ABSTRACT
El diagnóstico de la infección por Clostridioides dfficile (ICD) ha aumentado en el embarazo y periparto. Cambios fisiológicos e inmunológicos normales durante el embarazo pueden incrementar el riesgo de ICD. Mujeres embarazadas con ICD tienen una mayor frecuencia de fracaso al tratamiento y una significativa morbilidad y mortalidad. El trasplante de microbiota fecal (TMF) se ha convertido en el tratamiento estándar de la ICD recurrente y refractaria. Sin embargo, existen escasos datos sobre sus resultados en mujeres embarazadas. Presentamos el caso de una mujer embarazada que se sometió con éxito a un TMF para el tratamiento de una ICD recurrente.
The diagnosis of Clostridioides dfficile infection (CDI) in pregnant and peripartum women has increased. In this scenario, there are higher rates of treatment failure and a significant maternal morbidity and mortality. Fecal microbiota transplant (FMT) has become the gold standard for the treatment of recurrent and refractory CDI however, there are few data on its results in pregnant patients. This case showed that FMT could be a therapeutic strategy in pregnant women with recurrent CDI.
ABSTRACT
Aseptic meningitis represents a diagnostic challenge for the clinician. Cytological and chemical parameters are key in the differential diagnosis. Hypoglycorrhachia is a strong predictor of a bacterial origin for aseptic meningitis. We report a 44-year-old male with a history of recurrent febrile headaches admitted with fever and delirium. The initial cerebrospinal fluid (CSF) analysis showed low glucose levels. Magnetic resonance imaging did not show abnormalities. The patient was discharged but was admitted again three weeks later with fever, headache and a stiff neck. The CSF was inflammatory with low glucose levels. Serology for brucellosis was positive. The patient was treated with ceftriaxone and rifampicin with a good clinical response.
ABSTRACT
Resumen La infección por Clostridioides (previamente Clostridium) difficile se ha convertido en un problema de salud importante debido al aumento en su incidencia, gravedad y recurrencia. En este último escenario, una edad mayor de 65 años ha sido asociada a una evolución más desfavorable. Factores de riesgo como la presencia de una inmunidad alterada, co-morbilidades, malnutrición, polifarmacia y cambios en la microbiota intestinal explicarían este mayor riesgo a mayor edad. El trasplante de microbiota fecal (TMF) es una estrategia efectiva en el tratamiento de la infección recurrente por Clostridioides difficile cuando la terapia estándar fracasa. Guías publicadas recientemente sugieren que esta estrategia puede ser utilizada a partir de la segunda recurrencia. Sin embargo, escasos estudios han evaluado los resultados del TMF en pacientes mayores de 65 años y para nuestro conocimiento existe una escasa experiencia nacional en este grupo de pacientes. Presentamos dos casos de TMF en pacientes octogenarios con una infección recurrente por Clostridioides difficile, con una evolución satisfactoria a largo plazo.
Clostridioides (formerly Clostridium) difficile infection has become a major health problem due to the increase in its incidence, severity, and recurrence. In this last scenario, age over 65 has been associated with a more unfavorable evolution. Risk factors such as the presence of altered immunity, comorbidities, malnutrition, polypharmacy, and changes in the intestinal microbiota would explain this higher risk in this group of patients. On the other hand, fecal microbiota transplantation (FMT) is an effective strategy in the treatment of recurrent Clostridioides difficile infection when standard therapy fails. Recently published guidelines suggest that this strategy can be used from the second recurrence. However, few studies have evaluated the results of the FMT in patients over 65 years old, and for our knowledge, there is limited national experience in this group of patients. We present two cases of TMF in octogenarian patients with a recurrent infection due to Clostridioides difficile, with satisfactory recovery at the long term.
Subject(s)
Humans , Female , Aged, 80 and over , Clostridium Infections/therapy , Diarrhea/microbiology , Fecal Microbiota Transplantation , RecurrenceABSTRACT
Background: Most cases of Clostridium difficile infection (CDI) respond to a standard course of antibiotics, however recurrent CDI is becoming common and alternative therapeutic strategies are needed. In this scenario, fecal microbiota transplantation (FMT) has been suggested. Aim: To describe the efficacy and safety of FMT for the treatment of recurrent CDI. Patients and Methods: Review of medical records of all patients with recurrent CDI treated with FMT between April 2013 and April 2017. Demographic and clinical data were abstracted including details of treatment prior to FMT, rate of FMT treatment success and clinical course during follow-up period. Telephone surveys were conducted to determine patient satisfaction. Results: Eight patients aged 19 to 82 years (six women) underwent FMT. They experienced a median of four previous episodes of CDI (range 3-8). The mean duration of CDI was 18 days (range 3-36) before FMT. All procedures were performed by colonoscopy. Effectiveness with one session of FMT was 100%. During the follow-up period (median 24 months, range 7-55), two patients developed CDI, one of them after using antibiotics. Adverse events were reported in three patients. Two had bloating and one patient with Crohn's disease and a history of bacteremia had an episode of Escherichia coli bacteremia. All patients would use FMT again if necessary. Conclusions: FMT through colonoscopy appears to be a safe, effective and long-lasting therapy in cases of recurrent CDI.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Colonoscopy , Clostridium Infections/therapy , Fecal Microbiota Transplantation/methods , Recurrence , Clostridioides difficile , Treatment Outcome , Feces/microbiology , Fecal Microbiota Transplantation/adverse effects , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/therapeutic useABSTRACT
Serratia marcescens is a widely distributed gram-negative rod, often associated to nosocomial infections. Some outbreaks linked to contaminated antiseptic solutions have been reported. In this study we report a nosocomial outbreak of surgical site infection and catheter insertion site infection due to S. marcescens. 33 patients with positive cultures were studied after an index case was identified. Epidemiological, microbiological and molecular analysis demostrated an intrinsic contamination of alcohol free chlorhexidine solution as causal factor. Positive cultures were associated with 13 clinical infections, 9 colonized patients, 6 pseudobacteremia episodes and 5 patients without documented exposure. Hospital and national recall of contaminated chlorhexidine solution was performed after this study. Intrinsic contamination of antiseptic solutions is an infrequent cause of nosocomial infections with major epidemiological relevance.
Serratia marcescens es un bacilo gramnegativo de amplia distribución, frecuentemente asociado a infecciones nosocomiales. Se han descrito brotes asociados a la contaminación de diversas soluciones antisépticas. Describimos a continuación un brote de infección de sitio operatorio (ISO) y de infección de sitio de inserción de catéter vascular (ISC) por S. marcescens. A raíz de un caso índice se estudió un total de 33 pacientes con cultivo positivo para S. marcescens. El análisis epidemiológico, microbiológico y molecular logró demostrar la contaminación intrínseca de un lote de clorhexidina acuosa, como fuente común de exposición. Las muestras positivas correspondieron a 13 infecciones clínicas, nueve colonizaciones, seis pseudo-bacteriemias y cinco pacientes sin exposición demostrada. Los resultados de este estudio determinaron el retiro del producto de la institución y posteriormente a nivel nacional. La contaminación intrínseca de antisépticos es una causa poco frecuente de brotes de infecciones nosocomiales cuya identificación posee un gran impacto epidemiológico.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Chlorhexidine , Cross Infection/transmission , Disinfectants , Drug Contamination , Serratia Infections/transmission , Serratia marcescens/isolation & purification , Cross Infection/diagnosis , Cross Infection/epidemiology , Cross Infection/microbiology , Disease Outbreaks , Seasons , Serratia Infections/diagnosis , Serratia Infections/epidemiologyABSTRACT
Clostridium difficile (CD) infection is increasing in frequency and severity in in-hospital and outpatient clinical settings, with a recurrence that can reach 30% after first episode. The recurrences are usually treated with longer courses of metronidazole or vancomycin. Other treatments have been used, such as probiotics, fidaxomicin, rifaximin, immunoglobulins and monoclonal antibodies against toxins A and B. Fecal microbiota transplantation (FMT) has emerged as a promising strategy in this group of patients, with effectiveness greater than 90%. We present the first case reported in Chile of this therapeutic strategy in a patient with Crohn's disease and recurrent CD infection who presented after the fecal transplantation an Escherichia coli bacteremia, suggesting the need for caution in the use of this strategy. 10 months after the FMT the patient presented a new episode of E. coli bacteremia and two episodes of diarrhea due to CD infection, treated both of them with vancomycin with good clinical response.
La infección por Clostridium difficile (CD) está aumentando en frecuencia y gravedad tanto a nivel intrahospitalario como ambulatorio, con una recurrencia que puede alcanzar hasta 30% después de un primer episodio. Los cuadros recurrentes son generalmente tratados con cursos prolongados de metronidazol y/o vancomicina. Otras terapias han sido sugeridas como el uso de probióticos, fidaxomicina, rifaximina, inmunoglobulina y anticuerpos monoclonales para toxina A y B. El trasplante de microbiota fecal (TMF) ha emergido como una estrategia promisoria en este grupo de pacientes con una efectividad mayor a 90%. Presentamos el primer caso reportado en Chile de esta estrategia terapéutica en un paciente con enfermedad de Crohn y CD recurrente, quien presentó una bacteriemia por Escherichia coli post-TMF, sugiriendo la necesidad de tener precaución con el uso de esta estrategia. El paciente presentó a los 10 meses post-TMF un nuevo episodio de bacteriemia por E. coli y dos episodios de diarrea por CD siendo tratados ambos cuadros con vancomicina con buena respuesta clínica.
Subject(s)
Humans , Male , Middle Aged , Biological Therapy/adverse effects , Clostridioides difficile , Clostridium Infections/therapy , Escherichia coli Infections/etiology , Feces/microbiology , Microbiota , Bacteremia/microbiology , Biological Therapy/methods , Chile , Crohn Disease/microbiology , Recurrence , TransplantationABSTRACT
Background: We report a 21-year-old male, presenting with erythromelalgia and polycythe-mia. A solid renal mass of the lower pole of the right kidney was discovered. The patient was subjected to a right open partial nephrectomy. The pathological study of the surgical specimen showed a metanephric adenoma of the kidney. The patient had an uneventful postoperative evolution. Currently the patient is in good health without evidence of recurrence of the tumor and normal hematological parameters.
Subject(s)
Humans , Male , Young Adult , Adenoma/complications , Carcinoma, Renal Cell/complications , Erythromelalgia/complications , Kidney Neoplasms/complications , Polycythemia/complications , Adenoma/pathology , Kidney Neoplasms/pathologyABSTRACT
Background: Simultaneous kidney and páncreas transplantation (SKPT) is the best alternative for end stage renal disease among patients with insulin dependent diabetes mellitus. Aim: To report our experience with SKPT. Material andMethods: Retrospective analysis ofl2 recipients of SKPT transplanted in one center starting in 1994, with a meanfollow-upperiod of6.8years (2-15). Results: Eleven ofl2 recipients were in chronic hemodialysis before SKPT. Mean A, B, DR and HLA mismatch was 4.3. Mean preformed anti HLA antibodies was 3.3 percent. Mean cold ischemia times for páncreas and kidney were 6 and 10 hours, respectively. In the first eight cases, the páncreas was drained to the bladder, and in the last four, an enteric drainage was performed. Eleven recipients were induced with antibodies, and maintenance immunosuppression consisted ofCyclosporine or Tacrolimusplus an antiproliferative agent. Ten year patient survival was 70 percent. Páncreas and kidney survival, defined by insulin and dialysis independence, were 72 and 73 percent respectively. Fifty percent of recipients experienced acute graft rejection (cellular or humoral), with good response to treatment except in one case. Conclusions: This experience shows that SKPT is associated with an excellent patient survival associated to insulin and dialysis independence in 70 percent of patients at 10 years.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Diabetes Mellitus, Type 1/surgery , Kidney Failure, Chronic/surgery , Kidney Transplantation/mortality , Pancreas Transplantation/mortality , Chile , Diabetes Mellitus, Type 1/physiopathology , Epidemiologic Methods , Kidney Failure, Chronic/physiopathology , Kidney Transplantation/adverse effects , Pancreas Transplantation/adverse effects , Treatment OutcomeABSTRACT
Tipo de estudio: Prospectivo, analítico.Objetivos: Demostrar la eficacia de la prueba Amplicor HIV-1 Monitor como Standard predictivo en los pacientes con HIV-1 positivos atendidos en el servicio de Medicina Interna del hospital Teodoro Maldonado, durante el periodo comprendido entre septiembre de 1999 a diciembre de 2000.Método: Fueron estudiados 40 pacientes investigándose las siguientes variables, mes de mayor incidencia, edad, sexo, procedencia, instrucción, forma de contagio, grupo de riesgo, diagnóstico de ingreso, relación del diagnóstico con el estudio, niveles de CD4 y niveles de carga viral.Resultados: El grupo más afectado fue el masculino de 25 a 34 años, siendo la vía sexual la de mayor forma de contagio, con niveles bajos de CD4 y niveles altos de carga viral.Conclusión: El método de detección más veraz, en cuanto a predicción de la sobrevida en pacientes con HIV, es el Amplicor. De acuerdo a este resultado podemos manejarnos midiendo CD4 y carga viral para dar una mejor sobrevida al paciente.
The present analytic prospective study which investigates the standard use of Amplicor HIV-1 Monitor in the treatment of HIV-1 positive patients treated at the Internal Medicine Service at the IESS Hospital Dr. Teodoro Maldonado Carbo during the period between September 1999 thru December of 2000.Forty patients were studied in which the following variables investigated: the month in which there was a higher incidence, age, sex, place of origin, level of education, how the person got in infected, risk group, diagnosis when admitted, the connection between the diagnosis and the study, levels of CD4, levels of viral load.The age group that was most affected was from 25 to 34 years of age, the masculine sex was the predominant sex, first level education, sexual transmission was the form of infection, heterosexuals were the risk group with higher incidence, the primary cause of admission to the hospital was cerebral toxoplasmosis, CD4 levels were higher than 500 cells/mm3 and the level of viral load were elevated in half of the cases.
Subject(s)
Male , Adult , Female , Middle Aged , HIV Infections , HIV-1 , Lentivirus Infections , Viral LoadABSTRACT
El presente estudio retrospectivo trata sobre la incidencia de pacientes embarazadas que presentaron hemorragias transvaginales, siendo atendidas en el servicio de Gineco-Obstetricia del Hospital Regional de Portoviejo durante 1993 a 1995. Fueron atendidas un total de 112 pacientes de las cuales 77 fueron diagnosticadas con placenta previa (69 por ciento) y 35 pacientes diagnosticadas con desprendimiento prematuro de placenta (31 por ciento). El grupo de edad más afectado fue el de 21 a 30 años. Se concluyó que las multíparas tuvieron mayor incidencia de hemorragia transvaginal en el tercer trimestre de embarazo. La gran mayoría de embarazos fueron resueltos con cesárea segmentaria y el índice de natalidad fetal fue del 72 por ciento...
Subject(s)
Cesarean Section , Placenta Previa , Pregnancy Trimester, Third , Birth Rate , Ecuador , Hospitals, StateABSTRACT
Presenta un estudio estadístico retrospectivo de casos de luxación acromioclavicular G III diagnosticados y tratados quirúrgicamente en el Servicio de Traumatología y Ortopedia del Hospital Naval desde 1988 a 1996. Se revisó los expedientes de 44 pacientes que acudieron inicialmente a la emergencia por presentar trauma de hombros, pero luego de realizado el examen físico y estudio radiológico, se determinó que se trataba de luxación acromioclavicular G III de resolución quirúrgica. De las técnicas quirúrgicas utilizadas, las que menores resultados positivos dieron dueron aquellas que utilizaron implantes metálicos. La técnica de reducción abierta de luxación y fijación con doble lazada de ethibdon dio resultados más halagadores. Se utilizó una tercera técnica basada en reducción a foco cerrado y fijación con clavo de kirschner grueso, con resultados provisionales halagadores...
Subject(s)
Adult , General Surgery , Ligaments , Physical Examination , Radiology , Shoulder Dislocation , Ecuador , HospitalsABSTRACT
Se analizó los resultados obtenidos en el tratamiento de 35 pacientes con traumatismos hepático (1984-1991). La mayoría de sexo masculino, edad promedio 27,5 años. El 94% fue debido contusión y el 80% tenía lesiones asociadas. Catorce eran menores (Grado I ó II) y los 21 restantes eran traumatismos hepáticos complejos. (Grado III, IV ó V). Tres se trataron en forma conservadora. La indicación quirúrgica inicial fue clínica en 17 ó mediante un lavado peritoneal en 11. El 66% pudo ser tratado con medidas simples (electrocoagulación o hepatorrafia simple). En las restantes se utilizó hepatotomía (8,6%) o resección (20%). Como medidas adicionales se utilizó packing (4), toracotomía y clampeo aórtico (4), shunt cavo (2) y Balón de Morimoto (1). Doce pacientes presentaron complicaciones, siendo reintervenidos siete (21,9%). Fallecen por el traumatismo hepático seis pacientes (17,1%), cinco de ellos por hemorragia
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Abdominal Injuries/surgery , Liver/injuries , Liver Diseases/surgery , Liver Diseases/classification , Postoperative Complications , ThoracotomyABSTRACT
Se revisa el uso de anfotericina B, su forma de administración, dosis según cuadro clínico, efectos colaterales y propiedades farmacocinéticas. Comunicamos los resultados del uso de la droga en 10 pacientes tratados en el último año en nuestro servicio. 8/10 casos respondieron adecuadamente al tratamiento. Se concluye que la anfotericina B sigue siendo la droga de elección en la mayoría de las micosis profundas y su uso está justificado en casos clínicos bien fundamentados