Case for diagnosis. Suppurative nodule or something deeper?

The authors report the case of a 62-year-old man with a history of total left hip arthroplasty nine years previously presenting with a large infiltrated plaque on the posterior area of the left thigh with three months of evolution without systemic symptoms or elevated inflammatory markers. Computed tomography of the left lower limb revealed a 12-centimeter linear extension of the lesion to the posterior part of the left proximal femur. Prosthesis joint infection, although rare, is a surgical complication to be taken into account, even if the surgery was performed many years before.

Case for diagnosis. Suppurative nodule or something deeper?

Abstract: The authors report the case of a 62-year-old man with a history of total left hip arthroplasty nine years previously presenting with a large infiltrated plaque on the posterior area of the left thigh with three months of evolution without systemic symptoms or elevated inflammatory markers. Computed tomography of the left lower limb revealed a 12-centimeter linear extension of the lesion to the posterior part of the left proximal femur. Prosthesis joint infection, although rare, is a surgical complication to be taken into account, even if the surgery was performed many years before.

Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series.

OBJECTIVE: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. METHODS: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. RESULTS: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. CONCLUSIONS: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis.

Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series / Pneumonia por Streptococcus pneumoniae complicada por pericardite purulenta: uma série de casos

AbstractObjective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular.Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity.Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis.Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis.

ResumoObjetivo:Na era dos antibióticos, a pericardite purulenta é uma entidade rara. Entretanto, ainda há relatos de casos da doença, associados a alta mortalidade, muitos deles atribuídos ao diagnóstico tardio. Aproximadamente 40-50% de todos os casos de pericardite purulenta são causados por bactérias gram-positivas, particularmente Streptococcus pneumoniae.Métodos:Relatamos quatro casos de pneumonia pneumocócica complicada por pericardite, com diferentes características clínicas e níveis de gravidade.Resultados:Em três dos quatro casos, a principal complicação foi tamponamento cardíaco. A pesquisa microbiológica (teste de antígeno urinário e cultura de líquido pleural) confirmou o diagnóstico de pneumonia pneumocócica grave complicada por pericardite purulenta.Conclusões:Em casos de pneumonia pneumocócica complicada por pericardite, o pronto diagnóstico é de extrema importância para evitar comprometimento hemodinâmico grave. As complicações da pericardite aguda aparecem no início do curso clínico da infecção. As complicações mais graves são tamponamento cardíaco e suas consequências. A antibioticoterapia com pericardiocentese reduz sobremaneira a mortalidade associada à pericardite purulenta.

Phaeohyphomycosis Caused by a Novel Species, Pseudochaetosphaeronema martinelli.

Among the opportunistic mycoses that are emerging in patients with immunosuppression or severe underlying illness, many isolates lack of characteristic sporulation and until recently could not be identified. Clinical signs are mostly nonspecific and therefore such infections have often been disregarded. In the present paper we describe a novel, nonsporulating fungal species causing subcutaneous phaeohyphomycosis in two patients of different origin. One is a 73-year-old female from Martinique who suffered from rheumatoid arthritis, while the other case concerns a 72-year-old male from Mexico who had a history of type 2 diabetes mellitus. Sequencing of the partial ribosomal operon revealed that in both cases a member of the order Pleosporales was concerned which could not be affiliated to any family within this order. Multilocus analysis revealed that the fungus was related to another, unaffiliated agent of human mycetoma, Pseudochaetosphaeronema larense, and therefore the name Pseudochaetosphaeronema martinelli was introduced.

Clinical and microbiologic characteristics of children treated at the Fort de France university hospital after the 2010 Haiti earthquake.

Few data related to the care of children injured in an earthquake are available. The objective of our study was to analyze the results of clinical and microbiologic characteristics of children treated in a Fort de France hospital after the Haiti earthquake. Bacteria were mainly Gram-negative bacteria. Some of these infections seemed to be environmental; a significant portion was related to acquisition during hospitalization.

Suppuration-associated bacteria in patients with chronic and aggressive periodontitis.

BACKGROUND: Suppuration (SUP) on probing may be an indication of active periodontal breakdown. The aim of the present study is to analyze which subgingival species are associated with SUP in patients with chronic (CP) and aggressive (AgP) periodontitis. METHODS: A total of 156 patients with CP and 66 with AgP were submitted to full-mouth periodontal examination and subgingival biofilm sampling (14 sites/patient). The counts of 44 bacterial species were determined by checkerboard. Comparisons between groups and sites were analyzed by the Mann-Whitney and Wilcoxon tests, respectively. Associations between frequency of SUP and bacterial species were analyzed by the Spearman correlation coefficient. RESULTS: The prevalence of SUP in patients with CP was 24.4%, and in patients with AgP it was 30.3%, and the percentage of SUP sites in the groups was 5.72% ± 1.06% and 6.96% ± 1.70%, respectively (P >0.05). SUP sites from patients with CP had significantly higher counts of Veillonella parvula, Dialister pneumosintes, Tannerella forsythia, and Prevotella nigrescens than SUP sites from patients with AgP (P <0.005). Significant positive correlations between high frequency of SUP and high levels of Actinomyces spp, Streptococcus spp., members of the orange complex, Acinetobacter baumannii, and Pseudomonas aeruginosa were observed in patients with CP (P <0.05). In patients with AgP, Actinomyces oris, Propionibacterium acnes, P. aeruginosa, Staphylococcus aureus, and Streptococcus sanguinis were positively associated with SUP, whereas Prevotella intermedia presented a negative association with SUP (P <0.05). CONCLUSIONS: SUP sites from patients with CP harbored significantly higher counts of several periodontal species than SUP sites from patients with AgP. Actinomyces spp., Streptococcus spp., members of the orange complex, T. forsythia, and certain non-oral pathogens were associated with a high number of sites with SUP.

Multiple brain abscess from dental origin: case report and literature review.

BACKGROUND: Brain abscess of dental origin is a rare situation and deserves attention due to its high mortality rate even when adequate treatment is done. Few reports are available when dental origin is the main cause of this infection. CASE REPORT: We present the case of a 70-year-old man diagnosed with cerebral abscess caused by apical lesions located at superior and inferior teeth. The three lesions containing pus were drained from anterior and posterior brain region and the laboratory evaluation revealed the presence of Streptococcus viridians and Bacteroides. Postoperative period was uneventful with excellent recovery after 1 year of surgery. Final diagnosis was able to be done due to excellent image exams availability like computer tomography and magnetic resonance using diffusion and perfusion techniques. DISCUSSION: The early detection of this pathology with the correct diagnosis essential to give the patient the best treatment including antimicrobial drugs and drainage is of extreme importance.

[Anaerobiosis beyond anaerobic bacteria: its role in the recovery of aerobic microorganisms from purulent samples]. / La anaerobiosis más allá de las bacterias anaerobias: su importancia en la recuperación de microorganismos aerobios a partir de materiales purulentos.

The main objective of incubation in anaerobiosis is the recovery of obligate anaerobic bacteria, not excluding other microorganisms. In 2003, we conducted a comparative and prospective study from consecutive clinical samples on the recovery of aerobic microorganisms from primary cultures both in anaerobiosis and aerobiosis of the same sample. The aims were to evaluate the methodology used in anaerobiosis in the recovery of aerobic microorganisms not diagnosed in primary aerobic cultures, and to establish a relationship between them and the origin of the sample. From 2003 to 2004, 2776 bacteriological samples were analyzed and 1884 aerobic microorganisms were cultured altogether. The result was that 69.4% of the samples showed growth both in aerobic and anaerobic incubation from primary cultures of the sample, whereas 30.6% only in one of the mentioned incubation atmosphere: 49.2% in aerobiosis and 50.8% in anaerobiosis. According to these results, the methodology used in anaerobiosis (anaerobic incubation, culture media, stereoscopic microscope or hand lens to examine the primary plates), allowed an extra yield of aerobic organisms, especially gram positive facultative and microaerophilic cocci, which was particularly evident in polimicrobial cultures, and especially when gram negative accompanying flora was present, independently of the type of sample.

A case of severe pancreatitis complicated by Raoultella planticola infection.

A 45-year-old-male presented with severe pancreatitis. Two bacterial isolates obtained from peritoneal fluid and abdominal purulent secretion were identified to the species level by 15 biochemical tests and four supplementary tests as Raoultella planticola. Identification was confirmed by rpoB gene sequencing. R. planticola is difficult to identify in the clinical laboratory, and the clinical significance of this isolation remains uncharacterized. This is the first report of pancreatitis with a primary infection by R. planticola.

Multiplex PCR assay for identification of Corynebacterium pseudotuberculosis from pure cultures and for rapid detection of this pathogen in clinical samples.

Corynebacterium pseudotuberculosis is the aetiological agent of caseous lymphadenitis (CLA), a debilitating disease of sheep and goats. Accurate diagnosis of CLA primarily relies on microbiological examination, followed by biochemical identification of isolates. In an effort to facilitate C. pseudotuberculosis detection, a multiplex PCR (mPCR) assay was developed targeting three genes of this bacterium: the 16S rRNA gene, rpoB and pld. This method allowed efficient identification of 40 isolates of this bacterium that had been identified previously by biochemical testing. Analysis of taxonomically related species did not generate the C. pseudotuberculosis mPCR amplification profile, thereby demonstrating the assay's specificity. As little as 1 pg of C. pseudotuberculosis genomic DNA was detected by this mPCR assay, demonstrating the sensitivity of the method. The detection limit in clinical samples was estimated to be 10(3) c.f.u. C. pseudotuberculosis could be detected directly in pus samples from infected sheep and goats (n=56) with a high diagnostic sensitivity (94.6 %). The developed assay significantly improves rapid C. pseudotuberculosis detection and could supersede bacteriological culture for microbiological and epidemiological diagnosis of CLA.

Treponema species associated with abscesses of endodontic origin.

Spirochetes have been frequently observed in abscesses of endodontic origin, but they have rarely been identified. This study sought to investigate the prevalence of eight oral treponemes in acute periradicular abscesses using a species-specific nested polymerase chain reaction assay. Purulent exudate was collected by aspiration from 19 cases diagnosed as acute periradicular abscesses and DNA extracted from the samples was initially amplified using universal 16S rDNA primers. A second round of amplification used the first polymerase chain reaction products to detect a specific fragment of the 16S rDNA of each Treponema species. The species-specific nPCR assay used in this study allowed the detection of Treponema denticola in 79%(15 of 19), Treponema socranskii in 26%(5 of 19), Treponema pectinovorum in 21% (4 of 19), Treponema amylovorum in 16% (3 of 19), and Treponema medium in 5% (1 of 19) of the cases. Spirochetal DNA was found in 89% of the cases (17 of 19). The number of Treponema species per case ranged from 1 to 3 (mean, 1.5). Treponema vincentii, Treponema lecithinolyticum and Treponema maltophilum were not detected in any pus sample. The present data lend support to the assertion that Treponema species, particularly T. denticola and T. socranskii, may be involved in the pathogenesis of acute periradicular abscesses.

Schistosomiasis mansoni is associated with pyogenic liver abscesses in the state of Minas Gerais, Brazil.

The association between pyogenic liver abscesses and schistosomiasis has been confirmed by clinical and experimental studies. In this retrospective study of 78 patients with pyogenic liver abscesses the association with schistosomiasis has been investigated. Pyodermitis, a known focus of bacteremia, was observed in 19 patients (24%). Blood eosinophilia was observed in 30 patients (39%). Staphylococcus aureus was cultured from abscesses in 17 out of 38 patients (45%). Forty-one out of 57 patients (53%) had stool examination. Schistosoma mansoni was the main parasite identified. Eggs of S. mansoni were also identified in liver biopsies in 7 out of 19 patients who did the exam. The large number of young patients with liver abscesses described here is different from what has been observed in developed countries. This clinical study provide support for the concept that granulomas of S. mansoni in the liver are foci for colonization with S. aureus, which in presence of staphylococcal bacteremia can form liver abscesses.

Species belonging to the "Streptococcus milleri" group: antimicrobial susceptibility and comparative prevalence in significant clinical specimens.

The association between the three species belonging to the "Streptococcus milleri" group and different sites of isolation was examined for 73 successive strains recovered from clinically significant, purulent infections. Susceptibility testing was performed on 64 of these strains. The present study supports the association of particular species with different clinical sources. Susceptibility data suggest that emerging penicillin resistance among Streptococcus anginosus and Streptococcus intermedius isolates may represent a potential clinical problem in the therapeutic management of infections caused by these species.

Occurrence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia in juvenile periodontitis.

The occurrence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia in subgingival plaque in 24 juvenile periodontitis patients was determined using DNA probe. 36 samples of subgingival plaque from 36 pockets having > or = 6 mm depth, > or = 3 mm of loss of attachment, and bleeding on probing and/or suppuration were taken from 18 patients with localized juvenile periodontitis (LJP, age range 12-24 years); and 12 samples from 6 patients with generalized juvenile periodontitis (GJP, age range 23-26 years). As control, an equal numbers of samples from healthy sites in the same patients were studied. P. gingivalis was found in 17 of 18 LJP patients, and in 31 of 36 diseased sites in those patients. P. intermedia was found in 15 out of the 18 LJP patients and in 28 of the 36 diseased sites. A. actinomycetemcomitans was present in 7 of the 18 LJP patients, and in 9 of the 36 diseased sites, and was not found in any GJP patients. All GJP patients had P. gingivalis (11 out of 12 diseased sites) and P. intermedia (all of the diseased sites). None of the three bacterial species was detected in healthy sites of GJP patients, and were found in healthy sites in only 2 of 18 LJP patients. The high prevalence and high levels of P. gingivalis and P. intermedia found in the LJP and GJP patients studied, suggest that there are populations affected by juvenile periodontitis in which this type of periodontitis is more associated with these species than with A. actinomycetemcomitans.

Bacterias aisladas de exudados óticos en pacientes pediátricos / Bacteria isolated from otic exudates of pediatrics patients

En el período comprendido entre el 1 de junio de 1989 y el 30 de diciembre de 1992, se estudiaron 290 exudados óticos en pacientes, cuyas edades oscilaban entre 2 meses y 16 años. De acuerdo con los microorganismos aislados, se dividieron en tres grupos: grupo 1 :microorganismos provenientes de orofaringe (90 casos); grupo 2: bacilos Gram negativos no fermentadores y fermentadores de glucosa (166 casos) y grupo 3: flora mixta (38 casos). En el grupo 1 se encontraron los niños con diagnóstico de otitis media aguda con efusión y los microorganismos más halados fueron Haemophilus influenzae, Streptococcus pneumoniae y Streptococcus pyogenes. En el grupo 2 los microorganismos más hallados fueron Pseudomonas aeruginosa y proteus mirabilis solos o acompañados. En el grupo 3 se aisló flora mixta (se entiende cocos Gram positivos, bacilos Gram positivos, Bacilos Gram negativos por lo menos tres tipos de microorganismos

Bacterias aisladas de exudados óticos en pacientes pediátricos / Bacteria isolated from otic exudates of pediatrics patients

En el período comprendido entre el 1 de junio de 1989 y el 30 de diciembre de 1992, se estudiaron 290 exudados óticos en pacientes, cuyas edades oscilaban entre 2 meses y 16 años. De acuerdo con los microorganismos aislados, se dividieron en tres grupos: grupo 1 :microorganismos provenientes de orofaringe (90 casos); grupo 2: bacilos Gram negativos no fermentadores y fermentadores de glucosa (166 casos) y grupo 3: flora mixta (38 casos). En el grupo 1 se encontraron los niños con diagnóstico de otitis media aguda con efusión y los microorganismos más halados fueron Haemophilus influenzae, Streptococcus pneumoniae y Streptococcus pyogenes. En el grupo 2 los microorganismos más hallados fueron Pseudomonas aeruginosa y proteus mirabilis solos o acompañados. En el grupo 3 se aisló flora mixta (se entiende cocos Gram positivos, bacilos Gram positivos, Bacilos Gram negativos por lo menos tres tipos de microorganismos (AU)

Estudio bacteriológico de las afecciones clínicas cervicofaciales / Bacteriologic study of clinical cervicofacial conditions

Se presenta un estudio de las afecciones clínicas cervicofaciales supurativas, donde se aislaron 46 microorganismos en un total de 40 pacientes atendidos en el periodo comprendido entre junio de 1981 y mayo de 1983. Se valoran los gérmenes que con mayor frecuencia predominan en las infecciones de estas áreas y se determina el tipo de lesión sobre la cual se ha instalado el proceso supurativo y su relación con los microorganismos hallados en las mismas, así como la dsitribución de los gérmenes aislados según las regiones efectadas. Se establecen conclusiones al respecto

Estudio bacteriológico de las afecciones clínicas cervicofaciales / Bacteriologic study of clinical cervicofacial conditions

Se presenta un estudio de las afecciones clínicas cervicofaciales supurativas, donde se aislaron 46 microorganismos en un total de 40 pacientes atendidos en el periodo comprendido entre junio de 1981 y mayo de 1983. Se valoran los gérmenes que con mayor frecuencia predominan en las infecciones de estas áreas y se determina el tipo de lesión sobre la cual se ha instalado el proceso supurativo y su relación con los microorganismos hallados en las mismas, así como la dsitribución de los gérmenes aislados según las regiones efectadas. Se establecen conclusiones al respecto