ingresa en la unidad de cuidados intensivos luego de una cirugía de emergencia, debido a una herida abdominal por arma blanca con lesión hepática. La paciente desarrolla fiebre durante la internación, por lo que se toman cultivos. Se aísla B. cereus en hemocultivos y material de colección hepática. Se ajusta el tratamiento según los hallazgos, con buena evolución clínica. Esta comunicación ilustra una fuente poco común de bacteriemia por B. cereus. Asimismo, destaca el potencial patogénico de este microorganismo, cuyo hallazgo en muestras de sangre no siempre debe conducir a su rápida desjerarquización como contaminante.

Serum levels of NLRP3 and HMGB-1 are associated with the prognosis of patients with severe blunt abdominal trauma

OBJECTIVES: To investigate the relationship between the serum levels of NLRP3 and HMGB-1 and the prognosis of patients with severe blunt abdominal trauma. METHODS: In total, 299 patients were included in the current study from July 2014 to December 2015. All patients were divided into the mild/moderate blunt abdominal trauma group and the severe blunt abdominal trauma group according to their injury severity scores. Serum levels of NLRP3 and HMGB-1 were measured upon admission (0 h) and at 12 h, 24 h, 48 h, 72 h and 7 days after admission. RESULTS: Compared with the healthy controls, both the mild/moderate and severe blunt abdominal trauma groups had higher serum levels of NLRP3 and HMGB-1 at admission. At all points, the serum levels of NLRP3 and HMGB-1 were significantly higher in the severe group than in the mild/moderate group. The serum levels of both NLRP3 and HMGB-1 were significantly higher in the deceased patients than in the living patients. The Kaplan-Meier curve showed that compared with patients with higher levels of NLRP3 or HMGB-1, those with lower levels had longer survival times. The serum levels of both NLRP3 and HMGB-1 were independent risk factors for 6-month mortality in severe blunt abdominal trauma patients. CONCLUSION: The serum levels of NLRP3 and HMGB-1 were significantly elevated in severe blunt abdominal trauma patients, and the serum levels of both NLRP3 and HMGB-1 were correlated with 6-month mortality in severe blunt abdominal trauma patients.

Compactação primária do abomaso em 14 bovinos no estado de Pernambuco / Primary abomasal impaction in 14 cattle from Pernambuco State, northeastern Brazil

Apesar de forragens grosseiras e secas serem empregadas comumente na alimentação de vacas em várias regiões, especialmente durante o período seco, a compactação primária do abomaso tem sido pouco relatada no Brasil, provavelmente pela dificuldade de diagnóstico dos veterinários de campo. Este trabalho objetivou realizar um estudo retrospectivo sobre a compactação primária do abomaso em 14 bovinos no Estado de Pernambuco. Oito casos considerados moderados, sem grave distensão abdominal e sem compactação do rúmen, foram tratados conservativamente e quatro casos graves, com severa distensão abdominal e compactação do rúmen, foram tratados cirurgicamente. Um touro foi encaminhado para abate e uma vaca morreu antes de receber qualquer tratamento. O maior número de casos de compactação do abomaso ocorreu em bovinos da raça Holandesa com seis casos (42,9 por cento), seguido por animais mestiços com cinco casos (35,8 por cento) e as raças Pardo-Suiça, Nelore e Marchigiana com um caso cada (21,3 por cento). A composição da alimentação oferecida caracterizou-se por conter fibra de baixa qualidade e variou bastante dentre os casos. Os sinais clínicos mais frequentes foram comportamento apático, desidratação, timpanismo ruminal associado à hipomotilidade, distensão abdominal, hipomotilidade intestinal e fezes escassas ou ausentes com presença de muco. Os achados hematológicos revelaram, na maioria dos casos, leucocitose por neutrofilia e hiperfibrinogenemia. Na análise do fluido ruminal havia comprometimento da dinâmica da flora e fauna microbiana, e elevação no teor de cloreto. O índice de recuperação clínica (4/8) e cirúrgica (2/4) observado neste estudo foi de 50 por cento. As condutas clínica e cirúrgica permanecem como opções viáveis para o tratamento das compactações leves e severas, entretanto o prognóstico é considerado reservado, principalmente quando associado à gestação avançada.

Despite the frequent use of dry and fibrous roughage for feeding cows in many regions, especially during the dry season, impaction of the abomasum has been poorly reported in Brazil, probably because the condition is misdiagnosed by practitioners. The present paper aimed to accomplish a retrospective study on primary abomasal impaction in 14 cattle from Pernambuco State, northeastern Brazil. Eight moderate cases, without severe abdominal distention and with no rumen compaction, were treated conservatively, and four severe cases, with severe abdominal distention and rumen compaction, were treated surgically. One bull was slaughtered and one cow died without treatment. The greater number of abomasal impaction cases was in Holstein cows with six cases (42.9 percent), followed by crossbred cattle with five cases (35.8 percent), and the breeds Brown-Swiss, Nelore and Marchigiana, each with one case (21.3 percent). The food composition was characterized by low quality fibers and varied greatly among cases. Most frequent clinical signs were apathy, dehydration, hypomotility and ruminal bloat, intestinal hypomotility and scanty or absent feces with mucus. The hematological findings revealed leukocytosis with neutrophilia and hyperfibrinogenemia in most cases. Ruminal fluid analysis showed compromised flora and fauna dynamics and increased chlorine ion concentration. Clinical (4/8) and chirurgical (2/4) recovery rate achieved 50 percent. The clinical and chirurgical methods remain as viable options for the treatment of light and severe impaction, but the prognosis is always reserved especially when associated to late pregnancy.