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1.
Cochrane Database Syst Rev ; 10: CD008359, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33001448

RESUMO

This Cochrane review has been withdrawn. The Cochrane review is out of date and included a retracted article in the analysis. Withdrawn by Cochrane Colorectal Group. A new update is expected. The editorial group responsible for this previously published document have withdrawn it from publication.


Assuntos
Antibacterianos/uso terapêutico , Apendicectomia/métodos , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Doença Aguda , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Int J Med Sci ; 17(16): 2468-2476, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33029089

RESUMO

Rationale: Coronavirus disease 2019 (COVID-19) was first announced in Wuhan, and has rapidly evolved into a pandemic. However, the risk factors associated with the severity and mortality of COVID-19 are yet to be described in detail. Methods: We retrospectively reviewed the information of 1525 cases from the Leishenshan Hospital in Wuhan. Univariate and multivariate Cox regression analyses were generated to explore the relationship between procalcitonin (PCT) level and the progression and prognosis of COVID-19. Univariate and multivariate logistic regression analyses were performed to explore the relationship between disease severity in hospitalized patients and their PCT levels. Survival curves and the cumulative hazard function for COVID-19 progression were conducted in the two groups. To further detect the relationship between the computed tomography score and survival days, curve-fitting analyses were performed. Results: Patients in the elevated PCT group had a higher incidence of severe and critical severity conditions (P < 0.001), death, and higher computed tomography (CT) scores. There was an association between elevated PCT levels and mortality in the univariate ((hazard ratio [1], 3.377; 95% confidence interval [2], 1.012-10.344; P = 0.033) and multivariate Cox regression analysis (HR, 4.933; 95% CI, 1.170-20.788; P = 0.030). Similarly, patients with elevated PCT were more likely to have critically severe disease conditions in the univariate (odds ratio [2], 7.247; 95% CI, 3.559-14.757; P < 0.001) and multivariate logistic regression analysis (OR, 10.679; 95% CI, 4.562-25.000; P < 0.001). Kaplan-Meier curves showed poorer prognosis for patients with elevated PCT (P = 0.024). The CT score 1 for patients with elevated PCT peaked at day 40 following the onset of symptoms then decreased gradually, while their total CT score was relatively stable. Conclusion: PCT level was shown as an independent risk factor of in-hospital mortality among COVID-19 patients. Compared with inpatients with normal PCT levels, inpatients with elevated PCT levels had a higher risk for overall mortality and critically severe disease. These findings may provide guidance for improving the prognosis of patients with critically severe COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/etiologia , Infecções por Coronavirus/mortalidade , Pneumonia Viral/etiologia , Pneumonia Viral/mortalidade , Pró-Calcitonina/sangue , Idoso , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus/efeitos dos fármacos , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/tratamento farmacológico , Progressão da Doença , Feminino , Hospitalização , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico por imagem , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
3.
Global Health ; 16(1): 94, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-33032616

RESUMO

INTRODUCTION: COVID-19 has rapidly and radically changed the face of human health and social interaction. As was the case with COVID-19, the world is similarly unprepared to respond to antimicrobial resistance (AMR) and the challenges it will produce. COVID-19 presents an opportunity to examine how the international community might better respond to the growing AMR threat. MAIN BODY: The impacts of COVID-19 have manifested in health system, economic, social, and global political implications. Increasing AMR will also present challenges in these domains. As seen with COVID-19, increasing healthcare usage and resource scarcity may lead to ethical dilemmas about prioritization of care; unemployment and economic downturn may disproportionately impact people in industries reliant on human interaction (especially women); and international cooperation may be compromised as nations strive to minimize outbreaks within their own borders. CONCLUSION: AMR represents a slow-moving disaster that offers a unique opportunity to proactively develop interventions to mitigate its impact. The world's attention is currently rightfully focused on responding to COVID-19, but there is a moral imperative to take stock of lessons learned and opportunities to prepare for the next global health emergency.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Coronavirus/prevenção & controle , Resistência Microbiana a Medicamentos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Planejamento em Desastres/organização & administração , Previsões , Saúde Global , Humanos , Cooperação Internacional , Pneumonia Viral/epidemiologia
4.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(9): 1068-1073, 2020.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33051420

RESUMO

OBJECTIVES: To analyze the pathogenic distribution, antibiotic susceptibility and prognostic factors for acute leukemia (AL) patients with Gram negative (G-) bacterial bloodstream infection (BSI), in order to provide theoretical basis for reducing the infection-related mortality of AL patients. METHODS: The clinical data of 1 055 AL patients with BSI admitted to the hematology ward of three large-scale hospitals in Hunan Province from January 2010 to December 2018 were collected. The etiology, antibiotic susceptibility data and clinical features of patients with G- bacterial infection were analyzed. RESULTS: G- bacterial infection accounted for 622 AL patients with BSI, and the main pathogens were Escherichia coli (277 strains, 44.53%), Klebsiella pneumoniae (138 strains, 22.19%), and Pseudomonas aeruginosa (81 strains, 13.02%). Most G- bacteria were highly sensitive to carbapenems and ß-lactam/ß-lactamase inhibitor. State of disease, Pitt score ≥4, treatment with vasoactive agents and sensitive antibiotic >48 h were independent risk factors of 30-day mortality. CONCLUSIONS: Rational antibacterial treatment of G- bacterial BSI in AL patients requires adequate acquaintance of the local pathogenic epidemiology and antibiotic susceptibility-monitored data. Broad-spectrum antibiotics covering the most common and more virulent pathogens should be timely applicated and adjusted according to antibiotic susceptibility results and efficacy.


Assuntos
Bacteriemia , Farmacorresistência Bacteriana , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Humanos , Testes de Sensibilidade Microbiana , Prognóstico
7.
Rev Med Suisse ; 16(710): 1912-1915, 2020 Oct 14.
Artigo em Francês | MEDLINE | ID: mdl-33058576

RESUMO

The extraordinary development of medicine with the advent of solid organ and bone marrow transplants, chemotherapy and immunotherapy, as well as the explosion of invasive procedures (« foreign material ¼) has made our medicine dependant to the use of antibiotics. The overuse of « empirical ¼ antibiotics in breeding and medicine has favored the emergence and rapid dissemination of multidrug resistant pathogens (MDRs). This leaded clinicians today in a difficult situation. They should limit their empirical use of « broad-spectrum antibiotics ¼, although they face a higher risk of MDRs. To help them in this task, anti-microbial stewardship programs have been put in place, emphasizing the use of « hospital antibiograms ¼ and rapid and reliable microbiological diagnosis.


Assuntos
Antibacterianos , Gestão de Antimicrobianos/métodos , Resistência Microbiana a Medicamentos , Resistência a Múltiplos Medicamentos , Antibacterianos/provisão & distribução , Antibacterianos/uso terapêutico , Resistência Microbiana a Medicamentos/efeitos dos fármacos , Resistência a Múltiplos Medicamentos/efeitos dos fármacos , Hospitais , Humanos
8.
Rev Med Suisse ; 16(710): 1920-1923, 2020 Oct 14.
Artigo em Francês | MEDLINE | ID: mdl-33058578

RESUMO

Intravesical bacillus Calmette-Guérin immunotherapy is currently the most effective treatment for non-infiltrating bladder tumors. Although rare, « BCGitis ¼, local or disseminated, is a serious complication of this therapy. The diagnosis is difficult and often delayed but the infection may progress to multi-systemic failure and can be fatal. The microbiological samples are often negative, and biopsies sometimes do not help. Treatment consists of antimycobacterial agents in combination with corticosteroids in case of severe presentation.


Assuntos
Vacina BCG/administração & dosagem , Vacina BCG/efeitos adversos , Imunoterapia/efeitos adversos , Inflamação/induzido quimicamente , Administração Intravesical , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Humanos , Inflamação/tratamento farmacológico , Neoplasias da Bexiga Urinária/terapia
10.
BMC Infect Dis ; 20(1): 721, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004020

RESUMO

BACKGROUND: Listeria monocytogenes (L. monocytogenes) is a facultative intracellular bacterial pathogen which can invade different mammalian cells and reach to the central nervous system (CNS), leading to meningoencephalitis and brain abscesses. In the diagnosis of L. monocytogenes meningoencephalitis (LMM), the traditional test often reports negative owing to the antibiotic treatment or a low number of bacteria in the cerebrospinal fluid. To date, timely diagnosis and accurate treatment remains a challenge for patients with listeria infections. CASE PRESENTATION: We present the case of a 66-year-old woman whose clinical manifestations were suspected as tuberculous meningoencephalitis, but the case was finally properly diagnosed as LMM by next-generation sequencing (NGS). The patient was successfully treated using a combined antibacterial therapy, comprising ampicillin and trimethoprim-sulfamethoxazole. CONCLUSION: To improve the sensitivity of LMM diagnosis, we used NGS for the detection of L. monocytogenes. Hence, the clinical utility of this approach can be very helpful since it provides quickly and trust results.


Assuntos
Listeria monocytogenes/genética , Meningite por Listeria/microbiologia , Meningoencefalite/microbiologia , Idoso , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Erros de Diagnóstico , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Listeria monocytogenes/isolamento & purificação , Meningite por Listeria/diagnóstico , Meningite por Listeria/tratamento farmacológico , Meningoencefalite/diagnóstico , Meningoencefalite/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/microbiologia
12.
Rev Soc Bras Med Trop ; 53: e20200032, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33027413

RESUMO

INTRODUCTION: Essential oils can serve as novel sources of antibiotics for multidrug-resistant bacteria. METHODS: The multidrug-resistance profile of a Klebsiella aerogenes strain was assessed by PCR and sequencing. The antibacterial activity of Cinnamomum cassia essential oil (CCeo) against K. aerogenes was assessed by broth microdilution and time-kill methods. RESULTS: K. aerogenes showed high antibiotic resistance. The genes bla KPC-2, ampC, bla CTX-M-15, bla OXA-1, and bla TEM were present. CCeo exhibited an inhibitory effect with a minimum inhibitory concentration of 17.57 µg/mL. CONCLUSIONS: The antibacterial activity of CCeo makes it a potential candidate for treating carbapenem- and polymyxin-resistant K. aerogenes strains.


Assuntos
Antibacterianos/uso terapêutico , Cinnamomum aromaticum , Enterobacter aerogenes , Infecções por Klebsiella , Carbapenêmicos , Humanos , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae , Óleos Voláteis , Polimixinas , beta-Lactamases
13.
Trop Doct ; 50(4): 330-334, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32998655

RESUMO

Acute infectious purpura fulminans is a serious, potentially fatal condition. We present a case series of 11 patients from March 2005 to March 2017, whose clinical symptoms were fever (100%), confusion (63.6%) and headache (55%), and whose common laboratory abnormalities were thrombocytopenia (100%), elevated alkaline phosphatase (70%) and anaemia (63.6%). Three patients (27%) developed gangrene and two presented in shock. Only one grew Neisseria meningitidis in cerebrospinal fluid (CSF) culture and another confirmed by latex agglutination and polymerase chain reaction in CSF. Five others had serology confirmed spotted fever rickettsioses (SFG). All received broad spectrum antibiotics; in 9/11 patients, this included doxycycline or azithromycin. The mean hospital stay was 10.2 days and overall mortality was 18.2%.


Assuntos
Púrpura Fulminante/diagnóstico , Púrpura Fulminante/terapia , Adulto , Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Feminino , Hospitalização , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Púrpura Fulminante/mortalidade , Púrpura Fulminante/patologia , Rickettsiose do Grupo da Febre Maculosa/diagnóstico , Rickettsiose do Grupo da Febre Maculosa/tratamento farmacológico , Rickettsiose do Grupo da Febre Maculosa/mortalidade , Rickettsiose do Grupo da Febre Maculosa/patologia , Resultado do Tratamento
14.
Rev Med Suisse ; 16(711): 1965-1969, 2020 Oct 21.
Artigo em Francês | MEDLINE | ID: mdl-33085251

RESUMO

Cirrhosis results from chronic liver disease and is associated with a high mortality. The most frequent causes for chronic liver disease include alcoholic liver disease, non-alcoholic fatty liver disease and viral hepatitis B and C. Bacterial infections often complicate decompensated cirrhosis. It is estimated that up to 35% of patients with decompensated cirrhosis have an infection at admission or during hospital stay. There are considerable consequences to these bacterial infections. Whilst evidence supports the use of prophylactic antibiotics, the emergence of multi-resistant bacteria is changing the spectrum of antibiotics that have to be used.


Assuntos
Infecções Bacterianas , Cirrose Hepática , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecções Bacterianas/complicações , Infecções Bacterianas/tratamento farmacológico , Resistência Microbiana a Medicamentos/efeitos dos fármacos , Humanos , Cirrose Hepática/complicações , Hepatopatias Alcoólicas/complicações , Hepatopatia Gordurosa não Alcoólica/complicações
15.
Epidemiol Mikrobiol Imunol ; 69(3): 128-133, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33086854

RESUMO

Úvod: Biomarkery jsou u septických pacientů využívány jak k diagnostice sepse, tak k antibiotickému stewardshipu. Sepse vyvolaná gramnegativními bakteriemi mívá odlišné charakteristiky, především vysoký prokalcitonin vs C-reaktivní protein v porovnání se sepsí vyvolanou grampozitivními bakteriemi. Avšak jednotlivá infekční agens, především Streptococcus pyogenes, nemusí do tohoto schématu zapadat, což může vest k nesprávné iniciální volbě antibiotika. Metody: Retrospektivní analýza biomarkerů, iniciální volby antibiotické léčby a výsledků léčby u pacientů se sepsí vyvolanou S. pyogenes, Escherichia coli a Staphylococcus aureus. Hodnoty biomarkerů byly porovnány pomocí Kruskal-Wallis testu s následným Dunn post-Hoc testem s prahem p < 0,05. Výsledky: Hodnoty prokalcitoninu byly nejvyšší u sepse vyvolané S. pyogenes (12,51 ng/ml, IQR: 6,26-48,38 ng/ml) oproti sepsi vyvolaná E. coli (4,30 ng/ml, IQR: 1,50-10,00 ng/ml, p < 0,001) a S. aureus (0,75 ng/ml, QR: 0,34-1,62 ng/ml, p < 0,001). Poměr neutrofilů a lymfocytů vykazoval stejné charakteristiky jako prokalcitonin. Správná iniciální antibiotická léčba byla v souboru S. pyogenes 11,29 % v porovnání s 99,3 % a 100 % u S. aureus a E. coli skupin. Závěr: Oproti předchozím studiím byly v našem souboru pozorovány nejvyšší hodnoty prokalcitoninu u pacientů se sepsí vyvolanou S. pyogenes spíše než gramnegativními bakteriemi. Vysoké hodnoty prokalcitoninu imitující gramnegativní zánětlivou odpověď přispěli k ovlivnění výběru iniciální antibiotické léčby (bez znalosti původce), což mohlo vést k vyšší mortalitě u této skupiny pacientů. Proto doporučujeme přehodnocení významu prokalcitoninu v diagnostice sepse pro zlepšení přežití i kvality života pacientů.


Assuntos
Antibacterianos/uso terapêutico , Sepse/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus pyogenes , Biomarcadores , Escherichia coli , Staphylococcus aureus
16.
Nat Commun ; 11(1): 4915, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004811

RESUMO

A phenotype of Escherichia coli and Klebsiella pneumoniae, resistant to piperacillin/tazobactam (TZP) but susceptible to carbapenems and 3rd generation cephalosporins, has emerged. The resistance mechanism associated with this phenotype has been identified as hyperproduction of the ß-lactamase TEM. However, the mechanism of hyperproduction due to gene amplification is not well understood. Here, we report a mechanism of gene amplification due to a translocatable unit (TU) excising from an IS26-flanked pseudo-compound transposon, PTn6762, which harbours blaTEM-1B. The TU re-inserts into the chromosome adjacent to IS26 and forms a tandem array of TUs, which increases the copy number of blaTEM-1B, leading to TEM-1B hyperproduction and TZP resistance. Despite a significant increase in blaTEM-1B copy number, the TZP-resistant isolate does not incur a fitness cost compared to the TZP-susceptible ancestor. This mechanism of amplification of blaTEM-1B is an important consideration when using genomic data to predict susceptibility to TZP.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Escherichia coli/tratamento farmacológico , Proteínas de Escherichia coli/genética , Escherichia coli/genética , beta-Lactamases/genética , Antibacterianos/uso terapêutico , Cromossomos Bacterianos/genética , Elementos de DNA Transponíveis/genética , DNA Bacteriano/genética , Quimioterapia Combinada/métodos , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/microbiologia , Amplificação de Genes , Regulação Bacteriana da Expressão Gênica , Genoma Bacteriano/genética , Humanos , Testes de Sensibilidade Microbiana , Piperacilina/farmacologia , Piperacilina/uso terapêutico , Polimorfismo de Fragmento de Restrição , RNA Ribossômico 16S/genética , Tazobactam/farmacologia , Tazobactam/uso terapêutico , Sequenciamento Completo do Genoma
17.
BMC Infect Dis ; 20(1): 729, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028225

RESUMO

BACKGROUND: This study describes the disease burden, clinical characteristics, antibiotic management, impact of multidrug resistance and outcome of Pseudomonas aeruginosa bloodstream infection (PABSI) among children admitted to a tertiary referral hospital for children in Cape Town, South Africa. METHODS: A retrospective descriptive study was conducted at a paediatric referral hospital in Cape Town, South Africa. Demographic and clinical details, antibiotic management and patient outcome information were extracted from medical and laboratory records. Antibiotic susceptibility results of identified organisms were obtained from the National Health Laboratory Service database. RESULTS: The incidence risk of PABSI was 5.4 (95% CI: 4.34-6.54) PABSI episodes / 10,000 hospital admissions and the most common presenting feature was respiratory distress, 34/91 (37.4%). Overall, 69/91 (75.8%) of the PA isolates were susceptible to all antipseudomonal antibiotic classes evaluated. Fifty (54.9%) of the PABSI episodes were treated with appropriate empiric antibiotic therapy. The mortality rate was 24.2% and in multivariable analysis, empiric antibiotic therapy to which PA isolates were not susceptible, infections present on admission, and not being in the intensive care unit at the time that PABSI was diagnosed were significantly associated with 14-day mortality. CONCLUSIONS: PABSI caused appreciable mortality, however, appropriate empiric antibiotic therapy was associated with reduced 14-day mortality.


Assuntos
Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/isolamento & purificação , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Farmacorresistência Bacteriana/efeitos dos fármacos , Feminino , Hospitais Pediátricos , Humanos , Lactente , Unidades de Terapia Intensiva , Masculino , Testes de Sensibilidade Microbiana , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/mortalidade , Pseudomonas aeruginosa/efeitos dos fármacos , Estudos Retrospectivos , África do Sul/epidemiologia , Taxa de Sobrevida , Centros de Atenção Terciária
18.
BMC Infect Dis ; 20(1): 730, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028242

RESUMO

BACKGROUND: The incidence of Lyme disease (LD) in North America has increased substantially in the past two decades. Concomitant with the increased incidence of infection has been an enhancement in the recognition of LD complications. Here, we report a case of Lyme carditis complicated by heart block in a pediatric patient admitted to our children's hospital. What is unique about this case is that the complaint of chest palpitations is an infrequent presentation of LD, and what it adds to the scientific literature is an improved understanding of LD in the pediatric population. CASE PRESENTATION: The patient was a 16-year-old male who presented with the main concerns of acute onset of palpitations and chest pain. An important clinical finding was Erythema migrans (EM) on physical exam. The primary diagnoses were LD with associated Lyme carditis, based on the finding of 1st degree atrioventricular heart block (AVB) and positive IgM and IgG antibodies to Borrelia burgdorferi. Interventions included echocardiography, electrocardiography (EKG), and intravenous antibiotics. The hospital course was further remarkable for transition to 2nd degree heart block and transient episodes of complete heart block. A normal sinus rhythm and PR interval were restored after antibiotic therapy and the primary outcome was that of an uneventful recovery. CONCLUSIONS: Lyme carditis occurs in < 5% of LD cases, but the "take-away" lesson of this case is that carditis can be the presenting manifestation of B. burgdorferi infection in pediatric patients. Any patient with suspected Lyme carditis manifesting cardiac symptoms such as syncope, chest pain, or EKG changes should be admitted for parenteral antibiotic therapy and cardiac monitoring. The most common manifestation of Lyme carditis is AVB. AVB may manifest as first-degree block, or may present as high-grade second or third-degree block. Other manifestations of Lyme carditis may include myopericarditis, left ventricular dysfunction, and cardiomegaly. Resolution of carditis is typically achieved through antibiotic administration, although pacemaker placement should be considered if the PR interval fails to normalize or if higher degrees of heart block, with accompanying symptoms, are encountered. With the rising incidence of LD, providers must maintain a high level of suspicion in order to promptly diagnose and treat Lyme carditis.


Assuntos
Borrelia burgdorferi/isolamento & purificação , Doença de Lyme/diagnóstico , Administração Intravenosa , Adolescente , Antibacterianos/uso terapêutico , Borrelia burgdorferi/imunologia , Eletrocardiografia , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/etiologia , Humanos , Imunoglobulina M/sangue , Doença de Lyme/complicações , Doença de Lyme/tratamento farmacológico , Doença de Lyme/microbiologia , Masculino , Miocardite/diagnóstico
19.
Medicine (Baltimore) ; 99(41): e22476, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031278

RESUMO

RATIONALE: Sciatica is usually caused by lumbar spine disease; the incidence of sciatica from extra-spinal causes is noted to be only about 0.09%. PATIENT CONCERNS: We report a case of a 92-year-old man who came to the neurologist outpatient department due to left buttock pain and numbness that radiated to the left lower leg in the recent 6 months and progressed rapidly over 10 days. DIAGNOSIS: We arranged magnetic resonance imaging for lumbar nerve lesion. Magnetic resonance imaging showed a common iliac artery mycotic aneurysm, at about 6.3 cm in diameter, which compressed the psoas muscle, nerve plexus, and vein. INTERVENTIONS: We used a left-side iliac bifurcation stent graft of 12 mm in diameter for aneurysm repair. An internal iliac artery with a stent graft of 10 mm x 5 cm. An abdomen aortic aneurysm stent was inserted, 1 cm beneath the right renal artery from the right side femoral artery. OUTCOMES: After endovascular repair and 4 weeks of antibiotic treatment, he could walk again, and no sciatica was noted. We repeated computed tomography 5 months after the operation and noted that the size of the iliac artery aneurysm decreased without stent graft migration or extravasation. Our patient recovered from sciatic and left leg weakness; above all, he could walk again. LESSONS: We suggest practitioners check for common iliac artery aneurysms in the diagnosis of symptoms mimicking spinal cord origin sciatica, especially in elder patients.


Assuntos
Aneurisma Ilíaco/complicações , Aneurisma Ilíaco/diagnóstico por imagem , Síndromes de Compressão Nervosa/etiologia , Ciática/etiologia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Progressão da Doença , Humanos , Aneurisma Ilíaco/microbiologia , Aneurisma Ilíaco/cirurgia , Imagem por Ressonância Magnética , Masculino , Stents
20.
Medicine (Baltimore) ; 99(41): e22494, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031285

RESUMO

INTRODUCTION: Sneathia sanguinegens(S sanguinegens) is a gram-negative rod-shaped bacterium mostly reported to cause a perinatal infection, and there are no reports of S sanguinegens in prosthetic joint infection (PJI). The purpose of this report is to describe a very rare case of PJI after total hip arthroplasty (THA) caused by S sanguinegens. PATIENT CONCERNS: A 79-year-old woman presented with right coxalgia, inability to walk, and a fever of 39°C. She had undergone THA 28 years earlier for osteoarthritis of the hip. DIAGNOSES: The diagnosis was acute late-onset PJI, because blood tests revealed marked inflammatory reaction and computed tomography showed an abscess at the right hip joint; synovial fluid analysis resulted in detection of a gram-negative bacillus. INTERVENTION: Surgical debridement with retention of the implant and antibiotic therapy was performed. OUTCOMES: One month after surgery, polymerase chain reaction (PCR) assay showed that the pathogen was 99.9% likely to be S sanguinegens. There has been no recurrence of infection or loosening of the implant in the 2 years since her surgery. LESSONS: PCR should facilitate detection of previously unknown pathogens and potentially novel bacterial species.


Assuntos
Fusobactérias , Infecções por Bactérias Gram-Negativas/complicações , Infecções Relacionadas à Prótese/microbiologia , Idoso , Antibacterianos/uso terapêutico , Artroplastia de Quadril , Feminino , Fusobactérias/isolamento & purificação , Infecções por Bactérias Gram-Negativas/diagnóstico , Humanos , Reação em Cadeia da Polimerase , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/cirurgia
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