Leclercia adecarboxylata, a rare cause of soft tissue infections in immunocompromised patients, case report and review of the literature / Leclercia adecarboxylata, una causa rara de infección de tejidos blandos en pacientes inmunocomprometidos, reporte de caso y revisión de la literatura

Leclercia adecarboxylata is a member of the Enterobacteriaceae family that has been isolated from several environmental and animal specimens, however it rarely causes diseases in human beings. It has natural resistance to several antibiotics, and has shown the ability to harbor and produce enzymes capable of hydrolyzing most of the antibiotics used in daily clinical practice, making its treatment a challenge when a strain with such characteristics causes disease. Here we report the first known case of infection by Leclercia adecarboxylata after a trauma with plant material, in a 69-year-old male patient, with poorly controlled Diabetes Mellitus type 2.

Leclercia adecarboxylata es un miembro de la familia Enterobacteriaceae que ha sido aislada tanto de muestras de animales como medioambientales, sin embargo raramente produce enfermedad en seres humanos. Tiene resistencia natural a varios antibióticos y se ha encontrado que tiene enzimas capaces de hidrolizar la mayoría de los antibióticos utilizados en la práctica clínica, lo cual hace un verdadero tratar una infección por este microorganismo en humanos. Aquí reportamos el primer caso de infección por Leclercia adecarboxylata luego de un trauma con material vegetal, en un paciente de 69 años y con una diabetes tipo 2, mal controlada.

Bartonella quintana and Typhus Group Rickettsiae Exposure among Homeless Persons, Bogotá, Colombia.

In 2015, we investigated Bartonella quintana and typhus group rickettsiae in body lice from homeless persons in Bogotá, Colombia. We found B. quintana-infected body lice and seroprevalence of this microorganism in 19% of homeless persons and typhus group rickettsiae in 56%. Public health professionals should start preemptive measures and active vector control.

Algunas consideraciones diagnósticas y terapéuticas del paciente con síndrome febril en Colombia / Some considerations regarding diagnosis and therapeutics of patients with febrile syndrome in Colombia

Sr. Editor, hemos leído con gran interés la revisión realizada por Cortés et al. respecto al enfoque clínico del síndrome febril agudo en Colombia, recientemente publicada en la revista INFECTIO. A manera de contribución, en primer lugar, quisiéramos resaltar la importancia de incluir y considerar la enfermedad de Chagas (en su fase aguda) como otro de los diagnósticos diferenciales a tener en cuenta y de suma importancia, en el contexto del síndrome febril agudo en Colombia, particularmente en los últimos años.

Mr. Editor, we have read with great interest the review by Cortés et al. on the clinical approach to acute febrile syndrome in Colombia, recently published in the journal INFECTIO. As a contribution, first of all, we would like to highlight the importance of including and considering Chagas disease (in its acute phase) as another of the differential diagnoses to be taken into account and of utmost importance in the context of acute febrile syndrome in Colombia, particularly in recent years.

Probable case of spotted fever group rickettsial infection in a new suspected endemic area, Colombia.

Spoted fever group (SFG) rickettsioses are actually considered as emerging and re-emerging zoonotic diseases, caused by pathogenic bacteria of the spotted fever group rickettsiae (SFGR). Recently, serologic studies in human and animals conducted in Colombian Orinoquia, showed a high seroprevalence against SFGR. In June 2015, a 50-year-old male was admitted to a hospital in Bogotá, Colombia, with two days of malaise and temperature of 39°C, associated to generalized rash 24h after the onset of fever. He referred a work visit and outdoor activities in rural area of the Department of Meta 15days prior the onset of symptoms. The patient was transferred to the intensive care unit with supplementary oxygen, inotropic support and was assessed by the infectious diseases department, indicating the addition of Doxycycline. After seven days of antibiotic treatment the patient was discharged with no evidence of new symptoms or sequels. Retrospectively, two serum samples collected during the acute and convalescent phase were evaluated; there was four fold rise in titer against SFGR. With the foregoing, associated with the recent serological evidence that suggests the circulation of SFGR species in the Colombian Orinoquia, we consider to recognize this region as a new endemic area for SFG Rickettsioses.

Pielonefritis enfisematosa en paciente con infección por virus de inmunodeficiencia humana: reporte de caso / Emphysematous pyelonephritis in patient with human immunodeficiency virus infection: A case report

La pielonefritis enfisematosa es una infección necrosante del parénquima renal que puede afectar los tejidos perirrenales y cuyo espectro de presentación clínica, por esa razón, es variable (choque séptico, acidosis metabólica, hiperglucemia, hipoglucemia, falla renal, delirio, entre otros); la mayoría de los casos se han informado en pacientes con diabetes mellitus o presencia de uropatía obstructiva. Reportamos el caso de una paciente joven no diabética quien presentó pielonefritis enfisematosa como condición clínica que lleva al diagnóstico inicial de infección por VIH, sin otras comorbilidades relacionadas, exitosamente tratada con manejo quirúrgico y antibioticoterapia. Se realizó una búsqueda sistemática de la literatura, en la cual no se ha informado esta enfermedad como manifestación clínica que lleve al diagnóstico inicial de la infección por VIH.

Emphysematous pyelonephritis is a necrotising infection of the renal parenchyma that may affect the perirenal tissue. Thus, the spectrum of clinical presentation is variable (septic shock, metabolic acidosis, hyperglycaemia, hypoglycaemia, renal failure, delirium); most cases have been reported in patients with diabetes mellitus or obstructive uropathy. We report the case of a young female patient without diabetes who presented emphysematous pyelonephritis as the condition that led to the diagnosis of HIV infection, without related comorbidities, and who was successfully treated with surgical and antibiotical therapy. A systematic search of the literature revealed that this disease as a condition leading to an initial diagnosis of HIV infection has not been previously reported.

CONTRIBUTIONS TO RICKETTSIOSES RESEARCH IN COLOMBIA (1917-1943), LUIS B. PATIÑO CAMARGO.

Colombian physician Luis Benigno Patiño Camargo was one of the pioneers in the study of rickettsioses in South America, demonstrating for the first time in Colombia the presence of Rickettsia rickettsii as the etiological agent of a highly deadly exanthematic febrile syndrome in the 1930s. However, Patiño-Camargo performed other investigations from 1917-1943, which represent the first descriptions and scientific evidence of the presence of R. prowazekii and R. typhi in Colombia. Almost 60 years after the latest research conducted by Dr. Patiño-Camargo, rickettsioses were again a matter of interest and research. In the last decade over 20 research studies have been published, showing new endemic areas for R. rickettsii, as well as the description of new rickettsial species in Colombia.

A 30-year-old male with corneal opacity and a rapidly progressing ulcer / Hombre de 30 años con opacidad y úlcera corneal de rápida progresión

Gonococcal keratoconjunctivitis is a rapidly progressing and aggressive infection caused by Neisseria gonorrhoeae . We report a case of a patient who presented keratoconjunctivitis with an opacity in the left cornea that progressed into an ulcerative lesion despite initial treatment with antibiotic eye drops. Gram stains from the purulent discharge of the left eye showed gram-negative diplococci, and the culture from the ocular discharge was positive for Neisseria gonorrhoeae . Resolution was achieved with the administration of 2 g of intramuscular ceftriaxone in a single dose, and the patient had no sequelae.

La queratoconjuntivitis gonocócica es un infección agresiva y de rápida progresión causada por Neisseria gonorrhoeae . Reportamos el caso de un paciente quien presentó queratoconjuntivitis con opacidad corneal izquierda, la cual progresó a lesión ulcerativa a pesar del tratamiento inicial con antibiótico en gotas oftálmicas. La tinción de Gram y el cultivo a partir de la secreción purulenta del ojo izquierdo mostró diplococos gramnegativos y crecimiento de Neisseria gonorrhoeae , respectivamente. La curación del paciente se logró tras la administración de 2 g de ceftriaxona intramuscular en dosis única; el paciente no presentó secuelas.

Regarding Tick-Borne Relapsing Fever in the Americas; Some Historical Aspects of a Forgotten Disease in Colombia.

In the first decades of the 20th century, scientific papers were published suggesting the presence of Tick-Borne Relapsing Fever in Colombia. As a contribution, we present some historical aspects referring to this topic.

Occupational exposure to blood borne pathogens among healthcare workers: a cross-sectional study of a registry in Colombia.

BACKGROUND: Occupational exposure to blood borne pathogens caused by percutaneous injuries or mucosal contamination is frequent among Healthcare Workers (HCW). METHODS: A cross-sectional analysis of HCW with an occupational exposure to blood reported to professional risk insurance agencies between 2009 and 2014 was performed. Comparisons between groups according to exposure level (mild, moderate, and severe) were evaluated. RESULTS: Two thousand, four hundred three reports were classified according exposure as mild 2.7 %, moderate 74.8 %, severe 21.9 %. Factors related: health sciences student with mild exposure events [adjusted odds ratio (AOR) 11.91, 95 % CI 5.13-27.61, p < 0.00001], and physician with moderate exposure events (AOR 1.90, 95 % CI 1.17-3.07, p = 0.009). Factors inversely related: physician with severe exposure events (AOR 0.54, 95 % CI 0.32-0.91, p = 0.02) and health sciences student with moderate exposure events (AOR 0.08, 95 % CI 0.04-0.15, p < 0.00001). It was found an important relationship between severe events with infectious diseases specialist assessment, and follow-up adherence. Additionally, a case of Human Immunodeficiency Virus seroconversion was presented (0.0004 %), no other seroconversions were observed. CONCLUSIONS: Occupational exposure events must be managed according to established protocols, but adherence failure was evident with the exception of severe exposure cases. Thus, interventions to enhance occupational safety are required. Occupation must be considered as a risk factor during initial assessment of events.

Giant Molluscum Contagiosum in an HIV positive patient.

Molluscum Contagiosum (MC) is a skin infection caused by a double-stranded DNA virus of the family Poxviridae that replicates in the human epidermis, affecting mainly children and young sexually active adults and causing flesh colored papular lesions with central umbilication with an average size of 3-5mm, although atypical lesions that reach great size (Giant Molluscum Contagiosum), 10-15mm, can be seen in almost any immunodeficiency condition. We report the case of a 35 year old male patient with C3 HIV disease with an abdominal pathology associated to skin lesions predominantly in the forehead and scalp that reached sizes over 5mm, diagnosed as Giant Molluscum Contagiosum by skin biopsies.