Everybody nose: molecular and clinical characteristics of nasal colonization during active methicillin-resistant Staphylococcus aureus bloodstream infection.

BACKGROUND: Healthcare-associated infections pose a potentially fatal threat to patients worldwide and Staphylococcus aureus is one of the most common causes of healthcare-associated infections. S. aureus is a common commensal pathogen and a frequent cause of bacteremia, with studies demonstrating that nasal and blood isolates from single patients match more than 80% of the time. Here we report on a contemporary collection of colonizing isolates from those with methicillin-resistant S. aureus (MRSA) bloodstream infections to evaluate the diversity within hosts, and detail the clinical features associated with concomitant nasal colonization. METHODS: Swabs of the bilateral anterior nares were obtained from patients diagnosed with MRSA bacteremia. A single colony culture from the blood and an average of 6 colonies from the nares were evaluated for MRSA growth. For the nares cultures, we typed multiple isolates for staphylococcal protein A (spa) and derived the clonal complexes. Demographic and clinical data were obtained retrospectively from the electronic medical record system and analysed using univariate and multivariable regression models. RESULTS: Over an 11-month period, 68 patients were diagnosed with MRSA bloodstream infection, 53 were swabbed, and 37 (70%) were colonized with MRSA in the anterior nares. We performed molecular typing on 213 nasal colonies. Spa types and clonal complexes found in the blood were also detected in the nares in 95% of the cases. We also found that 11% of patients carried more than one clone of MRSA in the nares. Male sex and history of prior hospitalization within the past 90 days increased odds for MRSA colonization. CONCLUSION: The molecular epidemiological landscape of colonization in the setting of invasive disease is diverse and defining the interplay between colonization and invasive disease is critical to combating invasive MRSA disease.

Extranodal NK/T-Cell Lymphoma, Nasal Type, Presenting as Refractory Pseudomonas aeruginosa Facial Cellulitis.

Extranodal natural killer T-cell lymphoma, nasal type (ENKL), formerly called lethal midline granuloma or angiocentric T-cell lymphoma, is a predominantly extranodal non-Hodgkin lymphoma characterized by vascular damage, necrosis, and an association with Epstein-Barr virus. In the United States, it is more frequently seen in Asian, Asian Pacific Islander, and Hispanic descent populations and is more prevalent in males in their fifth decade. Clinical presentation of NK nasal lymphoma most commonly involves epistaxis; obstruction; discharge; destructive mass in sinuses, palate, and nose; and skin ulceration. These symptoms can mimic invasive fungal infections and other sinonasal disorders. Furthermore, ENKL has a broad cytologic spectrum and induces a mixture of inflammatory cells, causing difficulty in establishing the diagnosis, especially in initial biopsies. We present a case of refractory Pseudomonas aeruginosa facial cellulitis in a young woman whose treatment course was complicated by septic shock and resistance to multiple antibiotics, resulting in a delayed diagnosis of ENKL nasal type.

Cesarea como factor de riesgo para desarrollar asma bronquial en niños entre 3 y 5 años / Caesarea as a risk factor for developing asthma in children aged 3 to 5 years

Introducción y Objetivos: Se realizó un estudio de tipo caso y control, analítico, retrospectivo en el Instituto Nacional de Salud del Niño (INSN) entre Marzo y Junio del 2010. El objetivo es determinar si la cesárea es un factor de riesgo para desarrollar asma bronquial en niños entre 3 y 5 años. Materiales y Métodos: Se tomo una muestra de 630 Historias Clínicas (315 casos y 315 controles). Los casos fueron niños con diagnóstico de asma bronquial entre 3 y 5 años atendidos en la unidad de asma del INSN y para los controles fueron niños diagnosticados como niño sano atendidos en el servicio de pediatría del INSN. Tanto los casos como los controles fueron diagnosticados por consultorio externo entre los años 2007 al 2009. Resultados: El parto por cesárea está asociado al desarrollo de asma bronquial (p = 0.000), OR=2.8, LC (OR) = (1.9 - 4.1). Lo cual indica que el parto por cesárea tiene 2.8 veces más riesgo para desarrollar asma bronquial frente al parto por vía vaginal. Este riesgo es como mínimo 1.9 y máximo 4.1. Conclusiones: El parto por cesárea es un factor de riesgo para desarrollar asma bronquial en niños entre 3 y 5 años

Introduction and Objectives: This is an analytical, retrospective case and control study done in the Instituto Nacional de Salud del Niño (INSN) between March and June 2010. The objective is to determínate if caesarean delivery is a risk factor to develop bronchial asthma in children between 3 and 5 years old. Materials and Methods: The sample is 630 Clinical Histories (315 cases and 315 controls). The cases were children between 3 and 5 years old diagnosed with bronchial asthma. These were taken from the asthma unit outpacient consult in the INSN. The controls were children between 3 and 5 years old diagnosed as healthy child. These were taken from the pediatríc service outpatient consult in the INSN. The cases and the controls were diagnosed between 2007 and 2009. Results: Cesarean delivery is associated with the development of bronchial asthma (p = 0.000), OR = 2.8, Cl (OR) = (1.9 - 4.1). This indicates that cesarean delivery is 2.8 times more likely to develop asthma compared with vaginal deliver. Minimum and maximum risk is 1.9 and 4.1 respectively. Conclusions: Caesarean delivery is a risk factor to develop asthma in children between 3 and 5 years old