RESUMO
Melioidosis is an important disease in Asia and Australia. It is very rare in Venezuela. We describe the case of a 50-year-old diabetic patient with several episodes of right tibial osteomyelitis, left shoulder arthritis, sternal osteomyelitis, right parietal osteomyelitis, and subperiosteal abscess, followed by septic arthritis of the right knee. In all cases Gram stain smear showed Gram-negative bacilli. Culture yielded Burkholderia pseudomallei, susceptible to third- and fourth-generation cephalosporins, ciprofloxacin and aztreonam, and resistant to aminoglycosides. He developed sepsis syndrome. Blood cultures and culture of abscess and joint fluids also revealed B. pseudomallei. The patient was treated with ceftazidime and ciprofloxacin, then cefepime and trimethoprim-sulfamethoxazole. He was discharged with suppressive therapy consisting of oral doxycycline and trimethoprim-sulfamethoxazole, and follow-up has continued to date. At this time he remains asymptomatic. Melioidosis is an extremely rare disease in our country. To our knowledge, this is only the second case reported in Venezuela.
Assuntos
Bacteriemia/diagnóstico , Burkholderia pseudomallei/isolamento & purificação , Melioidose/diagnóstico , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Cefepima , Ceftazidima/uso terapêutico , Cefalosporinas/uso terapêutico , Ciprofloxacina/uso terapêutico , Quimioterapia Combinada , Humanos , Masculino , Melioidose/tratamento farmacológico , Melioidose/microbiologia , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
The objective of this work was to investigate the epidemiology of pneumocystosis in Venezuelan patients utilizing a retrospective study during a six year period. One hundred and twenty nine clinical samples collected from patients with AIDS, cancer and non-AIDS-non-cancer low respiratory tract infection patients were processed by direct immunofluorescence technique. Pneumocystosis was diagnosed in 30 patients with a general frequency of 23.3%, which varied according to the patient's group: 36.6% in AIDS patients, 38% in cancer patients, and 10.4% in non-AIDS-non-cancer low respiratory tract infection patients. This study demonstrated the existence of differences in pneumocystosis frequency related to the patient's underlying disease, and that the illness is an important health problem in immunocompromised patients in Venezuela. Pneumocystosis must be suspected in non-immunocompromised patients with signs and symptoms of low respiratory tract infection, and the study of this illness must include COPD and cancer patients. Direct immunofluorescence is a useful technique for pneumocystosis diagnosis, however, it requires an optimal sample and skilled personnel in the laboratory.
