RESUMO
We present a case report of a small boy with cystic fibrosis complicated by pertussis and pneumothorax. The child had not been vaccinated against Bordetella pertussis due to the failure to thrive and was infected with the bacterium at the age of 4 months. The course of the disease was severe, with respiratory distress and spontaneous pneumothorax. The diagnosis of pertussis was serologically confirmed. A suspicion for cystic fibrosis increased after an unusually prolonged course of the disease and a history of the failure to thrive. A comprehensive diagnostic procedure revealed Pseudomonas aeruginosa respiratory infection, anemia, pancreatic insufficiency, a positive sweat test and the presence of two CFTR gene mutations. The patient, treated with comprehensive cystic fibrosis therapy, recovered from acute respiratory illness and started to thrive soon.
Assuntos
Fibrose Cística/complicações , Coqueluche/complicações , Fibrose Cística/diagnóstico , Humanos , Lactente , Masculino , Pneumotórax/complicações , Coqueluche/diagnósticoRESUMO
"Mycobacterium avium subsp. hominissuis" often causes cervical lymphadenitis in children; its prompt and accurate identification enables adequate therapy, tracing, and prevention. The aims of this study were to determine the causative agent of lymphadenitis using culture, PCR, and triplex quantitative real-time PCR (qPCR) methods with DNA directly isolated from tissue, as well as to identify possible sources of infection from the environment. We confirmed the diagnoses by detecting M. avium subsp. hominissuis using qPCR with DNA directly isolated from lymph node biopsy specimens of two patients. In order to trace the source of infection from the environment, a method of DNA isolation from soil and other environmental samples, such as dust, cobwebs, and compost, was developed. The triplex qPCR examination revealed the presence of M. avium subsp. hominissuis in a high proportion of the environmental samples (42.8% in the first patient's house and 47.6% in the second patient's house). Both patients were also exposed to M. avium subsp. avium, which was present due to the breeding of infected domestic hens. The high infectious dose of M. avium subsp. hominissuis or the increased susceptibility of humans to M. avium subsp. hominissuis compared to M. avium subsp. avium could be the reason why the children were infected with M. avium subsp. hominissuis.
Assuntos
Técnicas Bacteriológicas/métodos , Microbiologia Ambiental , Mycobacterium avium/isolamento & purificação , Pescoço/microbiologia , Reação em Cadeia da Polimerase/métodos , Tuberculose dos Linfonodos/diagnóstico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Tipagem Molecular , Mycobacterium avium/classificação , Mycobacterium avium/genética , Mycobacterium avium/crescimento & desenvolvimento , Polimorfismo de Fragmento de Restrição , Tuberculose dos Linfonodos/microbiologiaRESUMO
In the Czech Republic, mycobacteriosis is relatively rare. The low incidence probably reflects high BCG coverage rates in the Czech population. Globally, the importance of BCG vaccine has been increasing, as a result of acquired immunodeficiencies, particularly HIV infection. The presented case report describes the course of disseminated mycobacteriosis in a Vietnamese asylum seeker with newly diagnosed advanced HIV infection. In HIV patients, disseminated mycobacteriosis, most frequently caused by members of Mycobacterium avium complex (MAC), is mostly manifested in the last stage, AIDS, with extremely severe immunodeficiency, or in immune reconstitution inflammatory syndrome (IRIS), shortly after initiation of antiretroviral therapy. From the beginning, the patient's condition was complicated by multiple simultaneous severe opportunistic infections which, together with gradually progressing atypical mycobacteriosis, resulted in overall exhaustion of the organism. The adverse prognosis of these infections is significantly influenced by prolonged diagnosis based on culture detection of slow-growing mycobacteria. In the above patient, the lethal course was contributed to by resistance to commonly used antitubercular drugs which was only detected post mortem due to time-consuming susceptibility tests.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Adulto , Humanos , Masculino , Infecção por Mycobacterium avium-intracellulare/complicaçõesRESUMO
BACKGROUND: In the differential diagnosis of protracted irritating cough we should always consider the possibility of pertussis. Serology performed primarily in a late stage of the disorder does not always provide a clear answer. We wanted to verify whether a quantitative determination of IgG antibodies to the pertussis toxin (IgG-PT) could help establish a clear diagnosis. MATERIAL AND METHODS: Between 1 January and 30 June 2005 we performed serological investigations in 139 children presenting with an irritable cough or after application of an acellular pertussis vaccine. In 95 children we compared the serological response of agglutination antibodies and IgG-PT. RESULTS: After vaccination the children presented with different levels of antibodies and these were not always identical in two types of serological response. Children with clinical manifestations of pertussis presented a good formation of antibodies, but the two kinds of antibodies often persisted for long periods at unchanged levels. CONCLUSIONS: The determination of IgG-PT can assist the diagnosis of the disease, but this investigation alone cannot yield a clear-cut confirmation of pertussis.