Vertebral tuberculosis as a paradoxical reaction to the treatment of pulmonary and meningeal tuberculosis in an immunocompetent patient: A case report.

INTRODUCTION: Paradoxical reaction in tuberculosis (TB) is defined as the reappearance of general symptoms, aggravation of pre-existing diseases, or appearance of new lesions despite adequate anti-TB therapy. It may result from the hyperactivity of the immune response, resulting in an intense inflammation. There are few cases of vertebral TB reported as paradoxical reaction, mainly among immunocompetents patients. PATIENT CONCERNS: We describe a male immunocompetent patient with confirmed pulmonary and meningeal TB. He was readmitted after 60 days of adequate treatment, with vertebral TB and paravertebral abscess, despite clinical improvement of the other locations. We defined as an uncommon case of a paradoxical reaction, confirmed by nuclear magnetic resonance and molecular rapid test for TB. DIAGNOSIS: Mycobacterium tuberculosis (MTB) was detected in cerebrospinal fluid by molecular rapid test (Gene Xpert MTB/ rifampicina method). Sputum research and culture were positive for the same agent. Lumbosacral spine nuclear magnetic resonance revealed bone destruction from T8 to T11, and a paravertebral collection was found. Gene Xpert MTB/rifampicina and culture were positive for M tuberculosis in the drained material of the paravertebral abscess. INTERVENTIONS: The paravertebral abscess was drainage by tomography-guided. Treatment with 4 anti-TB drugs was extended for 60 days and 2 anti-TB drugs was maintained for 10 months. There was a complete clinical improvement. OUTCOME: After draining the paravertebral abscess, the patient progressively improved and was discharged for outpatient follow-up. He was on antituberculous drugs for 1 year; subsequently, complete resolution of the infection was reported. CONCLUSION: Paradoxical reaction may be a difficult diagnosis in immunocompetent patient. Vertebral TB as a paradoxical reaction is an uncommon presentation. Therapeutic failure or resistance to treatment should be ruled out to confirm the diagnosis of paradoxical reaction.

Perfil microbiológico de bacteriemias e candidemias de origem comunitária em um hospital de Mato Grosso do Sul / Microbiological profile of bacteremies and candidemies of Community origin at the Mato Grosso do Sul hospital

Introdução: As infecções comunitárias, causadas por bactérias resistentes aos antibióticos, constituem um problema em potencial, contribuindo para o aumento da taxa de morbidade e mortalidade de pacientes hospitalizados. Objetivo: Descrever o perfil microbiológico das bacteriemia e candidemias de origem comunitária no Hospital Regional de Mato Grosso do Sul (HRMS) ao longo do ano de 2017. Método: Trata-se de um estudo transversal descritivo, através de buscas nos prontuários eletrônicos e registros do Laboratório de Microbiologia do HRMS. Foi utilizado o software BIOESTAT 5.0 para a análise estatística, com nível de significância de 5%. Resultados: Foram identificados 52 pacientes com bacteriemia de origem comunitária, correspondendo a 0, 5% de todas as hemoculturas realizadas e 4,21% das hemoculturas positivas no ano de 2017. Não houve diferença significativa entre gênero ou idade. Ao todo, 67,3% dos pacientes apresentavam comorbidades, principalmente cardíacas e diabetes mellitus e/ou obesidade. Infecções de corrente sanguínea foram em sua maioria primárias e causadas por bactérias gram-negativas. Os microrganismos resistentes corresponderam a 37,28% de todas as bactérias isoladas, dos quais 6 eram ESBL positivos. Não foram identificadas leveduras resistentes, exceto Candida krusei com resistência intrínseca à fluconazol. Conclusão: As infecções comunitárias foram principalmente causadas por bactérias gram-negativas, com prevalência de perfis com sensibilidade e acometeram pacientes acima de 60 anos, que estão mais sujeitos a complicações e evolução precoce a óbito, sobretudo os diabéticos e/ou obesos.

Introduction: Community infections, caused by antibiotic-resistant bacteria, are a potential problem, contributing to an increase in the morbidity and mortality rate of hospitalized patients. Objective: To describe the microbiological profile of bacteremia and candidemia of community origin at the Regional Hospital of Mato Grosso do Sul (HRMS) during the year 2017. Method: This is a cross-sectional descriptive study, through electronic records and records from the HRMS Microbiology Laboratory. BIOESTAT 5.0 software was used for statistical analysis, with a significance level of 5%. Results: We identified 52 patients with bacteremia of community origin, corresponding to 0.5% of all blood cultures performed and 4.21% of positive blood cultures in the year 2017. There was no significant difference between gender and age. Overall, 67.3% of the patients had comorbidities, mainly cardiac and diabetes mellitus and/or obesity. Bloodstream infections were mostly primary and caused by gram-negative bacteria. Resistant microorganisms corresponded to 37.28% of all bacteria isolated, of which 6 were ESBL positive. No resistant yeasts were identified except Candida krusei with intrinsic resistance to fluconazole. Conclusion: Community infections identified in the year 2017 were mainly caused by gram-negative bacteria, with prevalence of profiles with sensitivity and affected patients over 60 years, who are more subject to complications and early evolution to death, especially diabetics and / or obese.