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1.
J Investig Med High Impact Case Rep ; 11: 23247096231166674, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37032537

RESUMO

Blastomycosis is a rare endemic fungal infection caused by the dimorphic fungus Blastomyces dermatitidis. It is more likely to occur in persons living in areas of the United States and Canada, which border the Ohio and Mississippi River Valleys and the Great Lakes region. Most infections are localized to the lungs, often presenting as acute or chronic pneumonia. Occasionally, patients progress to develop disseminated disease and extrapulmonary infections. Blastomycosis tends to be misdiagnosed initially at clinical evaluation as it is rare and may resemble other common conditions. We present a case of a 78-year-old immunosuppressed renal transplant patient who was suspected of having gout but eventually was diagnosed with an unusual presentation of septic arthritis of the ankle secondary to blastomycosis.


Assuntos
Artrite Infecciosa , Blastomicose , Transplante de Rim , Pneumonia , Humanos , Estados Unidos , Idoso , Blastomyces , Blastomicose/diagnóstico , Blastomicose/epidemiologia , Blastomicose/microbiologia , Transplante de Rim/efeitos adversos , Artrite Infecciosa/diagnóstico
2.
BMJ Case Rep ; 12(12)2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31826907

RESUMO

A 66-year-old man was seen in clinic due to concerns of tuberculosis of the right hip. He had a history of urothelial bladder carcinoma, which was treated via transurethral resection followed by intravesicular instillations of Mycobacterium bovis BCG (BCG). A few months later, he developed slowly worsening pain over his prosthetic right hip, and it was recommended he undergo surgical revision. During surgery, joint effusion was noted and synovial fluid was sent for bacterial and mycobacterial cultures, growing an acid-fast bacillus after 3 weeks, identified as Mycobacterium tuberculosis complex via nucleic acid probe. Susceptibility testing revealed resistance to pyrazinamide, which is typically seen in M. bovis PCR confirmed the diagnosis of BCG infection. The patient was treated with isoniazid, rifampin and ethambutol, which he tolerated well. This case highlights the challenges associated with diagnosis and management of this rare complication of a commonly used therapy.


Assuntos
Antibióticos Antituberculose/uso terapêutico , Vacina BCG/efeitos adversos , Isoniazida/uso terapêutico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Rifampina/uso terapêutico , Idoso , Artroplastia de Quadril , Vacina BCG/uso terapêutico , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/diagnóstico por imagem , Falha de Prótese , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/tratamento farmacológico , Resultado do Tratamento
3.
Pharmacotherapy ; 39(3): 399-407, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30506900

RESUMO

The incidence and severity of Clostridium difficile infection (CDI) remain high across intensive care units in the United States despite national efforts to decrease this escalating health care burden. Most published literature and guidelines address treatment rather than prevention, yet this approach may be too downstream to limit morbidity and mortality from the disease and its complications. Mechanisms to prevent CDI successfully include reducing modifiable risk factors and minimizing horizontal transmission of C. difficile spores between patients and the health care environment. Because CDI prevention is characterized by a bundled approach, it is difficult to quantify the individual impact of any one element; however, a number of patient- and facility-level strategies can be considered for CDI prevention. Robust hygiene strategies, diagnostic and antimicrobial stewardship, and particular prophylaxis maneuvers such as continuation of oral vancomycin or fidaxomicin in the setting of systemic antibiotics have all demonstrated benefit. The preventive roles of deprescribing acid suppressants, routine use of probiotics, or early fecal microbiota transplantation remain unclear. The focus of this review is to summarize the evidence related to primary and secondary CDI prevention in critically ill adults and provide a concise implementation pathway for clinicians and policymakers.


Assuntos
Antibacterianos/administração & dosagem , Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/prevenção & controle , Adulto , Gestão de Antimicrobianos/métodos , Estado Terminal , Transplante de Microbiota Fecal/métodos , Humanos , Probióticos/administração & dosagem , Fatores de Risco
4.
J Interv Card Electrophysiol ; 50(1): 117-124, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28844107

RESUMO

PURPOSE: Cardiovascular implantable electronic device infection (CIEDI) rates are rising. To improve outcomes, our institution developed an online care process model (CPM) and a specialized inpatient heart rhythm service (HRS). METHODS: This retrospective review compared hospital length of stay (LOS), mortality, and times to subspecialty consultation and procedures before and after CPM and HRS availability. RESULTS: CPM use was associated with shortened time to surgical consultation (median 2 days post-CPM vs. 3 days pre-CPM, p = 0.0152), pocket closure (median 4 vs. 5 days, p < 0.0001), and days to new CIED implant (median 7 vs. 8 days, p = 0.0126). Post-HRS patients were more likely to have a surgical consultation (OR 7.01, 95% CI 1.56-31.5, p = 0.011) and shortened time to pocket closure (coefficient - 2.21 days, 95% CI - 3.33 to - 1.09, p < 0.001), compared to pre-HRS. CONCLUSIONS: The CPM and HRS were associated with favorable outcomes, but further integration of CPM features into hospital workflow is needed.


Assuntos
Eletrofisiologia Cardíaca , Desfibriladores Implantáveis/efeitos adversos , Pacientes Internados , Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Cardiologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/fisiopatologia , Estudos Retrospectivos , Análise de Sobrevida
5.
Am J Cardiol ; 115(7): 912-7, 2015 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-25779615

RESUMO

The cardiovascular implantable electronic device (CIED) infection rate is rising disproportionately to the rate of device implantation. Identification of microorganisms that cause CIED infections is not always achieved using present laboratory techniques. We conducted a prospective study to determine whether device vortexing-sonication followed by culture of the resulting sonicate fluid would enhance microbial detection compared with traditional swab or pocket tissue cultures. Forty-two subjects with noninfected and 35 with infected CIEDs were prospectively enrolled over 12 months. One swab each from the device pocket and device surface, pocket tissue, and the CIED were collected from each patient. Swabs and tissues were cultured using routine methods. The CIED was processed in Ringer's solution using vortexing-sonication and the resultant fluid semiquantitatively cultured. Tissue and swab growth was considered significant when colonies grew on ≥2 quadrants of the culture plate and device was considered significant when ≥20 colonies were isolated from 10 ml of sonicate fluid. In noninfected group, 5% of sonicate fluids yielded significant bacterial growth, compared with 5% of tissue cultures (p = 1.00) and 2% of both pocket and device swab cultures (p = 0.317 each). In infected group, significant bacterial growth was observed in 54% of sonicate fluids, significantly greater than the sensitivities of pocket swab (20%, p = 0.001), device swab (9%, p <0.001), or tissue (9%, p <0.001) culture. In conclusion, vortexing-sonication of CIEDs with semiquantitative culture of the resultant sonicate fluid results in a significant increase in the sensitivity of culture results, compared with swab or tissue cultures.


Assuntos
Infecções Bacterianas/diagnóstico , Desfibriladores Implantáveis/microbiologia , Contaminação de Equipamentos/prevenção & controle , Marca-Passo Artificial/microbiologia , Infecções Relacionadas à Prótese/diagnóstico , Ultrassonografia/estatística & dados numéricos , Idoso , Infecções Bacterianas/microbiologia , Infecções Bacterianas/prevenção & controle , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/prevenção & controle , Reprodutibilidade dos Testes , Estudos Retrospectivos
6.
Infect Control Hosp Epidemiol ; 35(9): 1169-75, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25111926

RESUMO

OBJECTIVE: To study a cluster of Mycobacterium wolinskyi surgical site infections (SSIs). DESIGN: Observational and case-control study. SETTING: Academic hospital. PATIENTS: Subjects who developed SSIs with M. wolinskyi following cardiothoracic surgery. METHODS: Electronic surveillance was performed for case finding as well as electronic medical record review of infected cases. Surgical procedures were observed. Medical chart review was conducted to identify risk factors. A case-control study was performed to identify risk factors for infection; Fisher exact or Kruskal-Wallis tests were used for comparisons of proportions and medians, respectively. Patient isolates were studied using pulsed-field gel electrophoresis (PFGE). Environmental microbiologic sampling was performed in operating rooms, including high-volume water sampling. RESULTS: Six definite cases of M. wolinskyi SSI following cardiothoracic surgery were identified during the outbreak period (October 1, 2008-September 30, 2011). Having cardiac surgery in operating room A was significantly associated with infection (odds ratio, 40; P = .0027). Observational investigation revealed a cold-air blaster exclusive to operating room A as well a microbially contaminated, self-contained water source used in heart-lung machines. The isolates were indistinguishable or closely related by PFGE. No environmental samples were positive for M. wolinskyi. CONCLUSIONS: No single point source was established, but 2 potential sources, including a cold-air blaster and a microbially contaminated, self-contained water system used in heart-lung machines for cardiothoracic operations, were identified. Both of these potential sources were removed, and subsequent active surveillance did not reveal any further cases of M. wolinskyi SSI.


Assuntos
Centros Médicos Acadêmicos , Surtos de Doenças , Controle de Infecções , Infecções por Mycobacterium/epidemiologia , Mycobacterium/isolamento & purificação , Infecção da Ferida Cirúrgica/epidemiologia , Procedimentos Cirúrgicos Cardíacos , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota , Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/etiologia , Infecções por Mycobacterium/prevenção & controle , Fatores de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle
7.
BMJ Case Rep ; 20142014 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-24596408

RESUMO

A 42-year-old woman with uterine fibroids underwent myomectomy. She developed postoperative sepsis and bloodstream infection with Clostridium hathewayi secondary to an infected haematoma. The patient was readmitted after failure of oral antibiotic therapy and underwent intrauterine drainage followed by prolonged parenteral antibiotic therapy. The patient was followed for 1 year and did not have any relapse of infection.


Assuntos
Bacteriemia/etiologia , Infecções por Clostridium/diagnóstico , Clostridium/isolamento & purificação , Leiomioma/cirurgia , Infecção da Ferida Cirúrgica/diagnóstico , Miomectomia Uterina , Neoplasias Uterinas/cirurgia , Adulto , Bacteriemia/sangue , Bacteriemia/diagnóstico , Infecções por Clostridium/sangue , Feminino , Humanos , Infecção da Ferida Cirúrgica/sangue , Infecção da Ferida Cirúrgica/complicações , Infecção da Ferida Cirúrgica/microbiologia
8.
BMJ Case Rep ; 20132013 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-24022903

RESUMO

A 51-year-old woman with diabetes, who immigrated to the USA 22 years ago from Laos, was admitted to the hospital for evaluation of fever, abdominal pain, vomiting and diarrhoea. A workup for acute gastroenteritis revealed a positive stool PCR for Shiga toxin-producing Escherichia coli. Two sets of blood cultures drawn at admission were positive for E coli. A review of her previous medical records revealed the presence of eosinophilia, up to 20%, 14 years prior to that was never investigated. Therefore, stool samples were examined and two of three specimens were positive for Strongyloides stercoralis larvae, confirming the diagnosis of Strongyloides hyperinfection syndrome.


Assuntos
Bacteriemia/etiologia , Coinfecção , Infecções por Escherichia coli/etiologia , Escherichia coli Shiga Toxigênica , Strongyloides stercoralis , Estrongiloidíase/complicações , Animais , Coinfecção/microbiologia , Coinfecção/parasitologia , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Pessoa de Meia-Idade
11.
J Biomed Biotechnol ; 2012: 697418, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22131822

RESUMO

PURPOSE: Diagnosis of WNV (WNV) relies upon serologic testing which may take several days after the onset of clinical symptoms to turn positive. Anecdotal reports suggest the presence of plasma cells or plasmacytoid lymphocytes in the cerebrospinal fluid (CSF) may be an early indicator of WNV infection. METHODS: The CSFs of 89 patients (12 with WNV, 12 with other viral illness {OVI}, and 65 with nonviral illness{NVI}) were compared for the presence of either plasma cells or plasmacytoid lymphocytes. RESULTS: Plasma cells were rarely seen in any of the patients. Plasmacytoid lymphocytes were more commonly seen in WNV (58%) and OVI (50%) than NVI (11%). The differences were significant for WNV versus NVI, but not WNV versus OVI (P < 0.001 and P = 0.58, resp.). CONCLUSIONS: A CSF pleocytosis with plasma cells or plasmacytoid lymphocytes was neither sensitive nor specific for the diagnosis of WNV infection.


Assuntos
Leucocitose/líquido cefalorraquidiano , Leucocitose/virologia , Plasmócitos/patologia , Febre do Nilo Ocidental/líquido cefalorraquidiano , Adulto , Idoso , Líquido Cefalorraquidiano/citologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Febre do Nilo Ocidental/patologia , Vírus do Nilo Ocidental/isolamento & purificação
12.
Curr Infect Dis Rep ; 13(4): 317-23, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21526349

RESUMO

Improvements in manufacturing and implantation techniques, coupled with an increasing prevalence of atherosclerosis in an aging population, have led to increased utilization of prosthetic vascular grafts. The infection rates of vascular grafts are low. However, when they do occur, high rates of morbidity and mortality can be expected. The purpose of this article is to review the published literature regarding epidemiology, risk factors, pathogenesis, and clinical manifestations of prosthetic vascular graft infections. Moreover, we provide a practical approach to the diagnosis and management of these complicated infections based on empirically grounded evidence.

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