ABSTRACT
Lawsonella clevelandensis es un bacilo anaerobio Gram positivo, parcialmente ácido-alcohol resistente, perteneciente al orden Corynebacteriales y considerado comensal de la piel y la cavidad bucal. En los últimos años se han reportado escasos casos de infección por este microorganismo, generalmente en pacientes inmunosuprimidos, siendo la presentación clínica más común la generación de abscesos. El aislamiento de esta bacteria es difícil ya que no crece en los medios de cultivo tradicionales, por lo que su identificación requiere habitualmente del uso de biología molecular. Presentamos el caso de una paciente de 29 años con trasplante renal y empeoramiento progresivo de la función renal en contexto de una vasculitis pauciinmune con requerimiento de mayor inmunosupresión. En el laboratorio destacaba leucocituria asintomática, con urocultivo negativo, por lo que se realizaron 7 baciloscopias en orina, con resultados positivos en 3, pero con PCR de M. tuberculosis y cultivo de micobacterias negativo. Se realizó secuenciación del gen que codifica para el ARN 16s del ribosoma bacteriano a partir de una muestra de orina, obteniéndose una secuencia compatible con Lawsonella clevelandensis. Tras el resultado, se indicó terapia con amoxicilina-ácido clavulánico por 7 meses. A conocimiento de los autores, este es el duodécimo caso de infección por Lawsonella clevelandensis descrito en la literatura médica y el primero que reporta el aislamiento del patógeno en la orina.
Lawsonella clevelandensis is a gram-positive anaerobic bacillus, partially acid-fast, belonging to the order Corynebacteriales and is considered commensal of the skin and oral cavity. In recent years, few cases of infection by this microorganism have been reported, generally in immunosuppressed patients, with the most reported clinical presentation being the generation of abscesses. The isolation of this bacterium is difficult since it does not grow in traditional cultures, so its identification usually requires the use of molecular biology. We present the case of a 29-year-old patient with a kidney transplant and progressive worsening of kidney function in the context of a pauci-immune vasculitis which required greater immunosuppression. During the investigation, it was identified an asymptomatic leukocyturia, with a negative urine culture, for which six urine smear microscopy tests were performed of which 3 were positive, but with a negative Koch culture. Sequencing of the gene that codes for the 16s RNA of the bacterial ribosome was performed from a urine sample, obtaining a sequence compatible with Lawsonella clevelandensis. After the result, therapy with amoxicillin-clavulanic acid was indicated with resolution of the leukocyturia and negative smear microscopy, and immunosuppression could be indicated without inconvenience. To the authors' knowledge, this is the twelfth case of Lawsonella clevelandensis infection described in the medical literature in the world and the first to report the isolation of the pathogen in urine.
ABSTRACT
Lawsonella clevelandensis is a gram-positive anaerobic bacillus, partially acid-fast, belonging to the order Corynebacteriales and is considered commensal of the skin and oral cavity. In recent years, few cases of infection by this microorganism have been reported, generally in immunosuppressed patients, with the most reported clinical presentation being the generation of abscesses. The isolation of this bacterium is difficult since it does not grow in traditional cultures, so its identification usually requires the use of molecular biology. We present the case of a 29-year-old patient with a kidney transplant and progressive worsening of kidney function in the context of a pauci-immune vasculitis which required greater immunosuppression. During the investigation, it was identified an asymptomatic leukocyturia, with a negative urine culture, for which six urine smear microscopy tests were performed of which 3 were positive, but with a negative Koch culture. Sequencing of the gene that codes for the 16s RNA of the bacterial ribosome was performed from a urine sample, obtaining a sequence compatible with Lawsonella clevelandensis. After the result, therapy with amoxicillin-clavulanic acid was indicated with resolution of the leukocyturia and negative smear microscopy, and immunosuppression could be indicated without inconvenience. To the authors' knowledge, this is the twelfth case of Lawsonella clevelandensis infection described in the medical literature in the world and the first to report the isolation of the pathogen in urine.
Subject(s)
Kidney Transplantation , Humans , Adult , Male , Kidney Transplantation/adverse effects , Latin America , Anti-Bacterial Agents/therapeutic useABSTRACT
Introducción: la formación en Psiquiatría tiene como primer desafío elegir los candidatos ideales para desempeñarse óptimamente como residentes, alcanzando las competencias necesarias para un posterior ejercicio de la especialidad. En general, no se cuenta con instrumentos específicos de selección de residentes, utilizándose diversas estrategias de elección de candidatos a la especialidad. El objetivo del presente estudio es identificar los atributos y los medios de selección que un grupo de académicos consideran necesarios al momento de seleccionar a los candidatos a sus programas de residencia en Psiquiatría. Metodología: se realizó una investigación cualitativa de tipo encuesta de percepción utilizando el Método Delphi. La encuesta se envió, por medio de una plataforma web, a todos los académicos del Departamento de Psiquiatría de la Pontificia Universidad Católica de Chile (n=39). Resultados: los atributos mencionados fueron agrupados en 8 dominios. Las principales categorías identificadas por los encuestados fueron: profesionalismo (41%), motivación por la especialidad (33%), habilidades de comunicación (13%) y estabilidad psicológica (12%). El principal instrumento mencionado para evaluar los atributos de los postulantes fue la entrevista personal. Las publicaciones científicas, las notas de pregrado y las cartas de recomendación son mencionadas secundariamente. Conclusiones: el actuar profesional en la acción médica, medido como profesionalismo, en este estudio es atributo esencial en un postulante a un programa de residencia en Psiquiatría. Aunque las entrevistas personales han demostrado poco valor predictivo con el rendimiento del residente durante su formación, siguen siendo un instrumento muy requerido en los procesos de selección de residentes.
Introduction: Training in Psychiatry has, as its first challenge, to choose the ideal candidates to perform optimally as residents, rea-ching the necessary skills for a subsequent exercise of the specialty. There are no specific instruments for selecting residents, but many different strategies are used to select proper candidates. The primary objective of this study is to recognize the attributes academics seek in a psychiatry residency applicant. The secondary objective was to identify the selection method academics thought as optimal.Methods: A qualitative investigation of perception was conducted using the Delphi Method. The perception survey was sent through a web platform to all academics of the Department of Psychiatry of the Pontificia Universidad Católica de Chile (n = 39).Results: Attributes were grouped into eight domains. The main identified categories were: professionalism (41%), specialty interest (33%), communication skills (13%), and psychological balance (12%). A personal interview was seen as the current optimal selection method. Publications, undergraduate scores, and letters of recommendation were also taken into account.Conclusions: Professionalism, is seen as an essential attribute in an applicant for a psychiatry residency program. Although personal interviews have shown little predictive value related to the resident's performance during their training, they are still a very common and valued instrument used in the resident selection processes.