RESUMEN
The prevalence of community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) is increasing worldwide. Whilst CA-MRSA has been reported in the UK, there is little information concerning its clinical impact. Here we report three epidemic lineages of CA-MRSA occurring in East Yorkshire and describe their epidemiology, microbiology and clinical impact. Although CA-MRSA was most often associated with uncomplicated skin and soft tissue infections or asymptomatic colonisation, serious infection and fatalities were documented. Community-based transmission was noted in two separate households. We highlight limitations to existing definitions and propose debate to further define CA-MRSA and allow further study of its epidemiology and clinical impact in the UK.
Asunto(s)
Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Técnicas de Tipificación Bacteriana/métodos , Niño , Preescolar , Análisis por Conglomerados , Dermatoglifia del ADN/métodos , ADN Bacteriano/genética , Electroforesis en Gel de Campo Pulsado/métodos , Femenino , Genotipo , Humanos , Lactante , Recién Nacido , Masculino , Staphylococcus aureus Resistente a Meticilina/clasificación , Staphylococcus aureus Resistente a Meticilina/genética , Persona de Mediana Edad , Epidemiología Molecular , Reino Unido/epidemiología , Adulto JovenRESUMEN
Treatment of resistant gram-positive endocarditis is difficult. We report a case of resistant Staphylococcus epidermidis endocarditis that failed to respond to conventional antibiotic therapy but was treated successfully with an oral regimen of a new antibiotic, linezolid as a single active agent. This case report demonstrates the use of linezolid as an effective alternative to conventional antibiotics in such cases.
Asunto(s)
Acetamidas/uso terapéutico , Antibacterianos/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Oxazolidinonas/uso terapéutico , Infecciones Estafilocócicas/tratamiento farmacológico , Administración Oral , Anciano , Endocarditis Bacteriana/microbiología , Resultado Fatal , Femenino , Humanos , Linezolid , Staphylococcus epidermidis/aislamiento & purificación , Resultado del TratamientoRESUMEN
A rare case of Corynebacterium striatum endocarditis on a bioprosthetic aortic valve replacement, treated medically, is reported. The presentation was subacute, and initially endocarditis screening was negative. Because of the failure of symptoms to settle further screening was performed which confirmed the organism in several sets of blood cultures. This emphasises the importance of persistent screening for endocarditis if the history raises any suspicion of this potentially serious infection, especially in the presence of prosthetic valves.
Asunto(s)
Válvula Aórtica , Infecciones por Corynebacterium/diagnóstico , Endocarditis Bacteriana/diagnóstico , Prótesis Valvulares Cardíacas/efectos adversos , Infecciones Relacionadas con Prótesis/diagnóstico , Endocarditis Bacteriana/microbiología , Femenino , Humanos , Persona de Mediana EdadAsunto(s)
Sepsis/microbiología , Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/clasificación , Streptococcus pyogenes/aislamiento & purificación , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Fiebre/microbiología , Humanos , Sepsis/epidemiologíaAsunto(s)
Válvula Aórtica , Muerte Súbita Cardíaca/etiología , Endocarditis Bacteriana/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Streptococcus agalactiae , Válvula Aórtica/patología , Muerte Súbita Cardíaca/patología , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad , Rotura Espontánea , Infecciones Estreptocócicas/patologíaRESUMEN
Forty patients undergoing routine bronchoscopy were randomised to receive inhaled micronised gentamicin powder (180 mg) or nebulised gentamicin solution (160 mg) one hour before the procedure. Similar levels of gentamicin were detected in bronchoalveolar lavage fluid in the two groups (micronised powder (n = 20) 9.3 (SD 9.3) mg/l, nebulised solution (n = 20) 8.0 (7.8) mg/l). The micronised gentamicin powder preparation caused cough in half the patients but this did not stop their receiving a full dose. Dry powder gentamicin may be a convenient formulation for long term inhaled treatment if the problem of cough can be overcome.
Asunto(s)
Gentamicinas/administración & dosificación , Administración por Inhalación , Administración Intranasal , Líquido del Lavado Bronquioalveolar/química , Broncoscopía , Tos/inducido químicamente , Tecnología de Fibra Óptica , Gentamicinas/efectos adversos , Gentamicinas/análisis , Humanos , Persona de Mediana Edad , PolvosRESUMEN
We report the electron-microscopic appearances of tissues from an immunocompromised patient who died of chickenpox. We observed structures consistent with some of the reported appearances of Varicella-Zoster virus in cultured cells, and tubular structures that have not to our knowledge been previously described.
Asunto(s)
Varicela/patología , Herpesvirus Humano 3/ultraestructura , Terapia de Inmunosupresión , Adulto , Esófago/microbiología , Humanos , Hígado/microbiología , Pulmón/microbiología , Pulmón/ultraestructura , Masculino , Microscopía Electrónica , Neumonía Viral/patología , Piel/ultraestructuraRESUMEN
We describe the first reported case of pneumonia due to Legionella pneumophila serogroup 12 in the UK. This hospital-associated infection occurred in an immuno-incompetent patient and coincided with a change in character of the local environmental strains of legionellas. The patient produced a serological response both to her own isolate and to L. pneumophila serogroups 1-6. Thus serodiagnosis was attainable using the usual screening antigens.
Asunto(s)
Infección Hospitalaria/etiología , Enfermedad de los Legionarios/etiología , Neumonía/etiología , Adulto , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/epidemiología , Humanos , Terapia de Inmunosupresión/efectos adversos , Trasplante de Riñón , Enfermedad de los Legionarios/diagnóstico , Enfermedad de los Legionarios/epidemiología , Neumonía/diagnóstico , Neumonía/epidemiología , Ingeniería Sanitaria , Reino Unido , Microbiología del AguaRESUMEN
We report a case of lower respiratory tract infection with Mycoplasma hominis in a patient with X-linked hypogammaglobulinaemia.
Asunto(s)
Agammaglobulinemia/genética , Infecciones por Mycoplasma/complicaciones , Infecciones del Sistema Respiratorio/complicaciones , Adulto , Ligamiento Genético , Humanos , Masculino , Mycoplasma , Cromosoma XRESUMEN
An aplastic crisis associated with parvovirus infection occurred in a patient suffering from hereditary erythrocytic multinuclearity associated with a positive acidified (Hams) test (HEMPAS). This case emphasises that any patient who has a shortened red cell survival is susceptible to an aplastic crisis induced by parvovirus.
Asunto(s)
Anemia Diseritropoyética Congénita/complicaciones , Anemia Hemolítica Congénita/complicaciones , Infecciones por Parvoviridae/complicaciones , Adulto , Anemia Diseritropoyética Congénita/sangre , Anticuerpos Antivirales/análisis , Envejecimiento Eritrocítico , Femenino , Hemoglobinas/análisis , Humanos , Inmunoglobulina G/análisis , Inmunoglobulina M/análisis , Recuento de Leucocitos , Infecciones por Parvoviridae/sangre , Recuento de PlaquetasRESUMEN
Sera from fifty couples were assayed for the presence of antibody to Cytomegalovirus. In twenty of the couples only one partner was seropositive. If serological status accurately distinguishes between infected and uninfected individuals, these data indicate that conjugal transmission of Cytomegalovirus is inefficient.