Melioidosis en Colombia, descripción de un caso clínico y consideraciones epidemiológicas / Melioidosis in Colombia, description of a clinical case and epidemiological considerations

Resumen La melioidosis es una enfermedad infecciosa causada por Burkholderia pseudomallei cuyo diagnóstico clínico puede ser difícil debido a su variada presentación clínica y a las dificultades del diagnóstico microbiológico, por lo cual pueden requerirse técnicas moleculares para su adecuada identificación una vez se sospecha su presencia. Son pocos los antibióticos disponibles para el tratamiento de esta enfermedad y, además, deben usarse durante un tiempo prolongado. Aunque se conoce por ser endémica en Tailandia, Malasia, Singapur, Vietnam y Australia, en Colombia se han reportado algunos pocos casos. Se presenta un caso de melioidosis en la región norte de Colombia, se hace una revisión de las características clínicas y el tratamiento, y se describe la epidemiología local de esta enfermedad.

Abstract Melioidosis is an infectious disease caused by Burkholderia pseudomallei whose clinical diagnosis can be difficult due not only to its varied clinical presentation but also to the difficulties in the microbiological diagnosis.Thus, it may be necessary to use molecular techniques for its proper identification once it is suspected. There are few antibiotics available for the treatment of this disease, which must be used over a long period of time. Although it is known to be endemic in Thailand, Malaysia, Singapore, Vietnam, and Australia, in Colombia there are few reported cases. We describe a case of melioidosis in the northern region of Colombia. Additionally, we review its clinical characteristics and treatment and we describe the local epidemiology of this disease.

Perfil dos pacientes com infecções do trato urinário diagnosticados no município de Flor do Sertão – SC / Profile of the patients with urinal treatment infections diagnosised in the city of Flor do Sertão - SC

Vários fatores, e entre eles o sexo, são determinantes para traçar o perfil epidemiológico das infecções do trato urinário. A caracterização das ITUs são essenciais para o tratamento e combate das mesmas, principalmente na saúde pública, onde a prevenção é o principal objetivo. Foram analisadas 126 uruculturas no período de 01 de outubro de 2006 a 01 de abril de 2007. As colônias isoladas foram identificadas por testes bioquímicos e tintoriais. Das 44 uruculturas positivas, 89% destas foram do sexo feminino e tendo como maior incidência os pacientes entre 20/30 anos (25%) e acima de 60 anos (25%). Foram isolados os seguintes microrganismos: Escherichia coli (50%), Klebsiella sp. (18%), Staphylococcus sp. (16%), Staphylococcus aureus e Proteus sp (7%) e Proteus vulgaris (2%). Foram 66% os pacientes que apresentaram ITU recorrente. Apenas 8% das pacientes estavam grávidas. Do total de pacientes com urucultura positiva, 11% estavam fazendo uso de algum tipo de antimicrobiano. A importância deste estudo se remete ao fato de ser o primeiro levantamento realizado no município. Os resultados mostraram a necessidade de um trabalho constante de orientação e acompanhamento, principalmente, das mulheres.

Some factors, and between them the sex, are determinative to trace the epidemiologist profile of the urinal treatment infections. The characterization of the UTIs is essential for the treatment and combat of the same ones, mainly in the public health, where the prevention is the main objective. Were analyzed 126 uricultures from October 01, 2006 to April 01, 2007. The isolated colonies were identified by biochemists and dye tests. Of the 44 positive uricultures, 89% of these were from the feminine sex and had as bigger incidence the patients between 20/30 years (25%) and above 60 years (25%). The following microrganisms had been isolated: Escherichia coli (50%), Klebsiella sp. (18%), Staphylococcus sp. (16%), Staphylococcus aureus and Proteus sp. (7%) and Proteus vulgaris (2%). 66 % of the patients presented recurrent UTI. Only 8% of the patients were pregnant. Of the total of patients with positive uriculture, 11% were making use of some type of antimicrobials. The importance of this study is the fact of being the first survey carried through in the city. The results had shown the necessity of a constant work of orientation and accompaniment, mainly, of the women.

Infección urinaria en el geronte / Urinary tract infection in the elderly

La infección urinaria es una patología común en el geronte. Esta población presenta diversos factores de riesgo, tales como la edad, la insuficiencia renal crónica y otras comorbilidades, el uso frcuente de sondas vesicales, que favorecen la incidencia de dichas infecciones. Se describe una actualización acerca de la etiología, las manifestaciones clínicas, el diagnóstico y tratamiento de las infecciones urinarias en grupos epidemiológicos seleccionados.

Renal and extrarenal manifestations of autosomal dominant polycystic kidney disease

The objective of the present study was to determine the frequency of the most common clinical features in patients with autosomal dominant polycystic kidney disease in a sample of the Brazilian population. The medical records of 92 patients with autosomal dominant polycystic kidney disease attended during the period from 1985 to 2003 were reviewed. The following data were recorded: age at diagnosis, gender, associated clinical manifestations, occurrence of stroke, age at loss of renal function (beginning of dialysis), and presence of a family history. The involvement of abdominal viscera was investigated by ultrasonography. Intracranial alterations were prospectively investigated by magnetic resonance angiography in 42 asymptomatic patients, and complemented with digital subtraction arteriography when indicated. Mean age at diagnosis was 35.1 ± 14.9 years, and mean serum creatinine at referral was 2.4 ± 2.8 mg/dL. The most frequent clinical manifestations during the disease were arterial hypertension (63.3 percent), lumbar pain (55.4 percent), an abdominal mass (47.8 percent), and urinary infection (35.8 percent). Loss of renal function occurred in 27 patients (mean age: 45.4 ± 9.5 years). The liver was the second organ most frequently affected (39.1 percent). Stroke occurred in 7.6 percent of the patients. Asymptomatic intracranial aneurysm was detected in 3 patients and arachnoid cysts in 3 other patients. In conclusion, the most common clinical features were lumbar pain, arterial hypertension, abdominal mass, and urinary infection, and the most serious complications were chronic renal failure and stroke. Both intracranial aneurysms and arachnoid cysts occurred in asymptomatic patients at a frequency of 7.14 percent.

Infecções do trato urinário / Urinary tract infections

As infecções do trato urinário(ITU) são consideradas as mais comuns infecções bacterianas, responsáveis por 80 em cada 1.000 consultas clínicas. Ademais, cerca de 15(por cemto) dos óbitos por insuficiência renal resultam de lesão secundária à infecção crônica renal. Conquanto as ITUs ocorram com a devida freqüência em crianças até os seis anos de idade e em mulheres jovens, a prevalência dessas inefcções se eleva com a idade, passando a representar doença de grande importância em adultos idosos.No presente artigo, os autores descrevem as caracteristicas epidemilógicas, os agentes patogênicos e os pontos importantes na clínica e diagnóstico da ITUs,abordando aspectos práticos do tratamento e profilaxia desta importante afecção.

Asymptomatic bacteriuria and inflammatory response urinary tract infection of elderly ambulatory women in nursing homes

Background. Bacteriuria = 10 to fifth CFU/ml is evidence of urinary tract infection in the absence of associated signs or symptoms. The presence of pyuria with asymptomatic bacteriuria established the response of elderly women against microorganisms capable of causing invasiveness or tissue injury of the urinary tract. Methods. The association between bacteriuria and pyuria was determined in 178 elderly, ambulatory women without symptoms of urinary tract infection in seven nursing homes. Urine culture results were subsequently analyzed in conjunction with absolute leukocyte count in urine. In this cross-sectional study, asymptomatic bacteriuria in elderly women was classified with and without pyuria. Results. The prevalence of asymptomatic bacteriuria was found in 44 (24.7 percent) elderly women. The presence of pyuria had a sensitivity of 63.6 percent for bacteriuria and a specificity of 91 percent. The positive predictive value for the presence of pyuria predicting those with bacteriuria was 70 percent, and the negative predictive value for the absence of pyuria predicting those without bacteriuria was 88.4 percent. Escherichia coli was the most common organism isolated in 81.8 percent of the women. Conclusions. bacteriuria = 10 to fifth CFU/ml associated with pyuria was detected in 77 percent of elderly women with asymptomatic urinary tract infections bacteriuria of < 10 to fifth CFU/ml with pyuria proves less sensitive as an indicator of urinary tract infection. Elderly women with pyuria but without bacteriuria should be studied for other causes of urinary tractinflammation

Presentaciones inhabituales de infecciones del tracto urinario en 6 casos / Unusual presentation of urinary tract infections in 6 cases

Urinary tract infections may have different clinical presentations that may range from asymptomatic bacteriuria to purulent collections and severe sepsis. We report 6 diabetic patients, 3 presenting with a renal carbuncle and 3 with an emphysematous pyelonephritis. All required medical and surgical treatment and had a good evolution. Two carbuncles were caused by beta-hemolitic type B streptococcus. This is the second notification of this agent as causative of renal abscesses, probably reaching the kidney through hematogenous dissemination from cutaneous foci

Infección urinaria en el niño / Urinary infection in children

La infección urinaria es una entidad nosológica de gran importancia en la edad pediátrica. El conocimiento de sus aspectos epidemiológicos y patogénicos, así como las perspectivas de su manejo son información necesaria y casi obligatoria para el Pediatra y el Médico General que atiende niños. La frecuencia de casos no diagnósticados y confundidos con otras patologías determina que, en muchas oportunidades, se produzcan alteraciones de la función renal de graves consecuencias en la edad adulta como son la hipertensión arterial y la insuficiencia renal crónica

Urolitiasis en la edad pediátrica: presentacion de 72 casos / Urolithiasis in the pediatric age: report of 72 cases

La litiasis urinaria en el niño ha demostrado, en nuestro medio, una incidencia mayor a la reportada en la mayoría de los estudios publicados hasta ahora. En el presente trabajo reportamos nuestra experiencia en 71 niños con diagnóstico de urolitiasis. Las manifestaciones clínicas más frecuentes fueron la hematuria y el dolor abdominal. Encontramos un predominio significativo de la litiasis del tracto urinario superior siendo sólo dos, los cálculos de localización vesical. En la totalidad de los casos se logró evidenciar un factor etiológico para la litiasis, siendo más importantes las causas de tipo metabólico acidosis tubular distal e hipercalcinuria). Las anomalías estructurales del tracto urinario también constituyen una causa importante de litiasis en nuestros pacientes, siendo la más frecuente de ellas el Riñón de Esponja. En la exploración diagnóstica del niño con urolitiasis debe incluirse la evaluación de la función renal, especialmente en lo que refiere a la excreción urinaria de calcio y la capacidad de acidificación distal. Es importante la ultrasonografía renal como método diagnóstico debido a su mayor sensibilidad para evidenciar calcificaciones renales incipientes. Se hace énfasis en la prevención de la urolitiasis en el niño mediante la educación, en cuanto a evitar las dietas ricas en lacticíneos y mediante la estimulación de una ingesta adecuada de líquidos, especialmente en las regiones más cálidas de nuestra geografía

Caracteristicas epidemiologicas de los pacientes que presentaron infeccion urinaria en el servicio de cirugia / Epidemiologic characteristics of the patients who presented urinary infection in the surgical ward

Analiza las caracteristicas de los pacientes que estando hospitalizados en el servicio quirurgico del Hospital San Ignacio presentaron infeccion urinaria, entre junio de 1985 y junio de 1986; con base en la informacion de la historia clinica. Durante este periodo la incidencia de infeccion urinaria tuvo una tasa de 0.9%de los pacientes infectados, 9 (41%) fueron mujeres y 13 (59%) hombres, entre 16 y 76 anos. El grupo de hombres de 16-31 constituyo el 46%y las mujeres entre 62 y 74 anos el 44.4%. Ademas de ser 2 grupos de poblacion que con frecuencia sufren traumatismos, claramente identificados como factores de riesgo, se encontro gran relacion (91%) entre la aparicion de la infeccion y la presencia de sonda vesical permanente. Los microorganismos detectados con mas frecuencia fueron E. coli 37.5%, pseudomona 16.6%, serratia, klepsiella y otros 12.5%respectivamente. Los pacientes mas afectados (33.3%) fueron quienes habian sufrido trauma del sistema nervioso central, seguidos por pacientes con cirugia gastrointestinal y lesiones de la columna vertebral. Los pacientes que tuvieron la sonda vesical entre 1 y 7 dias presentaron el mismo indice de infeccion que quienes la tuvieron entre 8 y 14 dias (35%) por lo cual se deduce que el tiempo de permanencia de la sonda no es factor de riesgo. El 49.13%de los casos recibio antibioticoterapia 7-13 dias, el 35.6%, 1-6 dias, el 12.3%, 14-20 dias y el 2.7%mas de 21 dias con una o mas drogas.

Bateriuria asintomática en hemodializados / Asymptomatic bacteriuria in hemodialysis patients

Tomado de la grabación de la sesión