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1.
Infection ; 48(2): 193-203, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32036556

RESUMO

PURPOSE: Malignant external otitis is an aggressive and potentially life-threatening infection. This rare disorder is typically caused by Pseudomonas aeruginosa and affects almost exclusively elderly diabetic patients. However, fungal malignant external otitis have been identified, especially in immunocompromised hosts. METHODS: We report a rare case of invasive malignant external otitis caused by Aspergillus flavus in a diabetic patient without other underlying immunosuppression. A review of Aspergillus spp. malignant external otitis since voriconazole became the first line for invasive aspergillosis was performed. RESULTS: A 72-year-old man with diabetes mellitus developed invasive malignant external otitis with a vascular involvement. The patient was treated with empiric courses of antibiotics until a fungal infection was diagnosed. Proven Apsergillus infection was based on histopathological examination and isolation of A. flavus from culture of osteo-meningeal biopsies. Despite optimal antimicrobial therapy with voriconazole, the patient presented with cerebral infarction in the setting of an angioinvasive fungal infection leading to a fatal outcome. From a review of the literature, we found 39 previously published cases of proven Aspergillus spp. malignant external otitis treated with new triazoles. CONCLUSION: Given our experience and the literature review, a fungal etiology should be considered early in the course of malignant external otitis unresponsive to a conventional broad spectrum antibiotic therapy, with the need for a tissue biopsy to confirm the diagnosis.


Assuntos
Aspergilose/complicações , Aspergilose/tratamento farmacológico , Aspergillus flavus/isolamento & purificação , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/microbiologia , Otite Externa/tratamento farmacológico , Otite Externa/microbiologia , Idoso , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Aspergilose/diagnóstico por imagem , Azóis/uso terapêutico , Complicações do Diabetes/diagnóstico por imagem , Evolução Fatal , Humanos , Masculino , Otite Externa/diagnóstico por imagem , Fatores de Tempo
2.
Clin Lab ; 65(12)2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31850719

RESUMO

BACKGROUND: Bacteroides caccae is a ubiquitous, anaerobic bacteria, but it is not a common cause of pathologic bloodstream infection. Diabetic patients are at increased risk of developing anaerobic bacteria infection. Here, we report a repeated fever case caused by Bacteroides caccae in a diabetic patient. The aim of this study was to describe the clinical characteristics and manifestations of Bacteroides caccae. METHODS: The pathogenic bacteria isolated from patient blood was identified as Bacteroides caccae. Identification of the Bacteroides caccae was done by 16s rDNA sequencing and matrix-assisted laser desorption/ionization-time of light spectrometry. The infection was cured by one-week combined therapy of intravenous Piperacillin tazobactam and oral Ornidazole tablet. RESULTS: After treatment had been completed, no episodes of fever occurred during the follow-up to date. CONCLUSIONS: Bacteroides caccae is regarded as an intestinal, opportunistic pathogenic bacteria. It can invade the mucosa of the intestine and cause various abdominal suppurative infections. Sequencing and matrix-assisted laser desorption/ionization-time of flight spectrometry could have a role for Bacteroides caccae diagnosis. The curative effect of using first generation cephalosporines therapy was unsatisfactory. Using intravenous Piperacillin tazobactam and ornidazole tablet might obtain certain curative effect. Early diagnosis and appropriate anti-infection therapy were necessary to improve the outcome of patients with Bacteroides caccae bloodstream infection.


Assuntos
Infecções por Bacteroides/microbiologia , Bacteroides/fisiologia , Complicações do Diabetes/microbiologia , Diabetes Mellitus/microbiologia , Febre/microbiologia , Bacteroides/efeitos dos fármacos , Bacteroides/isolamento & purificação , Infecções por Bacteroides/sangue , Infecções por Bacteroides/tratamento farmacológico , Complicações do Diabetes/sangue , Complicações do Diabetes/tratamento farmacológico , Quimioterapia Combinada , Feminino , Febre/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Ornidazol/uso terapêutico , Combinação Piperacilina e Tazobactam/uso terapêutico
3.
Biomed Res Int ; 2019: 7459236, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31531366

RESUMO

Diabetic foot ulcer (DFU) is a complication experienced by diabetic patients and does not heal well in an altered wound environment. Although diverse microbes in DFU were detected, little is known about their influences on diabetic foot wound (DFW) and the association with the skin microbiota in normal tissue from the same patients according to clinical features. We aimed to analyze the microbiota in normal skin and DFW tissue from the same subject and predict their roles based on clinical features. We analyzed the microbiota in normal skin and DFW tissue from the same subject and compared the associated members of microbiota with clinical parameters. The diversity of skin microbiota was higher than that of DFW tissues, along with compositional differences. In addition, different microbes were associated with clinical features. The proportions of Bacteroidetes, Prevotella, Peptoniphilus, Porphyromonas, and Dialister were higher in the severe groups than of the mild groups, whereas that of Firmicutes was lower in the severe groups. According to wound severity, the microbiota could be related to inflammation, damaging host cell membrane, and pathogenicity through lipopolysaccharide biosynthesis, cellular antigens, and protein digestion metabolism. The predicted DFW microbiota functions according to systemic diabetic status defined by ESRD and HbA1c, differed from those presented by wound severity. Results indicate that the microbiota in normal skin is related to the colonizing microbes in DFW tissue according to clinical features and the different microbes can play important roles in DFW prognosis. This information can be applied to prevent and manage DFW by modulating the microbiota.


Assuntos
Complicações do Diabetes/microbiologia , Complicações do Diabetes/patologia , Pé Diabético/microbiologia , Pé Diabético/patologia , Microbiota/fisiologia , Pele/microbiologia , Pele/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Membrana Celular/microbiologia , Membrana Celular/patologia , Diabetes Mellitus/microbiologia , Diabetes Mellitus/patologia , Feminino , Humanos , Inflamação/microbiologia , Inflamação/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Índice de Gravidade de Doença , Cicatrização/fisiologia
4.
J Biol Regul Homeost Agents ; 33(3 Suppl. 1): 35-41, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31538448

RESUMO

Candida species are commensal yeasts of the oral cavity, which, under predisposing systemic and/or local circumstances, are responsible for a wide variety of clinical manifestations, globally known as oral candidiasis. Candida-associated denture stomatitis is an oral candidiasis particularly affecting the oral mucosa covered by a dental prosthesis, with several degree of severity. Diabetics suffer oral candidiasis more frequently than healthy individuals do and if they are denture wearers, the risk increases. Since various controversies still remain regarding the interrelationship among diabetes, oral Candida spp. strains involved in denture stomatitis and the presence of dentures, the present review aims to investigate the differences in Candida species frequencies and degree of denture stomatitis severity existing among diabetic and non- diabetic individuals, with and without dentures.


Assuntos
Candida/classificação , Candidíase Bucal/complicações , Complicações do Diabetes/microbiologia , Diabetes Mellitus , Estomatite sob Prótese/complicações , Dentaduras , Humanos , Estomatite sob Prótese/microbiologia
5.
Clin Lab ; 65(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31414743

RESUMO

BACKGROUND: We report an invasive pulmonary aspergillosis (IPA) with negative (1,3)-ß-D-glucan and dynamically elevated white blood cells combined with procalcitonin proven by bronchoalveolar lavage fluid (BALF) culture. METHODS: Appropriate laboratory tests are carried out. Chest CTs were performed to assess the lungs. The cause of infection was determined using BALF culture. RESULTS: Serum (1,3)-ß-D-glucan was negative, white blood cells and procalcitonin were significantly higher than normal. The bronchoscopy revealed obvious necrotic detritus and pseudo membrane in the trachea, left and right main bronchi, and branches. BALF culture revealed the presence of Aspergillus. CONCLUSIONS: Negative (1,3)-ß-D-glucan is not safe to rule out invasive pulmonary aspergillosis. BALF culture is critical for IPA diagnosis.


Assuntos
Líquido da Lavagem Broncoalveolar/microbiologia , Complicações do Diabetes/diagnóstico , Aspergilose Pulmonar Invasiva/diagnóstico , Pneumonia/diagnóstico , Pró-Calcitonina/sangue , beta-Glucanas/sangue , Aspergillus/isolamento & purificação , Aspergillus/fisiologia , Complicações do Diabetes/sangue , Complicações do Diabetes/microbiologia , Diagnóstico Diferencial , Humanos , Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/microbiologia , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Pneumonia/complicações , Pneumonia/microbiologia
6.
BMC Urol ; 19(1): 78, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438919

RESUMO

BACKGROUND: Lower urinary tract symptoms (LUTS) is the most common complication of diabetes. However, the underlying pathogenesis of cultured negative LUTS (cn-LUTS) in diabetic patients has not been well understood. Numerous evidence indicates that urinary dysbiosis is related to urologic disorders. We aim to study alterations of the urinary microbiota of cn-LUTS in type 2 diabetes (T2D) patients. METHODS: Female T2D patients and controls were recruited and requested to finish the American Urological Association Symptom Index. Mid-stream urine was collected for culturing and extracting DNA. Microbial diversity and composition were analyzed by targeting to 16S rDNA. Linear discriminant analysis effect size (LEfSe) was carried out to identify significantly different bacteria. RESULTS: 32 female T2D patients and 26 controls were enrolled. No significant differences in alpha diversity were observed between patients and controls. However, statistically decreased richness (ACE index and Chao 1 index, 85.52(13.75, 204.84) vs. 129.82(63.89, 280.30) and 83.86(11.00, 210.77) vs. 125.19(62.00, 251.77), P = 0.005; Observed Species, 76(10, 175) vs. 98(54, 234), P = 0.011) and decreased species diversity (Shannon index, 1.37(0.04, 3.48) vs. 2.09(0.98, 3.43), P = 0.033; Simpson index, 0.46 (0.06, 0.99) vs. 0.23(0.07, 0.64), P = 0.029) were shown in moderate-to-severe LUTS group and high Hemoglobin A1c group, respectively. A significant difference of beta diversity was found between T2D patients and controls and T2D patients with different severity of cn-LUTS as well as the different level of Hemoglobin A1c. LEfSe revealed that 10 genera (e.g., Escherichia-Shigella and Klebsiella) were increased and 7 genera were decreasing in T2D patients, 3 genera (e.g., Escherichia-Shigella and Campylobacter) were increased and 16 genera (e.g., Prevotella) were reduced in moderate-to-severe LUTS group, 2 genera (Escherichia-Shigella and Lactobacillus) were over-represented and 10 genera (e.g., Prevotella) were under-represented in high Hemoglobin A1c group. Finally, Hemoglobin A1c was found positively correlated with the total score of the American Urological Association Symptom Index (r = 0.509, P = 0.003). CONCLUSIONS: Urinary dysbiosis may be related to cn-LUTS in female T2D patients. A better understanding of urinary microbiota in the development and progression of cn-LUTS in female T2D patients was necessary. The severity of cn-LUTS was correlated to hyperglycemia and chronic hyperglycemia might induce or promote cn-LUTS by influencing urinary microbiota.


Assuntos
Complicações do Diabetes/microbiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/microbiologia , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/microbiologia , Microbiota , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade
7.
J Microbiol Immunol Infect ; 52(4): 654-662, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31446929

RESUMO

BACKGROUND/PURPOSE: Diabetes is associated with increased mortality in Acinetobacter baumannii (AB) complex infection. This study investigated the risk factors and relationship of diabetic status and glycemic indices to mortality in patients with carbapenem-resistant (CR) AB complex bacteremia. METHODS: Relationship of glycemic indices to mortality were compared in adult diabetes (DM) and nondiabetes (non-DM) patients with CRAB complex bacteremia hospitalized from January 2010 to December 2015 in MacKay Memorial Hospital, Taiwan. RESULTS: Of 317 patients with CRAB complex bacteremia, 146 (46.06%) had diabetes. DM patients were elderly (mean age of 69.23 years) and the mortality rate was higher (64.38% vs. 52.05%, p = 0.036) than in non-DM patients. By multivariate analysis, septic shock was associated with increased mortality in DM patients. Hypoglycemia was associated with increased mortality in non-DM patients only (100% vs. 50.33%, p = 0.006). The lowest mortality was for the blood glucose range 70-100 mg/dL in non-DM patients (43.24%) and 100-140 mg/dL for DM patients (56.52%). Increased glycemic variability (coefficient of variation (CV) > 40% compared to < 20%) was associated with increased mortality in non-DM patients (86.36% vs. 47.12%, p = 0.003). CONCLUSION: Effects of dysglycemia on mortality due to CRAB complex bacteremia differ according to diabetic status. Mortality was higher in DM patients. In non-DM patients, hypoglycemia and increased CV were associated with increased mortality. The lowest mortality was for the blood glucose range 70-100 mg/dL in non-DM patients and 100-140 mg/dL for DM patients.


Assuntos
Infecções por Acinetobacter/mortalidade , Bacteriemia/mortalidade , Glicemia/análise , Carbapenêmicos/farmacologia , Complicações do Diabetes/microbiologia , Complicações do Diabetes/mortalidade , Farmacorresistência Bacteriana , Infecções por Acinetobacter/sangue , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Bacteriemia/sangue , Bacteriemia/microbiologia , Complicações do Diabetes/sangue , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
8.
Indian J Med Microbiol ; 37(1): 54-59, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31424011

RESUMO

Background: Porphyromonas gingivalis is a major periodontal pathogen. Saliva is the most easy, non-invasive microbiological sample for detection of periodontal pathogens. Aim and Objectives: A prospective study on 37 diabetic patients was grouped into well-controlled diabetes with/without periodontitis and uncontrolled diabetic with periodontitis. PCR and sequencing of P. gingivalis was performed in saliva samples. Materials and Methods: DNA was extracted from saliva using Triton X-100 and 16s rRNA gene (404 bp) was amplified by polymerase chain reaction. DNA sequencing was performed for two samples. Results: P. gingivalis was detected in 27.03% (n = 10), of which 30% (n = 9) were diabetic with periodontal disease and 14.3% (n = 1) were diabetic without periodontal disease. The percentage of poor oral hygiene was 50% and 20% in uncontrolled and controlled glycaemic patients, respectively. DNA sequencing of two samples showed 100% identity with the sequences in the GenBank database (Gen Bank accession no: KX640913-KX640914). Conclusion: Type 2 diabetes mellitus and periodontitis are interlinked. Early detection of P. gingivalis and appropriate treatment with doxycycline will also assist in controlling the glycaemic status.


Assuntos
Complicações do Diabetes/microbiologia , Diabetes Mellitus Tipo 2/epidemiologia , Periodontite/epidemiologia , Porphyromonas gingivalis/genética , Saliva/microbiologia , Adulto , Idoso , Infecções por Bacteroidaceae/tratamento farmacológico , Infecções por Bacteroidaceae/transmissão , Diabetes Mellitus Tipo 2/patologia , Doxiciclina/uso terapêutico , Feminino , Hemoglobina A Glicada/análise , Índice Glicêmico/efeitos dos fármacos , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Higiene Bucal/estatística & dados numéricos , Periodontite/tratamento farmacológico , Periodontite/microbiologia , Reação em Cadeia da Polimerase , Porphyromonas gingivalis/efeitos dos fármacos , Estudos Prospectivos , RNA Ribossômico 16S/genética
9.
Minerva Endocrinol ; 44(3): 301-309, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31304727

RESUMO

Research on Helicobacter pylori (H. pylori), a pathogenic bacterium that is widespread among humans, is investigating the medical implications of the infection in many fields beyond gastroenterology. Because of the ubiquitous presence of the infection, there is an increasing interest in finding a relationship between this bacterium and diabetes mellitus (DM). It is not clear whether a significant relation between H. pylori and DM exists, whether the infection influences diabetes or vice versa, and the mechanisms underlying such a relationship. This review provides an analysis of new insights from studies published in more recent years. New research on this topic concentrated on the common pathogenic aspects between the bacterium and insulin resistance or autoimmunity, on the role of the bacterial infection in cardiovascular risk and whether the infection worsen glycemic outcomes in patients with DM. Research in this field still has to conclusively assess and explain the existence of a possible relationship between H. pylori and DM. Some studies have reached antithetic conclusions. Unless more robust data from studies using consistent research methods become available in the near future, people with diabetes should be compared to the general population when it comes to investigating and treating the presence of H. pylori.


Assuntos
Complicações do Diabetes/terapia , Diabetes Mellitus/terapia , Infecções por Helicobacter/complicações , Helicobacter pylori , Complicações do Diabetes/microbiologia , Infecções por Helicobacter/terapia , Humanos , Fatores de Risco
10.
BMC Infect Dis ; 19(1): 603, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291896

RESUMO

BACKGROUND: This study aims to investigate the pathogen distribution and drug resistance in patients with acute cerebral infarction complicated with diabetes mellitus and nosocomial pulmonary infection. METHODS: From August 2015 to December 2017, 172 pathogenic bacterial strains from patients with acute cerebral infarction complicated with diabetes mellitus and nosocomial pulmonary infection in our hospital were identified, and the drug sensitivity was analyzed. RESULTS: Among these 172 strains of pathogenic bacteria, gram negative bacteria was the main cause of pulmonary infection in hospitalized patients with acute cerebral infarction, accounting for 75.6% of all pathogens. Furthermore, 80% of diabetic patients with cerebral infarction had lung infection induced by gram negative bacteria, which was significantly higher than that in non-diabetic patients (72.2%). Moreover, the drug resistance rate in the diabetic group (68.3%) was significantly higher than that in the non-diabetic group (54.3%). Gram positive bacteria accounted for 19.1% of all pathogenic bacteria. The infection rate of gram-positive bacteria in diabetic patients with cerebral infarction was 14.7%, which was lower than that in the non-diabetic group (22.6%). The drug-resistance rate was higher in the diabetic group (45.5%) than in the non-diabetic group (28.2%). Furthermore, the fungal infection rate in patients with lung infection in these two groups was 5.3 and 5.2%, respectively, and fungi presented with high sensitivity to commonly used antifungal agents. CONCLUSION: In patients with acute cerebral infarction complicated with diabetes mellitus and nosocomial pulmonary infection, the majority of pathogens are multidrug-resistant gram negative bacilli. Pathogen culture should be conducted as soon as possible before using antibiotics, and antimicrobial agents should be reasonably used according to drug sensitivity test results.


Assuntos
Infarto Cerebral/complicações , Infecção Hospitalar/microbiologia , Complicações do Diabetes/microbiologia , Resistência Microbiana a Medicamentos , Pneumonia/microbiologia , Doença Aguda , Anti-Infecciosos/farmacologia , Anti-Infecciosos/uso terapêutico , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Infarto Cerebral/tratamento farmacológico , Infarto Cerebral/microbiologia , Infecção Hospitalar/tratamento farmacológico , Complicações do Diabetes/tratamento farmacológico , Feminino , Fungos/classificação , Fungos/efeitos dos fármacos , Fungos/isolamento & purificação , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pneumonia/tratamento farmacológico
11.
Mater Sci Eng C Mater Biol Appl ; 103: 109741, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31349480

RESUMO

Wounds infected with methicillin-resistant Staphylococcus aureus (MRSA) biofilm represent a high risk in patients with diabetes. Nitric oxide (NO) has shown promise in dispersing biofilm and wound healing. For an effective treatment of MRSA biofilm-infected wounds, however, NO needs to be supplied to the biofilm matrix in a sustainable manner due to a short half-life and limited diffusion distance of NO. In this study, polyethylenimine/diazeniumdiolate (PEI/NONOate)-doped PLGA nanoparticles (PLGA-PEI/NO NPs) with an ability to bind to the biofilm matrix are developed to facilitate the NO delivery to MRSA biofilm-infected wound. In simulated wound fluid, PLGA-PEI/NO NPs show an extended NO release over 4 days. PLGA-PEI/NO NPs firmly bind to the MRSA biofilm matrix, resulting in a greatly enhanced anti-biofilm activity. Moreover, PLGA-PEI/NO NPs accelerate healing of MRSA biofilm-infected wounds in diabetic mice along with complete biofilm dispersal and reduced bacterial burden. These results suggest that the biofilm-binding NO-releasing NPs represent a promising NO delivery system for the treatments of biofilm-infected chronic wounds.


Assuntos
Antibacterianos/farmacologia , Complicações do Diabetes/tratamento farmacológico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Nanopartículas/química , Infecções Cutâneas Estafilocócicas/tratamento farmacológico , Ferimentos e Lesões/tratamento farmacológico , Animais , Antibacterianos/química , Antibacterianos/metabolismo , Compostos Azo/química , Biofilmes/efeitos dos fármacos , Complicações do Diabetes/microbiologia , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Experimental/microbiologia , Liberação Controlada de Fármacos , Masculino , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos ICR , Óxido Nítrico/farmacocinética , Polietilenoimina/química , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/química , Infecções Cutâneas Estafilocócicas/complicações , Cicatrização/efeitos dos fármacos , Ferimentos e Lesões/complicações , Ferimentos e Lesões/microbiologia , Ferimentos e Lesões/patologia
12.
Rev Assoc Med Bras (1992) ; 65(5): 678-681, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31166445

RESUMO

OBJECTIVE: We describe the case of a diabetic patient who developed vertebral osteomyelitis and bilateral psoas abscess with gas formation due to klebsiella pneumoniae. METHODS: A 64-year-old woman with a 4-year history of type-2 diabetes mellitus was admitted to the Emergency Department. The subject had a 2-day history of high-grade fever associated with chills and a 5-hour history of consciousness. She received empirical treatment with febrifuge, after which her fever decreased. RESULTS: Her fever recurred after an interval of three hours. A computed tomography scan of the abdomen revealed vertebral osteomyelitis and bilateral psoas muscle abscess with gas formation. Blood culture and purulent fluid described the growth of the Klebsiella pneumoniae. The patient received antibiotic therapy and bilateral drainage therapy after the drainage catheter was placed into the abscess cavity by CT-guidance. Due to the serious damage to the vertebral column and permanent pain, the patient underwent minimally invasive internal spinal fixation and recovered successfully. CONCLUSION: A case of vertebral osteomyelitis and bilateral psoas abscess with gas formation caused by Klebsiella pneumoniae in a diabetic patient. Antibiotic therapy, drainage, and minimally invasive internal spinal fixation were performed, which enabled a good outcome.


Assuntos
Complicações do Diabetes/cirurgia , Infecções por Klebsiella/cirurgia , Klebsiella pneumoniae/patogenicidade , Osteomielite/cirurgia , Abscesso do Psoas/cirurgia , Doenças da Coluna Vertebral/cirurgia , Complicações do Diabetes/microbiologia , Drenagem/métodos , Feminino , Gases/metabolismo , Humanos , Infecções por Klebsiella/microbiologia , Pessoa de Meia-Idade , Osteomielite/microbiologia , Abscesso do Psoas/microbiologia , Reprodutibilidade dos Testes , Doenças da Coluna Vertebral/microbiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
13.
Afr Health Sci ; 19(1): 1617-1627, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31148991

RESUMO

Purpose: To determine the pattern and bacteriological characteristics of diabetic foot ulcers in patients attending a tertiary health care facility. Method: 160 Patients with Diabetes Mellitus foot syndrome were recruited, out of which 52 had diabetic foot ulcers. Relevant clinical, biochemical, and microbiological evaluations were carried out on the subjects. Data analysis was done using SPSS version 20. p value was set at <0.05. Results: 52 (32.5%) out of 160 subjects with Diabetes Mellitus Foot Syndrome (DMFS) had diabetic foot ulcers. Poor glycaemic control (mean HbA1c = 9.2 (2.7) %), and abuse of antibiotics (76.9%) characterized the subjects. Foot ulcers mainly involved the right lower limb and followed spontaneous blister formation (50%). Microbiological culture pattern was polymicrobial (71.2%); predominantly anaerobic organisms (53.3%). Gram positive and negative aerobic isolates yielded high sensitivity to common quinolones (76% - 87.8%). The gram positive and negative anaerobic isolates were highly sensitive to Clindamycin and Metronidazole respectively (80.2% - 97.8%). High sensitivity (>80%) yield for gram negative anaerobes was recorded for Imipinem and Ampicillin/Sulbactam. Conclusion: Diabetic foot ulcers (DFU) contribute about one-third of DMFS. The bacteriological isolates from these ulcers are mainly polymicrobial with high sensitivity to common antibiotics. The need for appropriate use of antibiotics should be advocated among the patients.


Assuntos
Infecções Bacterianas/microbiologia , Complicações do Diabetes/microbiologia , Pé Diabético/microbiologia , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Glicemia/metabolismo , Pé Diabético/tratamento farmacológico , Pé Diabético/epidemiologia , Resistência Microbiana a Medicamentos , Feminino , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Hospitais de Ensino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Nigéria/epidemiologia , Centros de Atenção Terciária
14.
Curr Microbiol ; 76(7): 842-847, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31053906

RESUMO

Diabetic foot ulcer infections are frequently polymicrobial in nature and exhibit increased morbidity and mortality, as well as, treatment failures. Interactions between Acinetobacter baumannii and Staphylococcus aureus were studied, which showed strain-dependent changes in growth and antibiotic susceptibility. This study examined the interactions between two clinical strains of A. baumannii (1929) and S. aureus (1928) that were recovered from skin and soft tissues of a diabetic patient. When S. aureus 1928 and A. baumannii 1929 were co-cultured together, there was no significant decrease in growth in either clinical strains, indicating that both strains can co-exist in the same site of infection. Additionally, neither strains experienced statistically significant changes in susceptibility. These findings highlight that these two pathogens can be found in the same niche of infection, which may lead to more aggressive outcome of the infection.


Assuntos
Infecções por Acinetobacter/microbiologia , Coinfecção/microbiologia , Pé Diabético/microbiologia , Interações Microbianas , Infecções dos Tecidos Moles/microbiologia , Infecções Estafilocócicas/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/crescimento & desenvolvimento , Acinetobacter baumannii/isolamento & purificação , Acinetobacter baumannii/fisiologia , Antibacterianos/farmacologia , Complicações do Diabetes/microbiologia , Humanos , Testes de Sensibilidade Microbiana , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/crescimento & desenvolvimento , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/fisiologia
15.
ABCS health sci ; 44(1): 75-79, 02 maio 2019. tab
Artigo em Inglês | LILACS | ID: biblio-995057

RESUMO

INTRODUCTION: Tropical pyomyositis is an infectious disease that affects skeletal muscle and may appear as a diffuse inflammation or a rapidly progressive myonecrotic process. The predisposition of this disease in diabetics is already mentioned in several studies. The pathogenesis is possibly related to changes in neutrophils and the reversal of the immune response pattern that occurs in situations such as parasitic diseases. Staphylococcus aureus is the most common microorganism, accounting for 90% of cases of tropical pyomyositis. The diagnosis is sometimes late because patients usually do not seek care by the first symptoms, and because it is a rare disease and physicians are not very familiar with it. CASE REPORT: A 42-year-old male patient with diabetes mellitus, hypothyroidism, anemia, thrombocytopenia, and hypoalbuminemia developed tropical pyomyositis with multiple muscle abscesses in quadriceps, soleus and anterior tibial, triceps and biceps brachialis and pronator round, requiring prolonged antibiotic therapy and surgical drainage. CONCLUSION: Pyomyositis is a little known disease and if not diagnosed early can be fatal.


INTRODUÇÃO: A piomiosite tropical é uma doença infecciosa que afeta o músculo esquelético, aparecendo como uma inflamação difusa ou um processo mionecrótico rapidamente progressivo. A predisposição desta enfermidade em diabéticos já é referida em vários estudos. A patogênese possivelmente está relacionada a alterações nos neutrófilos e na inversão do padrão de resposta imune que acontece em situações como parasitoses. Staphylococcus aureus é o microorganismo mais comum, representando 90% dos casos de piomiosite tropical. O diagnóstico pode ser tardio porque os pacientes geralmente não buscam cuidados com os primeiros sintomas e, por ser uma doença rara, pode surpreender um médico ainda não familiarizado com esta entidade clínica. RELATO DE CASO: Paciente do sexo masculino com 42 anos de idade com diabetes mellitus, hipotireoidismo, anemia, trombocitopenia e hipoalbuminemia que desenvolveu piomiosite tropical com múltiplos abscessos musculares em quadríceps, sóleo e tibial anterior, tríceps e bíceps braquial e pronador redondo, necessitando de antibioticoterapia prolongada e drenagem cirúrgica. CONCLUSÃO: A piomiosite não é uma doença bem conhecida e pode ser fatal se não for diagnosticada precocemente.


Assuntos
Humanos , Masculino , Adulto , Complicações do Diabetes/microbiologia , Piomiosite/microbiologia , Infecções Estafilocócicas , Abscesso
16.
Transpl Infect Dis ; 21(3): e13082, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30892778

RESUMO

Burkholderia cepacia complex (Bcc) includes several phenotypically similar but genotypically distinct gram-negative bacteria (GNB) that can colonize the respiratory tract of Cystic Fibrosis (CF) patients. Pathogens are difficult to treat due to intrinsic resistance to multiple antibiotics and are associated to a more rapid decline in lung function and to increased mortality, particularly after lung transplantation. For all these reasons, chronic infection by Burkholderia (B) cenocepacia is presently considered a relative or absolute contraindication in almost all lung transplant centres. We report the case of a young adult CF patient chronically colonized by B multivorans genomovar II, with diabetes and end-stage renal disease treated with renal replacement therapy: a few months after lung transplantation, she developed post-surgery B multivorans bacteremia and multiple brain abscesses. This severe infection did not improve despite multiple standard antibiotic regimen. The introduction of ceftazidime-avibactam, a new ß-lactam/ ß-lactamase inhibitor combination resulted in clinical recovery and in radiological and biochemical improvement.


Assuntos
Compostos Azabicíclicos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Infecções por Burkholderia/tratamento farmacológico , Ceftazidima/uso terapêutico , Fibrose Cística/complicações , Transplante de Pulmão/efeitos adversos , Adulto , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Abscesso Encefálico/microbiologia , Infecções por Burkholderia/etiologia , Complexo Burkholderia cepacia/efeitos dos fármacos , Fibrose Cística/microbiologia , Complicações do Diabetes/microbiologia , Combinação de Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/microbiologia , Pulmão/microbiologia , Pulmão/patologia , Resultado do Tratamento
17.
J Laryngol Otol ; 133(4): 324-328, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30924432

RESUMO

BACKGROUND: The incidence of deep neck space abscesses, which can result in significant morbidity and mortality, is rising. The aetiology is thought to be dental. However, this study suggests a reduction in tonsillectomies may be associated with the rise. METHOD: In a retrospective cohort study, patients were identified by a clinical code within one hospital over 10 years. Evidence of preceding infection source, management, lifestyle risks, comorbidities and demographics were extracted. RESULTS: Fifty-two patients were included: 23 (44 per cent) had concurrent or recent tonsillitis; 11 (21 per cent) had poor dental hygiene; 22 (42 per cent) were smokers; and 9 (17 per cent) had diabetes. The incidence of deep neck space abscess cases increased from 1 in 2006, to 15 in 2015 (correlation value 0.9; p = 0.00019). CONCLUSION: The incidence of deep neck space abscess cases is increasing. Risk factors include tonsillitis, smoking and dental infection. This paper adds to the growing evidence that deep neck space abscesses are increasingly related to tonsillitis, and questions whether the threshold for tonsillectomy has been raised too high.


Assuntos
Complicações do Diabetes/microbiologia , Abscesso Peritonsilar/epidemiologia , Fumar/efeitos adversos , Doenças Estomatognáticas/microbiologia , Tonsilite/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Higiene Bucal , Abscesso Peritonsilar/etiologia , Estudos Retrospectivos , Doenças Estomatognáticas/complicações , Adulto Jovem
18.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 45(2): 117-127, mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-188060

RESUMO

Es conocida la relación bidireccional entre enfermedades infecciosas y diabetes. Las personas con diabetes tienen mayor riesgo de presentar enfermedades infecciosas, pudiendo ser estas de mayor severidad; y por otro lado, las enfermedades infecciosas desestabilizan el control metabólico de las personas con diabetes. El envejecimiento importante de la población es debido en parte al aumento de la supervivencia de pacientes con enfermedades crónicas, entre ellas la diabetes. Mejorar la prevención de enfermedades infecciosas en este grupo de población podría disminuir las complicaciones de estas enfermedades, así como las consecuencias de la desestabilización de la enfermedad de base (morbilidad, discapacidad, ingresos hospitalarios, costes sanitarios, tasas de mortalidad), mejorando además la calidad de vida de las personas con diabetes. La presente revisión expone el tratamiento de las enfermedades infecciosas en personas con diabetes y el abordaje de las enfermedades inmunoprevenibles con las vacunas recomendadas en la actualidad


The bidirectional relationship between infectious diseases and diabetes is well-known. On the one hand, diabetes patients are at a higher risk of presenting with infectious diseases, possibly with more severity, and on the other hand, infectious diseases impair metabolic control in patients with diabetes. Population ageing arises partly due to an increased survival rate in chronic diseases, of which diabetes is amongst them. Improving infectious disease prevention could reduce complications arising from the former diseases, consequences of decompensated diabetes condition (morbidity, incapacity, hospital admissions, healthcare costs, and mortality rates) and result in improved quality of life in patients with diabetes. The current review presents the treatment of infectious diseases in patients with diabetes and the dealing with immuno-preventable diseases with the currently advised vaccinations


Assuntos
Humanos , Infecções Bacterianas/terapia , Complicações do Diabetes/microbiologia , Complicações do Diabetes/prevenção & controle , Infecções Bacterianas/complicações , Infecções Bacterianas/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Micoses/complicações , Micoses/prevenção & controle , Guias de Prática Clínica como Assunto
19.
PLoS One ; 14(2): e0211822, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30730937

RESUMO

BACKGROUND: Diabetes Mellitus (DM) is a known risk factor for tuberculosis (TB) but little is known on TB-Diabetes Mellitus (TBDM) co-morbidity in Sub-Saharan Africa. METHODS: Consecutive TB cases registered at a tertiary facility in Ghana were recruited from September 2012 to April 2016 and screened for DM using random blood glucose and glycated hemoglobin (HbA1c) level. TB patients were tested for other clinical parameters including HIV co-infection and TB lesion location. Mycobacterial isolates obtained from collected sputum samples were characterized by standard methods. Associations between TBDM patients' epidemiological as well as microbiological variables were assessed. RESULTS: The prevalence of DM at time of diagnosis among 2990 enrolled TB cases was 9.4% (282/2990). TBDM cases were significantly associated with weight loss, poor appetite, night sweat and fatigue (p<0.001) and were more likely (p<0.001) to have lower lung cavitation 85.8% (242/282) compared to TB Non-Diabetic (TBNDM) patients 3.3% (90/2708). We observed 22.3% (63/282) treatment failures among TBDM patients compared to 3.8% (102/2708) among TBNDM patients (p<0.001). We found no significant difference in the TBDM burden attributed by M. tuberculosis sensu stricto (Mtbss) and Mycobacterium africanum (Maf) and (Mtbss; 176/1836, 9.6% and Maf; 53/468, 11.3%, p = 0.2612). We found that diabetic individuals were suggestively likely to present with TB caused by M. africanum Lineage 6 as opposed to Mtbss (odds ratio (OR) = 1.52; 95% confidence interval (CI): 0.92-2.42, p = 0.072). CONCLUSION: Our findings confirms the importance of screening for diabetes during TB diagnosis and highlights the association between genetic diversity and diabetes. in Ghana.


Assuntos
Coinfecção , Complicações do Diabetes , Infecções por HIV , HIV-1 , Mycobacterium tuberculosis , Tuberculose , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Coinfecção/diagnóstico , Coinfecção/epidemiologia , Coinfecção/microbiologia , Coinfecção/virologia , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/microbiologia , Complicações do Diabetes/virologia , Feminino , Gana/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/microbiologia , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/microbiologia , Tuberculose/virologia
20.
BMC Infect Dis ; 19(1): 143, 2019 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-30755178

RESUMO

BACKGROUND: Melioidosis is an infection caused by Burkholderia pseudomallei, which is more prevalent in the tropics and leads to significant morbidity and mortality. It characteristically produces widespread caseous lesions and abscesses, and can present with varied clinical manifestations. Melioidosis involving the central nervous system is uncommon. CASE PRESENTATION: A 42-year-old Sri Lankan male with type 2 diabetes presented with a febrile illness of 6 days with headache and constitutional symptoms. Clinical examination was unremarkable. Four days later, he developed focal seizures involving the left leg and numbness of the left side. Initial laboratory investigations were suggestive of a bacterial infection. Blood culture was reported as positive for a Pseudomonas species, which was resistant to gentamicin. Contrast enhanced CT and MRI scans of the brain showed a subdural collection in the right fronto-temporo-parietal region with possible abscess formation. Melioidosis antibody testing using indirect hemagglutination method was reactive with a titre more than 1/10,240. He was treated with intravenous meropenem and oral co-trimoxazole for 8 weeks (Intensive phase). The subdural collection was managed conservatively, and seizures were treated with oral antiepileptics. At 7 weeks, follow-up contrast enhanced MRI showed improvement of the subdural collection, and inflammatory markers had normalized. He was discharged after 8 weeks, and treated with oral co-trimoxazole and doxycycline for 6 months (eradication phase). At 6 months follow-up, the patient is asymptomatic. CONCLUSIONS: Cerebral melioidosis is an unusual presentation of melioidosis where the diagnosis can be easily missed. Knowledge of the protean manifestations of melioidosis is of paramount importance in order to detect and treat this potentially fatal infection appropriately, especially in tropical countries where the disease is endemic.


Assuntos
Encefalopatias/microbiologia , Burkholderia pseudomallei , Melioidose/complicações , Adulto , Antibacterianos/uso terapêutico , Encéfalo/patologia , Encefalopatias/complicações , Complicações do Diabetes/microbiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Doxiciclina/uso terapêutico , Gentamicinas/uso terapêutico , Humanos , Imagem por Ressonância Magnética , Masculino , Melioidose/diagnóstico , Melioidose/microbiologia , Meropeném , Espaço Subdural/patologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
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