Impact of Adding a Rapid PCR-Based Blood Culture Identification Panel to the Antimicrobial Stewardship Program of Patients with Febrile Neutropenia in a Peruvian Referral Hospital.

The addition of Biofire® FilmArray® Blood Culture Identification panel 2 (BCID2) to the antimicrobial stewardship program (ASP) could improve outcomes in bloodstream infections (BSI) of patients with febrile neutropenia (FN). A pre- and post-quasi-experimental single-center study was conducted at a reference hospital in Peru. Three groups were considered: patients with BSI before ASP intervention (control group), patients with BSI after ASP intervention (group 1), and patients with BSI after ASP intervention plus BCID2 PCR Panel implementation (group 2). Overall, 93 patients were identified (32 control, 30 group 1, 31 group 2). The median time to effective therapy was significantly shorter in group 2 compared to group 1 and control group, respectively (3.75 vs. 10 h, p = 0.004; 3.75 vs. 19 h, p < 0.001). No significant differences in terms of relapse of bacteremia, in-hospital mortality (all cause), and 30-day-all-cause hospital readmission between the three study periods were found. The appropriateness of empirical antimicrobial use, adding or change, and the following de-escalation or discontinuation was significant when the two intervention periods were compared with the control group (p < 0.001). In addition to the lack of local studies documenting the microbiological profile of FN episodes, adding syndromic panels-based testing could allow for the consolidation of ASP strategies.

Biofilm fúngico asociado a dispositivo intravascular de larga permanencia: Complicaciones y dificultades terapéuticas / Fungal biofilm associated with long-term central venous access device: Complications and therapeutic difficulties

Las infecciones fúngicas asociadas a biofilms en dispositivos biomédicos son refractarias al tratamiento antifúngico y habitualmente se requiere del retiro oportuno del dispositivo, así como la administración de antifúngicos sistémicos. Presentamos el caso de una paciente mujer de 36 años que recibe terapia para el dolor administrada por dispositivo intravascular de larga permanencia, catéter Port-A-Cath, y que desarrolló candidemia y endocarditis por Candida parapsilosis asociada al catéter; el cual tuvo que ser retirado mediante toracotomía por persistencia de la infección a pesar de la terapia antifúngica sistémica. Se evidenció extenso biofilm rodeando al catéter, con aislamiento de Candida parapsilosis y se completaron seis semanas de tratamiento antifúngico con evolución clínica favorable

Fungal infections associated with biofilms in biomedical devices are refractory to antifungal treatment and usually require the timely removal of the device, as well as the administration of systemic antifungals. We present the case of a 36-year- old female patient who received pain therapy administered by a Port-A-Cath long-term central venous access device. She developed catheter-related candidemi a and endocarditis caused by Candida parapsilosis. The catheter had to be removed by thoracotomy due to persistent infection despite the systemic antifungal therapy. An extensive biofilm surrounding the catheter was observed and Candida parapsilosis was isolated. Six weeks of antifungal treatment with a favorable clinical evolution were completed

[Intramedullary toxoplasmosis in HIV-tuberculosis co-infected patient]. / Toxoplasmosis intramedular en una paciente con coinfección por VIH y tuberculosis.

The most common clinical presentation of Toxoplasma gondii in HIV patients is encephalitis; however, the intramedullary involvement has been reported in a few cases. We report a case of intramedullary toxoplasmosis in a female patient diagnosed with HIV/tuberculosis co-infection, and history of poor adherence to antiretroviral therapy. The patient developed subacute paraparesis with compromise of sensory function and urinary sphincter. The nuclear magnetic resonance evaluation showed a single intramedullary ring-enhanced lesion at the T-8 level which was solved after an anti-Toxoplasma therapy with trimethoprim/sulfamethoxazole.

Toxoplasmosis intramedular en una paciente con coinfección por VIH y tuberculosis / Intramedullary toxoplasmosis in HIV-tuberculosis co-infected patient

The most common clinical presentation of Toxoplasma gondii in HIV patients is encephalitis; however, the intramedullary involvement has been reported in a few cases. We report a case of intramedullary toxoplasmosis in a female patient diagnosed with HIV/tuberculosis co-infection, and history of poor adherence to antiretroviral therapy. The patient developed subacute paraparesis with compromise of sensory function and urinary sphincter. The nuclear magnetic resonance evaluation showed a single intramedullary ring-enhanced lesion at the T-8 level which was solved after an anti-Toxoplasma therapy with trimethoprim/sulfamethoxazole.

El compromiso encefálico por Toxoplasma gondii en pacientes con VIH es la localización más frecuente, no obstante, la localización intramedular ha sido escasamente reportada. Comunicamos un caso de toxoplasmosis intramedular en una mujer con diagnóstico de coinfección por VIH y tuberculosis, con mala adherencia a la terapia antirretroviral, que desarrolló de forma subaguda un cuadro de paraparesia con compromiso sensitivo y de esfínteres. La resonancia magnética mostró una lesión única intramedular con captación de contraste periférico en anillo a nivel T-8, que se resolvió tras recibir tratamiento anti-toxoplasmosis con cotrimoxazol.

[Paracoccidiomicosis in the central nervous system: a case report]. / Paracoccidiomicosis en el sistema nervioso central: reporte de un caso.

Paracoccidioidomycosis is a fungal disease which can compromise the central nervous system (CNS).We present a case of an immunocompetent 45 year old man from Satipo, Peru who developed paracoccidioidomycosis in the CNS without any apparent point of entry or infection. The patient was diagnosed by imaging with a cerebellar granuloma, followed by a craniotomy where tissue and secretion of the granuloma abscess was obtained. Histological and microbiological diagnoses were performed on the tissue and secretion, respectively. Yeasts were observed in the histological section and growth of the fungus in the culture. The patient initially received antifungals, then acquired an intrahospital infection, received colistin and subsequently died. The case report emphasizes the importance of early and correct diagnosis for good outcomes of paracoccidioidomycosis cases.

Paracoccidiomicosis en el sistema nervioso central: reporte de un caso / Paracoccidiomicosis in the central nervous system: a case report

La paracoccidiomicosis es una enfermedad micótica que puede comprometer el sistema nervioso central (SNC). Se presenta el caso de un paciente varón de 45 años, inmunocompetente, de la ciudad de Satipo, que desarrollo paracoccidiomicosis en el SNC sin punto de entrada e infección aparente. El paciente fue diagnosticado por imágenes con un granuloma cerebelar, posteriormente, se realiza una craneotomía de donde se obtiene tejido y secreción del absceso del granuloma, se procedió al diagnóstico histológico y microbiológico, respectivamente, donde se observó la presencia de levaduras en el corte histológico y el crecimiento del hongo en el cultivo. El paciente, inicialmente, recibe antifúngicos, luego adquiere una infección intrahospitalaria, recibe colistina y posteriormente fallece. El caso reportado pone énfasis en la importancia del diagnóstico temprano y correcto para la buena evolución de los casos de paracoccidiomicosis.

Paracoccidioidomycosis is a fungal disease which can compromise the central nervous system (CNS).We present a case of an immunocompetent 45 year old man from Satipo, Peru who developed paracoccidioidomycosis in the CNS without any apparent point of entry or infection. The patient was diagnosed by imaging with a cerebellar granuloma, followed by a craniotomy where tissue and secretion of the granuloma abscess was obtained. Histological and microbiological diagnoses were performed on the tissue and secretion, respectively. Yeasts were observed in the histological section and growth of the fungus in the culture. The patient initially received antifungals, then acquired an intrahospital infection, received colistin and subsequently died. The case report emphasizes the importance of early and correct diagnosis for good outcomes of paracoccidioidomycosis cases.