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PLoS Negl Trop Dis ; 13(4): e0007293, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30986214


Non-typhoidal Salmonella (NTS) bacteremia is a significant cause of morbidity and mortality worldwide. It is considered to be an emerging and neglected tropical disease in Africa. We studied this in two tertiary hospitals-Al Farwaniya and Al Amiri-in Kuwait, a subtropical country, from April 2013-May 2016. NTS bacteremia was present in 30 of 53,860 (0.75%) and 31 of 290,36 (1.33%) blood cultures in the two hospitals respectively. In Al Farwaniya hospital, one-third of the patients were from some tropical developing countries of Asia. About 66% of all patients (40/61) had diarrhea, and of these, 65% had the corresponding blood serovar isolated from stool culture. A few patients had Salmonella cultured from urine. Patients were either young or old. Most of the patients had co-morbidities affecting the immune system. Two patients each died in both hospitals. The number of different serovars cultured in each hospital was 13, and most infections were due to S. Enteritidis (all sequence type [ST]) 11) and S. Typhimurium (all ST19) except in a subgroup of expatriate patients from tropical developing countries in Al Farwaniya hospital. About a quarter of the isolates were multidrug-resistant. Most patients were treated with a cephalosporin with or without other antibiotics. S. Enteritidis and S. Typhimurium isolates were typed by pulsed field-gel electrophoresis (PFGE) and a selected number of isolates were whole-genome sequenced. Up to four different clades were present by PFGE in either species. Whole-genome sequenced isolates showed antibiotic-resistance genes that showed phenotypic correlation, and in some cases, phenotypes showed absence of specific genes. Whole-genome sequenced isolates showed presence of genes that contributed to blood-stream infection. Phylogeny by core genome analysis showed a close relationship with S. Typhimurium and S. Enteritidis from other parts of the world. The uniqueness of our study included the finding of a low prevalence of infection, mortality and multidrug-resistance, a relatively high prevalence of gastrointestinal infection in patients, and the characterization of selected isolates of S. Typhimurium and S. Enteritidis serovars by whole-genome sequencing that shed light on phylogeny, virulence and resistance. Similarities with studies from developing countries especially Africa included infection in patients with co-morbidities affecting the immune system, predominance of S. Typhimurium and S. Enteritidis serovars and presence of drug-resistance in isolates.

Bacteriemia/microbiologia , Bacteriemia/patologia , Infecções por Salmonella/microbiologia , Infecções por Salmonella/patologia , Salmonella/classificação , Salmonella/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/epidemiologia , Sangue/microbiologia , Pré-Escolar , Farmacorresistência Bacteriana , Fezes/microbiologia , Feminino , Genótipo , Humanos , Lactente , Kuweit/epidemiologia , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Tipagem Molecular , Prevalência , Infecções por Salmonella/epidemiologia , Sorogrupo , Centros de Atenção Terciária , Urina/microbiologia , Sequenciamento Completo do Genoma , Adulto Jovem
Mycoses ; 61(6): 410-416, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29430718


Candida fungus ball is a rare presentation of urinary tract infections among adult patients and is associated with considerable morbidity. Because clinical signs are not specific, diagnosis is often delayed. Furthermore, treatment is occasionally difficult, and the approach to such cases varies widely among different centers. In this report, we describe a patient with retroperitoneal fibrosis who developed a renal fungus ball. Management of this challenging case is discussed, and review of the literature is presented.

Candida albicans/isolamento & purificação , Candidíase/microbiologia , Rim/microbiologia , Doenças Raras/microbiologia , Fibrose Retroperitoneal/complicações , Infecções Urinárias/microbiologia , Adulto , Antifúngicos/uso terapêutico , Candida albicans/efeitos dos fármacos , Candidíase/complicações , Candidíase/tratamento farmacológico , Gerenciamento Clínico , Fluconazol/uso terapêutico , Humanos , Rim/patologia , Masculino , Doenças Raras/complicações , Doenças Raras/tratamento farmacológico , Fibrose Retroperitoneal/tratamento farmacológico , Fibrose Retroperitoneal/microbiologia , Resultado do Tratamento , Infecções Urinárias/complicações , Infecções Urinárias/tratamento farmacológico