RESUMEN
Borrelia burgdorferi, the causative agent of Lyme disease, is a vector-borne bacterial infection that is transmitted through the bite of an infected tick. If not treated with antibiotics during the early stages of infection, disseminated infection can spread to the central nervous system (CNS). In non-human primates (NHPs) it has been demonstrated that the leptomeninges are among the tissues colonized by B. burgdorferi spirochetes. Although the NHP model parallels aspects of human borreliosis, a small rodent model would be ideal to study the trafficking of spirochetes and immune cells into the CNS. Here we show that during early and late disseminated infection, B. burgdorferi infects the meninges of intradermally infected mice, and is associated with concurrent increases in meningeal T cells. We found that the dura mater was consistently culture positive for spirochetes in transcardially perfused mice, independent of the strain of B. burgdorferi used. Within the dura mater, spirochetes were preferentially located in vascular regions, but were also present in perivascular, and extravascular regions, as late as 75 days post-infection. At the same end-point, we observed significant increases in the number of CD3+ T cells within the pia and dura mater, as compared to controls. Flow cytometric analysis of leukocytes isolated from the dura mater revealed that CD3+ cell populations were comprised of both CD4 and CD8 T cells. Overall, our data demonstrate that similarly to infection in peripheral tissues, spirochetes adhere to the dura mater during disseminated infection, and are associated with increases in the number of meningeal T cells. Collectively, our results demonstrate that there are aspects of B. burgdorferi meningeal infection that can be modelled in laboratory mice, suggesting that mice may be useful for elucidating mechanisms of meningeal pathogenesis by B. burgdorferi.
Asunto(s)
Borrelia burgdorferi/patogenicidad , Capilares/microbiología , Duramadre/microbiología , Interacciones Huésped-Patógeno , Enfermedad de Lyme/microbiología , Meninges/microbiología , Animales , Adhesión Bacteriana , Borrelia burgdorferi/fisiología , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD4-Positivos/microbiología , Linfocitos T CD8-positivos/inmunología , Linfocitos T CD8-positivos/microbiología , Capilares/inmunología , Capilares/patología , Movimiento Celular , Modelos Animales de Enfermedad , Duramadre/irrigación sanguínea , Duramadre/inmunología , Duramadre/patología , Humanos , Inyecciones Intradérmicas , Enfermedad de Lyme/inmunología , Enfermedad de Lyme/patología , Masculino , Meninges/irrigación sanguínea , Meninges/inmunología , Meninges/patología , Ratones , Ratones Endogámicos C3HRESUMEN
OBJECTIVE: Post-operative meningitis, caused mainly by Staphylococcus aureus and Gram-negative rods, is a life-threatening complication after neurosurgery, and its pathogenesis is far from clear. The purpose of this work was to study the experimental infection of human dura-mater fibroblasts and whole human dura by S. aureus. METHODS: In vitro cultures of human dura-mater fibroblasts and organotypic cultures of small pieces of human dura mater were inoculated with a human-derived S. aureus strain. The pattern of bacterial infection as well as cytokines secretion by the infected fibroblasts was studied. RESULTS: Our results suggest that colonisation of human dura-mater fibroblasts in culture and whole dura-mater tissue by S. aureus includes bacterial growth on the cell surface, fibroblast intracellular invasion by bacteria and a significant synthesis of interleukin 1beta (IL-1beta) by the infected cells. CONCLUSION: This is the first report of human dura-mater fibroblast infection by S. aureus. Hopefully, these results can lead to a better understanding of the pathogenesis of meningitis caused by this bacterial species and to a more rational therapeutic approach.
Asunto(s)
Duramadre/microbiología , Fibroblastos/microbiología , Infecciones Estafilocócicas/metabolismo , Células Cultivadas , Duramadre/metabolismo , Duramadre/ultraestructura , Fibroblastos/metabolismo , Fibroblastos/ultraestructura , Humanos , Técnicas In Vitro , Interleucina-1beta/metabolismo , Técnicas de Cultivo de Órganos , Staphylococcus aureus/ultraestructuraAsunto(s)
Cryptococcus neoformans/aislamiento & purificación , Duramadre/microbiología , Huésped Inmunocomprometido , Meningitis Criptocócica/diagnóstico , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Masculino , Meningitis Criptocócica/inmunología , Meningitis Criptocócica/microbiología , Persona de Mediana Edad , Mielografía , Región SacrococcígeaRESUMEN
BACKGROUND AND IMPORTANCE: Since the introduction of vacuum-assisted closure (VAC) in 1997, it has been used successfully in treating difficult wounds, including spinal wounds and wounds in pediatric patients. There are no reports on VAC therapy in pediatric patients on the scalp, especially with exposed dura. This report describes a 10-year-old boy with a chronic wound of the scalp with exposed dura after multiple neurosurgical interventions who was treated successfully with VAC. CLINICAL PRESENTATION: A 10-year-old mentally disabled boy with Apert syndrome suffered from a chronic wound with community-associated methicillin-resistant Staphylococcus aureus (MRSA) infection after multiple neurosurgeon operations. For wound closure, VAC therapy was initiated on the bony defect with exposed dura. The wound healed successfully, and the MRSA disappeared. CONCLUSION: The aims of VAC therapy are formation of new granulation tissue, wound cleansing, and bacterial clearance. In this case, the VAC device was excellent for temporary coverage of the defect and for wound cleaning, and it allowed a thick bed of granulation tissue to form over the dura, even with minimal constant negative pressure. The application and management were feasible even in a mentally disabled child. With this experience, we are encouraged to use the VAC device in difficult wounds, even in the head and neck area in children, and to bring this treatment into the outpatient clinic.
Asunto(s)
Duramadre/cirugía , Staphylococcus aureus Resistente a Meticilina , Terapia de Presión Negativa para Heridas/métodos , Cuero Cabelludo/cirugía , Infecciones Cutáneas Estafilocócicas/cirugía , Infección de la Herida Quirúrgica/cirugía , Niño , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/cirugía , Duramadre/microbiología , Estudios de Factibilidad , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Cuero Cabelludo/microbiología , Infecciones Cutáneas Estafilocócicas/diagnóstico , Infección de la Herida Quirúrgica/diagnósticoRESUMEN
OBJECT: Parafalcine subdural empyema and those along the superior and inferior surface of the tentorium are rare entities. We present a series of 10 patients where we have attempted to describe the pathophysiology, clinical features, and management of subdural empyema. METHODS: The study group included 10 cases of falcotentorial subdural empyemas managed between 2004 and 2010. The mean age group was 14.4 years. Seven patients had empyema along the falx or superior surface of tent, and the remaining three had empyema along the inferior surface of tent. Fever, raised intracranial pressure symptoms, falx syndrome, and seizures were the usual presenting features. These patients had an indolent presentation as compared to convexity subdural empyemas. The diagnosis was made based on radiology. Chronic suppurative otitis media was a causative factor in five patients; in the remaining patients, the source was ascribed to be hematogenous. All patients were treated with antibiotic therapy (6 weeks) ± surgery. Two patients were treated conservatively, and the remaining eight patients underwent definitive surgery in the form of craniotomy (supratentorial)/craniectomy (infratentorial) and evacuation of pus. The pus was limited within two leaves, one adherent to the falx/tent and the other one to the pia-arachnoid of adjacent parenchyma. The wall along the falx or tent could be peeled off easily and was excised in all cases to lay open the cavity widely. The wall along pia-arachnoid was left as it is. Pus culture was positive in four and blood culture positive in two cases. There was only a single mortality in our series. The outcome was assessed by the Glasgow Outcome Scale. The mean duration of follow-up was for 18.8 months, and all patients who survived had a good outcome. CONCLUSION: Falcotentorial empyema remains a rare entity. The presentation is indolent as compared to convexity subdural empyemas, possibly due to its limitation secondary to arachnoid adhesions at the junction of falx, tent, and convexity dura. The main stay of management remains craniotomy, evacuation, and partial excision of the wall, laying it completely open, unless it is extremely thin. With appropriate surgery and antibiotic therapy, a good outcome can be expected.
Asunto(s)
Duramadre/diagnóstico por imagen , Duramadre/patología , Empiema Subdural/diagnóstico por imagen , Empiema Subdural/diagnóstico , Espacio Subdural/diagnóstico por imagen , Espacio Subdural/patología , Adolescente , Adulto , Niño , Preescolar , Duramadre/microbiología , Empiema Subdural/etiología , Femenino , Humanos , Masculino , Radiografía , Espacio Subdural/microbiología , Adulto JovenRESUMEN
We report a case of epidural abscess caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strain USA300 in a previously healthy 25-year-old American woman who lived in Japan for more than 1 year. She started to complain of severe headache that continued for about 10 days after improvement of subcutaneous abscesses caused by MRSA. Computed tomography (CT) and magnetic resonance imaging (MRI) showed epidural abscess. As epidural abscess was not improved by treatment with vancomycin and ceftriaxone, craniotomy and drainage were performed, and the severe headache disappeared. Characteristics of the MRSA strain isolated from the abscess were identical to those of strain USA300; multilocus sequence typing sequence type 8, staphylococcal cassette chromosome mec type IVa, Panton-Valentine leukocidin positive, arginine catabolic mobile element positive, and pulsed-field gel electrophoresis type USA300. This may be the first report of epidural abscess caused by USA300 strain in Japan. Because CA-MRSA strains, including USA300, have begun to spread in Japan, epidural abscess should be taken into account in the diagnosis of previously healthy patients with persistent headache accompanied by skin lesions.
Asunto(s)
Infecciones Comunitarias Adquiridas/microbiología , Absceso Epidural/microbiología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/microbiología , Adulto , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/patología , Duramadre/microbiología , Duramadre/patología , Absceso Epidural/diagnóstico , Absceso Epidural/patología , Femenino , Humanos , Japón , Staphylococcus aureus Resistente a Meticilina/clasificación , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/patologíaRESUMEN
INTRODUCTION: Candida infection limited to the central nervous system is extremely rare, and may be confused with tuberculosis on the grounds of the clinical and cerebrospinal fluid findings. CASE REPORT: A 23-year-old immunocompetent drug addict presented with alternating sciatica over a period of several months, followed by multiple cranial nerve involvement in the setting of marked weight loss. The histopathologic examination of a leptomeningeal neurosurgical biopsy was required to establish the diagnosis of neuromeningeal infection with Candida albicans. CONCLUSION: This case report underlines diagnostic difficulties of candidal meningitis and reviews current therapeutic recommendations.
Asunto(s)
Candidiasis/diagnóstico , Dependencia de Heroína/complicaciones , Meningitis Fúngica/diagnóstico , Polirradiculopatía/diagnóstico , Abuso de Sustancias por Vía Intravenosa/complicaciones , Dolor de Espalda/etiología , Biopsia , Candida albicans/aislamiento & purificación , Candidiasis/etiología , Sistema Nervioso Central/microbiología , Sistema Nervioso Central/patología , Enfermedades de los Nervios Craneales/diagnóstico , Enfermedades de los Nervios Craneales/etiología , Duramadre/microbiología , Duramadre/patología , Humanos , Inmunocompetencia , Imagen por Resonancia Magnética , Masculino , Meningitis Fúngica/etiología , Polirradiculopatía/etiología , Fumar , Pérdida de Peso , Adulto JovenRESUMEN
Spinal infections are commonly reported to be located in the extradural or intramedullary spaces. Infection involving the intradural-extramedullary space are uncommon. We report a patient with uncontrolled diabetes mellitus and an infected foot ulcer who presented with a cervical cord abscess and intradural gas. Early diagnosis and aggressive treatment are necessary for a favourable outcome in gas-forming intradural spinal abscesses. To our knowledge, a gas-forming intradural spinal abscess has not been reported previously and we discuss the relevant literature.
Asunto(s)
Absceso/patología , Complicaciones de la Diabetes/patología , Duramadre/patología , Huésped Inmunocomprometido/inmunología , Compresión de la Médula Espinal/patología , Enfermedades de la Columna Vertebral/patología , Absceso/microbiología , Absceso/cirugía , Antibacterianos/uso terapéutico , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/patología , Infecciones Bacterianas/fisiopatología , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/patología , Vértebras Cervicales/cirugía , Descompresión Quirúrgica , Complicaciones de la Diabetes/microbiología , Duramadre/microbiología , Duramadre/cirugía , Escherichia coli , Resultado Fatal , Úlcera del Pie/complicaciones , Úlcera del Pie/microbiología , Gases/metabolismo , Humanos , Laminectomía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Dolor de Cuello/etiología , Procedimientos Neuroquirúrgicos , Cuadriplejía/etiología , Sepsis/microbiología , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/cirugía , Enfermedades de la Columna Vertebral/microbiología , Enfermedades de la Columna Vertebral/cirugía , Staphylococcus aureus , Espacio Subdural/diagnóstico por imagen , Espacio Subdural/patología , Espacio Subdural/cirugía , Tomografía Computarizada por Rayos XRESUMEN
A tuberculous spinal epidural abscess is seen rarely as a late complication of Pott's disease or in immunocompromised patients. Such abscesses in isolation are rare indeed and very uncommon in the developed and developing world. We report a patient with an isolated subacute tuberculous spinal epidural abscess without disc or vertebral involvement and no primary focus or risk factors associated with the development of spinal tuberculosis.
Asunto(s)
Vértebras Cervicales/patología , Duramadre/patología , Absceso Epidural/patología , Espacio Epidural/patología , Tuberculosis Meníngea/patología , Adulto , Antituberculosos/uso terapéutico , Vértebras Cervicales/diagnóstico por imagen , Descompresión Quirúrgica , Duramadre/diagnóstico por imagen , Duramadre/microbiología , Absceso Epidural/diagnóstico por imagen , Absceso Epidural/microbiología , Espacio Epidural/microbiología , Espacio Epidural/cirugía , Humanos , Laminectomía , Imagen por Resonancia Magnética , Masculino , Dolor de Cuello/etiología , Radiculopatía/etiología , Radiografía , Compresión de la Médula Espinal/etiología , Resultado del Tratamiento , Tuberculosis Meníngea/diagnóstico por imagenRESUMEN
We describe a case of calvarial tuberculosis with an associated extra-dural collection. This presentation has rarely been reported in the literature and the magnetic resonance imaging features are not well documented.
Asunto(s)
Cráneo/microbiología , Tuberculoma Intracraneal/diagnóstico , Adolescente , Antituberculosos/uso terapéutico , Duramadre/microbiología , Cefalea/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Mycobacterium tuberculosis/aislamiento & purificación , Radiografía , Cráneo/diagnóstico por imagen , Tuberculoma Intracraneal/complicaciones , Tuberculoma Intracraneal/tratamiento farmacológicoRESUMEN
BACKGROUND: Infratentorial empyema is an uncommon complication of bacterial meningitis. Very little is known about its recognition and appropriate management. METHOD: We present a patient with infratentorial subdural empyema and compare findings with 41 cases with infratentorial empyema reported in the literature. RESULTS: Many patients with infratentorial empyema presented as subacute meningitis with neck stiffness and decreased consciousness. Diagnosis was often delayed. The minority had cerebellar findings and cranial nerve deficits. Clues to the diagnosis were presence of otitis, sinusitis, or mastoiditis and recent surgery for these disorders. The majority of patients underwent craniotomy; conservative treatment with antibiotics was associated with relapse of symptoms. The mortality rate was high especially in those with subdural empyema. CT failed to clearly visualize infratentorial subdural empyema in several reported cases. CONCLUSIONS: Infratentorial empyema is a life-threatening rare complication of bacterial meningitis. MRI, including diffusion-weighted imaging, is the preferred imaging technique in patients with suspected or proven bacterial meningitis and associated ear-nose-throat infection with deterioration in consciousness and neurologic signs that suggest a posterior fossa lesion. Neurosurgery should be regarded as first choice therapy.
Asunto(s)
Fosa Craneal Posterior/patología , Diagnóstico por Imagen/normas , Duramadre/patología , Empiema Subdural/diagnóstico , Meningitis Bacterianas/diagnóstico , Espacio Subdural/patología , Adulto , Antibacterianos/uso terapéutico , Enfermedades Cerebelosas/etiología , Enfermedades Cerebelosas/fisiopatología , Colesteatoma del Oído Medio/complicaciones , Colesteatoma del Oído Medio/cirugía , Fosa Craneal Posterior/diagnóstico por imagen , Fosa Craneal Posterior/microbiología , Enfermedades de los Nervios Craneales/etiología , Enfermedades de los Nervios Craneales/fisiopatología , Diagnóstico Diferencial , Diagnóstico por Imagen/métodos , Duramadre/diagnóstico por imagen , Duramadre/microbiología , Diagnóstico Precoz , Empiema Subdural/microbiología , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/etiología , Hidrocefalia/fisiopatología , Imagen por Resonancia Magnética/métodos , Imagen por Resonancia Magnética/normas , Masculino , Meningitis Bacterianas/microbiología , Otitis Media Supurativa/complicaciones , Otitis Media Supurativa/microbiología , Valor Predictivo de las Pruebas , Recurrencia , Espacio Subdural/diagnóstico por imagen , Espacio Subdural/microbiología , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/normas , Resultado del TratamientoRESUMEN
Papilledema is an uncommon presentation of spinal cord processes. Spinal subdural abscess (SSA) is a rare site of post-operative infection. We report a patient who developed papilledema as the primary manifestation of a post-operative lumbar subdural abscess. A spinal abscess should be considered in the post-operative spinal surgery patient who develops papilledema in the setting of persistent back pain. The increased intracranial pressure associated with lumbar spinal cord abscess most likely results from a markedly elevated cerebrospinal fluid (CSF) protein or the disruption of CSF flow in the spinal cul-de-sac.
Asunto(s)
Absceso/complicaciones , Hipertensión Intracraneal/etiología , Papiledema/etiología , Canal Medular/patología , Espacio Subdural/patología , Infección de la Herida Quirúrgica/complicaciones , Absceso/microbiología , Absceso/fisiopatología , Antibacterianos/uso terapéutico , Aracnoides/microbiología , Aracnoides/patología , Aracnoides/cirugía , Aracnoiditis/tratamiento farmacológico , Aracnoiditis/microbiología , Aracnoiditis/fisiopatología , Descompresión Quirúrgica , Discectomía/efectos adversos , Duramadre/microbiología , Duramadre/patología , Duramadre/cirugía , Humanos , Hipertensión Intracraneal/fisiopatología , Laminectomía/efectos adversos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos , Papiledema/fisiopatología , Recuperación de la Función , Reoperación , Canal Medular/microbiología , Canal Medular/fisiopatología , Espacio Subdural/microbiología , Espacio Subdural/fisiopatología , Resultado del Tratamiento , Baja Visión/etiología , Baja Visión/fisiopatologíaRESUMEN
STUDY DESIGN: A case report of pyogenic intradural abscess is described. OBJECTIVES: The rarity of the presentation and its successful management are discussed. SUMMARY OF BACKGROUND DATA: Intradural abscesses are exceptionally rare. METHOD: The abscess was drained by performing a posterior midline lumbar durotomy, and intravenous antibiotics were initiated. RESULT: At the 1 year follow-up, the patient has made significant neurologic recovery. CONCLUSION: Intradural pyogenic abscess secondary to chronic pyogenic spondylodiscitis is a rare manifestation. MRI is a vital component in diagnosis, which revealed key pathologic features within the dural sac as well as in the vertebral column. An emergency decompression and appropriate antibiotic regimen is the solution for a favorable outcome.
Asunto(s)
Absceso/patología , Discitis/patología , Duramadre/patología , Vértebras Lumbares , Infecciones Estafilocócicas/patología , Absceso/tratamiento farmacológico , Absceso/microbiología , Anciano , Antibacterianos/administración & dosificación , Enfermedad Crónica , Discitis/microbiología , Drenaje , Duramadre/microbiología , Floxacilina/administración & dosificación , Humanos , Dolor de la Región Lumbar/microbiología , Dolor de la Región Lumbar/patología , Imagen por Resonancia Magnética , Masculino , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/tratamiento farmacológicoRESUMEN
Despite the frequency of dural tears in spinal surgery, meningitis is a rare complication reported to occur with a frequency of 0.18%. To the best of our knowledge, no case of Acinetobacter baumanii meningitis has been reported in the literature after a dural tear secondary to lumbar spine discectomy. This case highlights the importance of repairing all dural tears and commencing antibiotics that cover uncommon bacteria in those who develop symptoms of meningitis in this setting.
Asunto(s)
Infecciones por Acinetobacter/complicaciones , Acinetobacter baumannii , Discectomía , Duramadre/cirugía , Meningitis Bacterianas/microbiología , Adulto , Duramadre/microbiología , Femenino , Humanos , Complicaciones Posoperatorias/microbiologíaRESUMEN
OBJECTIVE: To report three cases of intradural spinal tuberculosis (TB) by calling attention to atypical forms of spinal TB. SETTING: A University Hospital, Istanbul, Turkey. METHODS: Histopathological, radiological, surgical and physical examination findings of three patients with spinal TB were retrospectively reviewed. RESULTS: Based on histopathological, surgical and radiological findings, diagnosis of intramedullary abscess had been made in the first case and early and late phases of arachnoiditis in the other two patients, respectively. The clinical outcome was evaluated as satisfactory for the patient with intramedullary abscess who had been treated with medical and surgical interventions. The remaining two patients with arachnoiditis, who had been treated by shunting or simple decompression, had a relatively less favorable clinical outcome. CONCLUSION: Spinal TB, in its atypical forms, is a rare clinical entity and low index of suspicion on the part of the surgeon may result in misdiagnosis such as neoplasm. In cases presenting with an intraspinal mass lesion, possibility of a tuberculous abscess and/or a granuloma should be considered in the differential diagnosis.
Asunto(s)
Duramadre/patología , Tuberculosis de la Columna Vertebral/patología , Tuberculosis de la Columna Vertebral/cirugía , Adulto , Niño , Duramadre/microbiología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Radiografía , Estudios Retrospectivos , Resultado del Tratamiento , Tuberculosis de la Columna Vertebral/diagnóstico por imagen , TurquíaRESUMEN
PURPOSE: To study bacterial adherence to processed dura mater, processed pericardium, pericardium in saline, and human sclera and the difference in bacterial adherence to these tissues. SETTING: Research Laboratory, Loyola University Medical Center, Maywood, Illinois, USA. METHODS: Specimens of processed dura mater, processed human pericardium, pericardium in saline, and human sclera (N = 32) were exposed to Staphylococcus epidermidis (concentration 3 x 10(8)) for 10, 20, 40, and 60 minutes, washed for 5 seconds, fixed, and processed for scanning electron microscopy (SEM). Each bacterial count represents an average of 50 random SEM fields at x5,000 magnification. After SEM, selected specimens were processed for transmission electron microscopy. RESULTS: The mean number of bacteria/mm(2) +/- SD adhering to the tissues at 10, 20, 40, and 60 minutes, respectively, were dura mater, 107,833 +/- 65,410, 104,500 +/- 13,471, 96,067 +/- 113,884, and 204,267 +/- 153,697; processed pericardium, 131,550 +/- 86,194, 100,900 +/- 20,031, 144,683 +/- 51,730, and 176,933 +/- 111,818; pericardium in saline, 7,925 +/- 1,520, 33,933 +/- 32,085, 1,217 +/- 1,287, and 21,550 +/- 16,436; and human sclera, 4,850 +/- 2,121, 23,700 +/- 17,961, 5,150 +/- 1,273, and 8,175 +/- 8,450. A 2-way analysis of variance showed significant differences among groups (P =.001) and no significant difference in sample time (P =.929). CONCLUSIONS: Bacterial adherence to processed dura mater, processed pericardium, pericardium in saline, and human sclera should be considered when these materials are used clinically during ophthalmic surgery and other surgical specialties. Adequate broad-spectrum antibiotic coverage is needed to prevent infection and subsequent complications in patients.
Asunto(s)
Adhesión Bacteriana , Duramadre/microbiología , Pericardio/microbiología , Esclerótica/microbiología , Staphylococcus epidermidis/fisiología , Recuento de Colonia Microbiana , Duramadre/ultraestructura , Humanos , Microscopía Electrónica de Rastreo , Pericardio/ultraestructura , Esclerótica/ultraestructura , Staphylococcus epidermidis/ultraestructuraRESUMEN
OBJECTIVE: To develop a method to experimentally induce Borrelia burgdorferi infection in young adult dogs. ANIMALS: 22 healthy Beagles. PROCEDURE: All dogs were verified to be free of borreliosis. Twenty 6-month-old dogs were exposed to Borrelia burgdorferi-infected adult ticks and treated with dexamethasone for 5 consecutive days. Two dogs not exposed to ticks were treated with dexamethasone and served as negative-control dogs. Clinical signs, results of microbial culture and polymerase chain reaction (PCR) testing, immunologic responses, and gross and histologic lesions were evaluated 9 months after tick exposure. RESULTS: Predominant clinical signs were episodic pyrexia and lameness in 12 of 20 dogs. Infection with B burgdorferi was detected in microbial cultures of skin biopsy specimens and various tissues obtained during necropsy in 19 of 20 dogs and in all 20 dogs by use of a PCR assay. All 20 exposed dogs seroconverted and developed chronic nonsuppurative arthritis. Three dogs also developed mild focal meningitis, 1 dog developed mild focal encephalitis, and 18 dogs developed perineuritis or rare neuritis. Control dogs were seronegative, had negative results for microbial culture and PCR testing, and did not develop lesions. CONCLUSIONS AND CLINICAL RELEVANCE: Use of this technique successfully induced borreliosis in young dogs. Dogs with experimentally induced borreliosis may be useful in evaluating vaccines, chemotherapeutic agents, and the pathogenesis of borreliosis-induced arthritis.
Asunto(s)
Borrelia burgdorferi/crecimiento & desarrollo , Dexametasona/farmacología , Enfermedades de los Perros/microbiología , Glucocorticoides/farmacología , Enfermedad de Lyme/veterinaria , Animales , Anticuerpos Antibacterianos/sangre , Biopsia/veterinaria , Western Blotting/veterinaria , Borrelia burgdorferi/genética , ADN Bacteriano/química , ADN Bacteriano/aislamiento & purificación , Enfermedades de los Perros/patología , Perros , Duramadre/microbiología , Duramadre/patología , Ensayo de Inmunoadsorción Enzimática/veterinaria , Femenino , Ixodes/microbiología , Cápsula Articular/microbiología , Cápsula Articular/patología , Cojera Animal/microbiología , Enfermedad de Lyme/sangre , Enfermedad de Lyme/microbiología , Enfermedad de Lyme/patología , Masculino , Reacción en Cadena de la Polimerasa/veterinaria , Telencéfalo/microbiología , Telencéfalo/patología , Infestaciones por GarrapatasRESUMEN
To our knowledge we report the first case of meningitis from Coccidioides immitis associated with massive dural and cerebral venous thrombosis and with mycelial forms of the organism in brain tissue. The patient was a 43-year-old man with late-stage acquired immunodeficiency syndrome (AIDS) whose premortem and postmortem cultures confirmed C immitis as the only central nervous system pathogenic organism. Death was attributable to multiple hemorrhagic venous infarctions with cerebral edema and herniation. Although phlebitis has been noted parenthetically to occur in C immitis meningitis in the past, it has been overshadowed by the arteritic complications of the disease. This patient's severe C immitis ventriculitis with adjacent venulitis appeared to be the cause of the widespread venous thrombosis. AIDS-related coagulation defects may have contributed to his thrombotic tendency.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/patología , Venas Cerebrales/patología , Coccidioides/aislamiento & purificación , Coccidioidomicosis/patología , Duramadre/patología , Trombosis Intracraneal/patología , Meningitis Fúngica/patología , Trombosis de la Vena/patología , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Adulto , Edema Encefálico/patología , Hemorragia Cerebral/patología , Venas Cerebrales/microbiología , Coccidioides/patogenicidad , Coccidioidomicosis/diagnóstico por imagen , Coccidioidomicosis/microbiología , Duramadre/microbiología , Resultado Fatal , Humanos , Trombosis Intracraneal/diagnóstico por imagen , Trombosis Intracraneal/microbiología , Masculino , Meningitis Fúngica/diagnóstico por imagen , Meningitis Fúngica/microbiología , Esporas Fúngicas/aislamiento & purificación , Tomografía Computarizada por Rayos X , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/microbiologíaRESUMEN
Antimicrobial agents played a miraculous role in the treatment of bacterial infections until resistant bacteria became widespread. Besides antimicrobial-resistant bacteria, many factors can influence the cure of infection. Nocardia infection may be a good example which is difficult to cure with antimicrobial agents alone. A 66-year-old man developed soft tissue infection of the right buttock and thigh. He was given prednisolone and azathioprine for pachymeningitis 3 months prior to admission. Despite surgical and antimicrobial treatment (sulfamethoxazole-trimethoprim), the infection spread to the femur and osteomyelitis developed. The case showed that treatment of bacterial infection is not always as successful as was once thought because recent isolates of bacteria are more often resistant to various antimicrobial agents, intracellular parasites are difficult to eliminate even with the active drug in vitro, and infections in some sites such as bone are refractory to treatment especially when the patient is in a compromised state. In conclusion, for the treatment of infections, clinicians need to rely on laboratory tests more than before and have to consider the influence of various host factors.