RESUMEN
Clostridium difficile, the most common cause of antibiotic-associated diarrhea, is occasionally isolated from extraintestinal sites and is usually found as part of a polymicrobial flora. We report a case of brain empyema that occurred after the recurrent intestinal carriage of a nontoxigenic strain of C. difficile. Brain abscess cultures contained both toxigenic and nontoxigenic isolates. Pulsed-field gel electrophoresis showed that nontoxigenic isolates from the intestine and from the brain were identical.
Asunto(s)
Encefalopatías/microbiología , Clostridioides difficile/aislamiento & purificación , Empiema/microbiología , Enterocolitis Seudomembranosa/complicaciones , Encefalopatías/etiología , Electroforesis en Gel de Campo Pulsado , Empiema/etiología , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Amoxicilina/uso terapéutico , Neisseria/crecimiento & desarrollo , Penicilinas/uso terapéutico , Complicaciones Infecciosas del Embarazo/microbiología , Infecciones Urinarias/complicaciones , Adulto , Amoxicilina/administración & dosificación , Femenino , Humanos , Resistencia a las Penicilinas , Penicilinas/administración & dosificación , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , Orina/microbiologíaRESUMEN
SETTING: Ten correctional facilities in Paris, including suburbs. OBJECTIVE: To prospectively determine the incidence of tuberculosis (TB) in prisons during a one-year period and to trace the transmission of tuberculosis by restriction fragment length polymorphism (RFLP) analysis of Mycobacterium tuberculosis strains from inmates. RESULTS: Of 93 cases of tuberculosis observed, 50 were culture-confirmed. The incidence of tuberculosis in correctional facilities was 215 cases per 100,000 inmates. A high turnover of inmates was observed. All patients were male, and a quarter had been homeless. Seventy-two per cent were diagnosed with pulmonary tuberculosis. Several severe cases of TB were observed, including three of tuberculous meningitis. No multidrug-resistant strains were noted. RFLP analysis (n = 24) revealed 22 distinct patterns which made up two clusters. Epidemiological investigation did not show direct tuberculosis transmission, which was, however, probable for one cluster. CONCLUSION: Independently of incarceration, prison inmates run a higher risk of developing active tuberculosis than the general population, which might be the main reason for the high incidence of tuberculosis observed in prisons. However, some cases of transmission may occur inside prisons.