ABSTRACT
Background: Listeriosis is a known cause of community acquired bacterial meningitis/meningoencephalitis. It occurs more frequently in neonates, older people and immunocompromised hosts. Rarely, brain abscesses can complicate the course of infection, which poses a difficulty in the management and elevates morbidity and mortality. Myasthenia gravis is an autoimmune disease that often requires immunosuppressive treatment, which increases the risk for invasive infections. Case description: A 75-year-old myasthenic patient, treated with prednisone and pyridostigmine, was diagnosed with invasive listeriosis. He presented with muscle weakness, dyspnea, hemiparesis and altered mental status. Brain imaging revealed multiple abscesses and blood cultures were positive for Listeria monocytogenes. Despite combination antibiotic therapy, he died 6 weeks after admission. Systematic review: Ninety-six cases of brain abscesses from 1968 to 2023 were reviewed; the majority of the patients were men, 54 years-old on average, and had at least one risk factor for invasive listeriosis. The mortality exceeded 22%. Blood cultures and CSF/abscess cultures were positive in only 79.2% and 54.6%, respectively. The most common therapeutic approach was a combination regimen that included amoxicillin or ampicillin. Only 8 patients underwent surgery, of which one died. Conclusion: This case highlights the importance of L. monocytogenes as a cause of brain abscesses in populations at risk, including myasthenic patients. The challenge of diagnosing and treating this condition is aggravated by the paucity of literature and the high mortality rate.
ABSTRACT
Mycetoma is a neglected tropical disease caused by fungi (eumycetoma) or bacteria (actinomycetoma), with high morbidity. Gordonia spp. are gram-positive bacteria that have previously been reported to cause mycetoma. Here, we report a case of Gordonia soli (initially misidentified as Nocardia spp.) as the etiological agent of actinomycetoma in a 64-year-old patient. After a literature search in the Cochrane Library, LILACS, SciELO, MEDLINE, PubMed, and PubMed Central databases, we concluded that this is the first case report of mycetoma caused by Gordonia soli. The current case highlights the importance of microbiological diagnosis of mycetoma and the challenges in its management.
Subject(s)
Actinobacteria , Mycetoma , Nocardia , Humans , Middle Aged , Mycetoma/diagnosis , Mycetoma/drug therapy , Mycetoma/microbiology , Fungi , Neglected DiseasesABSTRACT
ABSTRACT Mycetoma is a neglected tropical disease caused by fungi (eumycetoma) or bacteria (actinomycetoma), with high morbidity. Gordonia spp. are gram-positive bacteria that have previously been reported to cause mycetoma. Here, we report a case of Gordonia soli (initially misidentified as Nocardia spp.) as the etiological agent of actinomycetoma in a 64-year-old patient. After a literature search in the Cochrane Library, LILACS, SciELO, MEDLINE, PubMed, and PubMed Central databases, we concluded that this is the first case report of mycetoma caused by Gordonia soli. The current case highlights the importance of microbiological diagnosis of mycetoma and the challenges in its management.
ABSTRACT
INTRODUCTION: We defined the cut-off values of the antigenemia and cytomegalovirus (CMV) DNA tests in HIV/AIDS patients to identify CMV disease. METHODS: A total of 97 samples from 68 patients with and without CMV disease were analyzed by viral DNA detection and antigenemia assay. RESULTS: Qualitative and quantitative results significantly differed between assays. The cut-off values for the antigenemia and qPCR assays were 1.5 positive cells/200,000 leukocytes and 3.715 log/mL, respectively. CONCLUSIONS: Antigenemia and qPCR are suitable for monitoring CMV disease in HIV patients, however, the threshold values should be determined within the centers where the patients are monitored.
Subject(s)
AIDS-Related Opportunistic Infections/diagnosis , Cytomegalovirus Infections/diagnosis , Cytomegalovirus/isolation & purification , DNA, Viral/analysis , AIDS-Related Opportunistic Infections/blood , Antigens, Viral/blood , Brazil/epidemiology , Cytomegalovirus/genetics , Cytomegalovirus Infections/blood , DNA, Viral/blood , Humans , Predictive Value of Tests , Prospective Studies , ROC Curve , Real-Time Polymerase Chain Reaction , Sensitivity and Specificity , Viral LoadABSTRACT
Abstract INTRODUCTION: We defined the cut-off values of the antigenemia and cytomegalovirus (CMV) DNA tests in HIV/AIDS patients to identify CMV disease. METHODS: A total of 97 samples from 68 patients with and without CMV disease were analyzed by viral DNA detection and antigenemia assay. RESULTS: Qualitative and quantitative results significantly differed between assays. The cut-off values for the antigenemia and qPCR assays were 1.5 positive cells/200,000 leukocytes and 3.715 log/mL, respectively. CONCLUSIONS: Antigenemia and qPCR are suitable for monitoring CMV disease in HIV patients, however, the threshold values should be determined within the centers where the patients are monitored.
Subject(s)
Humans , DNA, Viral/analysis , AIDS-Related Opportunistic Infections/diagnosis , Cytomegalovirus Infections/diagnosis , Cytomegalovirus/isolation & purification , Brazil/epidemiology , DNA, Viral/blood , Predictive Value of Tests , Prospective Studies , ROC Curve , Sensitivity and Specificity , AIDS-Related Opportunistic Infections/blood , Cytomegalovirus Infections/blood , Viral Load , Cytomegalovirus/genetics , Real-Time Polymerase Chain Reaction , Antigens, Viral/bloodSubject(s)
Bacterial Proteins/cerebrospinal fluid , Cross Infection/cerebrospinal fluid , Klebsiella Infections/cerebrospinal fluid , Klebsiella pneumoniae/isolation & purification , Meningitis, Bacterial/cerebrospinal fluid , beta-Lactamases/cerebrospinal fluid , Cross Infection/diagnosis , Female , Humans , Klebsiella Infections/diagnosis , Meningitis, Bacterial/diagnosis , Middle Aged , Polymerase Chain ReactionABSTRACT
The genus Vibrio is a member of the family Vibrionaceae, and among their disease-causing species, Vibrio vulnificus, a lactose-positive gram-negative bacillus, is one of the most virulent pathogen of the noncholerae vibrios. We describe the case of a 39-year-old male patient, who was using immunosuppressive therapy, admitted to the hospital for liver transplantation. Twelve hours later, the patient presented high fever, myalgia, anuria and erythematous plaques on lower limbs, of rapid growth and proximal progression. The patient was treated with ceftriaxone, meropenem and oxacillin, however he expired within 30 hours. Blood cultures showed growth of a gram-negative bacillus, which was later identified as Vibrio vulnificus.
Subject(s)
Foodborne Diseases/microbiology , Seafood/poisoning , Vibrio Infections/diagnosis , Vibrio vulnificus/isolation & purification , Adult , Brazil , Fatal Outcome , Humans , Immunocompromised Host , Male , Seafood/microbiology , Vibrio Infections/complicationsABSTRACT
The genus Vibrio is a member of the family Vibrionaceae, and among their disease-causing species, Vibrio vulnificus, a lactose-positive gram-negative bacillus, is one of the most virulent pathogen of the noncholerae vibrios. We describe the case of a 39-year-old male patient, who was using immunosuppressive therapy, admitted to the hospital for liver transplantation. Twelve hours later, the patient presented high fever, myalgia, anuria and erythematous plaques on lower limbs, of rapid growth and proximal progression. The patient was treated with ceftriaxone, meropenem and oxacillin, however he expired within 30 hours. Blood cultures showed growth of a gram-negative bacillus, which was later identified as Vibrio vulnificus.
O gênero Vibrio é membro da família Vibrionaceae, e entre as espécies patogênicas, Vibrio vulnificus, bacilo gram negativo lactose positivo, tem sido frequentemente citado. Descrevemos o caso de um paciente masculino de 39 anos, em uso de medicação imunossupressora, admitido no hospital para transplante hepático. Doze horas após a internação, o paciente evoluiu com febre, mialgias, anúria e placas eritematosas em membros inferiores, com rápido crescimento e evolução proximal. O paciente foi tratado com ceftriaxona, meropenem e oxacilina sem melhora, evoluindo para óbito em 30 horas. Hemocultura mostrou crescimento de bacilo gram negativo posteriormente identificado como Vibrio vulnificus.
Subject(s)
Adult , Humans , Male , Foodborne Diseases/microbiology , Seafood/poisoning , Vibrio Infections/diagnosis , Vibrio vulnificus/isolation & purification , Brazil , Fatal Outcome , Immunocompromised Host , Seafood/microbiology , Vibrio Infections/complicationsABSTRACT
This case report, along with the review presented, describes a patient diagnosed with acute viral hepatitis, who developed a framework of intense abdominal pain and laboratorial alterations compatible with acute pancreatitis. The association of acute pancreatitis complicating fulminant and non-fulminant acute hepatitis virus (AHV) has been reported and several mechanisms have been proposed for this complication, but so far none is clearly involved. As acute hepatitis is a common disease, it is important to stimulate the development of other studies in order to determine local incidence and profile of patients presenting this association in our environment.
Este relato de caso, junto com a revisão de literatura, descreve um paciente com diagnóstico de hepatite viral aguda, que desenvolveu quadro de dor abdominal intensa e alterações laboratoriais compatíveis com pancreatite aguda. Casos de pancreatite aguda complicando hepatites virais agudas fulminantes e não fulminantes tem sido esporadicamente relatados e vários mecanismos são propostos para explicar esta complicação, no entanto sua causa ainda se mantém desconhecida. Como a hepatite aguda é doença comum, é importante estimular o desenvolvimento de mais estudos na América Latina que visem determinar a incidência local e o perfil dos pacientes que apresentam esta complicação.
Subject(s)
Adult , Female , Humans , Hepatitis, Viral, Human/complications , Pancreatitis/etiology , Acute Disease , Hepatitis, Viral, Human/classification , Hepatitis, Viral, Human/diagnosis , Pancreatitis/diagnosisABSTRACT
This case report, along with the review presented, describes a patient diagnosed with acute viral hepatitis, who developed a framework of intense abdominal pain and laboratorial alterations compatible with acute pancreatitis. The association of acute pancreatitis complicating fulminant and non-fulminant acute hepatitis virus (AHV) has been reported and several mechanisms have been proposed for this complication, but so far none is clearly involved. As acute hepatitis is a common disease, it is important to stimulate the development of other studies in order to determine local incidence and profile of patients presenting this association in our environment.
Subject(s)
Hepatitis, Viral, Human/complications , Pancreatitis/etiology , Acute Disease , Adult , Female , Hepatitis, Viral, Human/classification , Hepatitis, Viral, Human/diagnosis , Humans , Pancreatitis/diagnosisABSTRACT
Results from a cross-sectional observational study on candidemia conducted at Hospital de Clínicas, Federal University of Paraná, are presented. From January 2001 to December 2004, one hundred candidemia cases were evaluated. The incidence was 1.27 episodes per 1,000 hospitalizations and Candida was the eighth most frequently isolated agent from bloodstream infections. The patients ages ranged from five days to 89 years, with a mean of 32 years. Sixty percent of the cases occurred in adults (66% > 50 years old) and 40% in children (52% < one year old). Fifty-nine percent had been admitted to medical wards and 41% to the intensive care unit. Candida albicans was the most (59%) frequent species followed by Candida tropicalis (15%) and Candida parapsilosis (9%). The most (97%) prevalent coexisting conditions were the use of antibacterial drugs, central venous catheter (77%), H2 blockers (57%), total parenteral nutrition (49%) and admission to the intensive care unit (41%). Out of the 51 isolates tested, three of Candida glabrata presented dose-dependent susceptibility to fluconazole and resistance to itraconazole. One sample of Candida krusei presented dose-dependent susceptibility to fluconazole and one of Candida pelliculosa presented dose-dependent susceptibility to itraconazole. Among the study population, 68% received antifungal therapy, but the mortality was 56%.
Subject(s)
Antifungal Agents/pharmacology , Candidiasis/epidemiology , Fungemia/epidemiology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Brazil/epidemiology , Candida/classification , Candida/drug effects , Candidiasis/microbiology , Child , Child, Preschool , Cross-Sectional Studies , Female , Fungemia/microbiology , Humans , Incidence , Infant , Infant, Newborn , Male , Microbial Sensitivity Tests , Middle Aged , Risk Factors , Sex DistributionABSTRACT
São apresentados os resultados de estudo transversal e observacional sobre candidemia realizado no Hospital de Clínicas da Universidade Federal do Paraná. No período de janeiro de 2001 a dezembro de 2004, foram analisados 100 episódios de candidemia. A incidência foi de 1,27 por 1.000 internações, sendo Candida spp o oitavo agente mais isolado nas infecções da corrente sanguínea. A idade variou de 5 dias a 89 anos com uma média de 32 anos, 60 por cento dos casos ocorreram em adultos (66 por cento > 50 anos) e 40 por cento em crianças (52 por cento < 1 ano). Cinqüenta e nove pacientes estavam internados em enfermarias e 41 em unidade de terapia intensiva. Candida albicans foi a espécie mais (59 por cento) freqüente, seguida por Candida tropicalis (15 por cento), Candida parapsilosis (9 por cento). As condições associadas mais (97 por cento) freqüentes foram uso de antibióticos, cateter venoso central (77 por cento), bloqueador H2 (57 por cento), nutrição parenteral total (49 por cento) internamento em unidade de terapia intensiva (41 por cento). Dos 51 isolados testados, 3 de Candida glabrata apresentaram suscetibilidade dose-dependente ao fluconazol e eram resistentes ao itraconazol. Uma amostra de Candida krusei apresentou suscetibilidade dose-dependente ao fluconazol, e uma de Candida pelliculosa suscetibilidade dose-dependente ao itraconazol. Na população de estudo, 68 por cento receberam tratamento antifúngico, no entanto a mortalidade foi de 56 por cento.
Results from a cross-sectional observational study on candidemia conducted at Hospital de Clínicas, Federal University of Paraná, are presented. From January 2001 to December 2004, one hundred candidemia cases were evaluated. The incidence was 1.27 episodes per 1,000 hospitalizations and Candida was the eighth most frequently isolated agent from bloodstream infections. The patients ages ranged from five days to 89 years, with a mean of 32 years. Sixty percent of the cases occurred in adults (66 percent > 50 years old) and 40 percent in children (52 percent < one year old). Fifty-nine percent had been admitted to medical wards and 41 percent to the intensive care unit. Candida albicans was the most (59 percent) frequent species followed by Candida tropicalis (15 percent) and Candida parapsilosis (9 percent). The most (97 percent) prevalent coexisting conditions were the use of antibacterial drugs, central venous catheter (77 percent), H2 blockers (57 percent), total parenteral nutrition (49 percent) and admission to the intensive care unit (41 percent). Out of the 51 isolates tested, three of Candida glabrata presented dose-dependent susceptibility to fluconazole and resistance to itraconazole. One sample of Candida krusei presented dose-dependent susceptibility to fluconazole and one of Candida pelliculosa presented dose-dependent susceptibility to itraconazole. Among the study population, 68 percent received antifungal therapy, but the mortality was 56 percent.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Antifungal Agents/pharmacology , Candidiasis/epidemiology , Fungemia/epidemiology , Age Distribution , Brazil/epidemiology , Cross-Sectional Studies , Candida/classification , Candida/drug effects , Candidiasis/microbiology , Fungemia/microbiology , Incidence , Microbial Sensitivity Tests , Risk Factors , Sex DistributionABSTRACT
A sessão de pôster é a forma mais comum de apresentação de trabalhos e pesquisas em encontros científicos médicos, e, apesar disso, são escassas as informações sobre este tema na literatura médica. Desde o planejamento, é importante traçar prazos realistas, seguir as instruções fornecidas pelos organizadores do evento e se preparar de acordo com a audiência. O pôster contém um cabeçalho e o texto, que inclui: resumo, introdução, material e métodos, discussão, conclusões e referências. O estilo e o tamanho das fontes devem possibilitar a leitura a uma distância de 1 a 2 metros. Em algumas situações, figuras, gráficos e tabelas no pôster podem apresentar certas informações mais claramente e em menor espaço do que se descritas sob a forma de texto. Bom planejamento e treinamento diminuem eventuais dificuldades na apresentação do pôster. Este trabalho revisa o assunto, trazendo informações objetivas sobre este método.
Posters are the most common form of presentation of scientific works in medical meetings. In spite of their importance however there is very little information about this issue available in the medical literature. It is important to plan since the beginning, to set a realistic time schedule, to follow the instructions provided by the organizers of the meeting and to prepare oneself according to the audience. The poster contains a title and a text including abstract, introduction, method, results, discussion, conclusions and references. Font and size used should allow reading from a 1 to 2 meters distance. In some situations, certain kind of information is presented more clearly and occupying less space in form of tables, graphs, and figures than in form of a text. Good planning and training diminish possible difficulties during the poster presentation. This paper reviews the subject and provides objective information on the advantages of this method.