Progress in the extraintestinal infection of rotavirus / 国际儿科学杂志

In recent years,there has been repeated in the course of rotavirus enteritis in children with extraintestinal infection and multi-organ infection reports,mainly in lung,heart,liver and gallbladder,kidney and nervous system damage.And organs involved in some clear-cut evidence has been founded,suggesting that there may be a new rotavirus pathogenesis and infection,but not yet entirely clear.

The relationship between extraintestinal rotavirus infections and serum mannose-binding protein levels / 中国小儿急救医学

Objective To explore the relationship between extraintestinal rotavirus infections and serum MBP levels. Methods Serum MBP levels were measured by double-antibody sandwich enzyme-linked immunosorbent assays (ELISA) in children including extraintestinal rotavirus infections (n = 76) and common rotavirus enteritis ( n = 63 ) during the acute and convalescence phases. A group of healthy children ( n =50) were recruited as control. Results MBP levels were significantly lower in patients with extraintestinal rotavirus infections( 176.35 ± 113.12 ) μg/L in acute phases than those in patients with common rotavirus enteritis (392. 27 ± 128.96) μg/L and healthy control group(676. 25 ± 248. 63) μg/L, and the difference was significant (P ＜0. 001 ). The serum MBP levels in convalescence phases in the group of extraintestinal rotavirus infections( 358.63 ± 106. 54 ) μg/L was lower than those in the group of common rotavirus enteritis (558. 49 ± 173. 24 ) μg/L and the healthy controls, and their difference was significant ( P ＜ 0. 001 ). The MBP levels in the acute phases among pneumonia group, hepatic lesion group, cardiac damage group and central nervous system damage group caused by rotavirus infection were ( 198.24 ± 126.47) μg/L, ( 169.34 ±124. 38) μg/L,( 184. 62 ± 123.64) μg/L, ( 180. 74 ± 126. 86) μg/L, respectively. The difference among those groups was not significant ( P ＞ 0. 05 ). Conclusion Patients with extraintestinal rotavirus infections showed significantly lower MBP levels during acute and convalescence phases than patients with common rotavirus enteritis. But MBP levels showed no significant differences among those groups of patients with different extraintestinal organ damage caused by rotavirus infection. Lower MBP levels may be associated with the increased susceptibility to extraintestinal rotavirus infections.

Salmonelosis extraintestinal: clínica, epidemiología y resistencia antimicrobiana / Salmonella extraintestinal infection: clinic features, epidemiology and antimicrobial resistance

Se evaluaron retrospectivamente las características clínicas de 59 pacientes con aislamientos extraintestinales de Salmonella enterica no Typhi y la resistencia antibiótica entre 1988 y 2004. En el 95% de los casos se conocieron las condiciones de base del huésped que consistieron en: enfermedad oncohematológica (15), lupus eritematoso sistémico (11), síndrome de inmuno deficiencia adquirida (10), pacientes internados en neonatología (8), colecistitis (4) y otras (7). Las formas clínicas halladas fueron: bacteriemias primarias (26), bacteriemias secundarias a gastroenteritis (15), artritis séptica (7), infección urinaria (12), infección intraabdominal (5), meningitis (1) y pericarditis (1). En 29 pacientes se aisló Salmonella enterica no Typhi en más de una localización. El 15,8% y el 21,0% de 59 aislamientos presentaron resistencia a cefalosporinas de 3ª generación y a ampicilina, respectivamente. Salmonella Agona causó un brote epidémico en la sala de cuidados intensivos de neonatología, aislándose de sangre en 5 pacientes y en uno también de LCR. Este serotipo fue multirresistente. Imipenem, trimetroprima-sulfometoxazol y ciprofloxacina fueron los antibióticos más activos (CIM 50: 0,5; 0,5 y 0,002 µg/mL, respectivamente).

The clinical and antimicrobial resistance of 59 patients with extraintestinal infection by nontyphi Salmonella was retrospectively evaluated from 1988 to 2004. In 95% of the patients there were underlying diseases, which included: oncohematologic disease (15), systemic lupus erythematosus (11), acquired immunodeficiency disease (AIDS) (10), patients of neonatal units (8), colecistitis (4), and other disorders (7). The clinical manifestation were primary bacteremias (26), bacteremias secondary to gastroenteritis (15), arthritis (7), urinary tract infections (12), abdominal infections (5), meningitis (1) and pericarditis (1). In 29 patients Salmonella enterica no Typhi was isolated in more than one site. Resistance to third generation cephalosporins was observed in 15,8 % of these isolates, and resistance to ampicillin in 21,0%. Salmonella Agona was isolated from an outbreak in neonatal ICU; the organism was recovered from blood samples of five neonates and in one patient also isolated from CSF. These isolates showed multiresistance. Imipenem, trimetoprim-sulfametoxazol and ciprofloxacin were the three most active antimicrobial agents (MIC 50: 0.5, 0.5 and 0.002 µg/mL, respectively).

A Case of Hafnia alvei Peritonitis with Septicemia / 대한임상미생물학회지

Hafnia alvei is gram-negative bacilli that is rarely isolated from human specimens and is rarely considered to be pathogenic. It has been associated with gastroenteritis, pneumonia, meningitis, bacteremia, and nosocomial wound infections. But, no case of extraintestinal H. alvei infection was documented in Korea to our knowledge. A 50-year-old man with hepatocellular carcinoma was admitted to our hospital via emergecy department because of abdominal pain. The peritoneal fluid and 3 consecutive blood cutures yielded H. alvei. The organism was susceptible to all antimicrobial agents tested, except cefazolin. Despite treatment with intravenous cefotaxime, the patient was expired after 4 days due to septicemia.

A Case of Septicemia by Plesiomonas shigelloides / 대한임상미생물학회지

Plesiomonas shigelloides is an oxidase-positive, fermentative, gram-negative rod currently classified as a member of the family Vibrionaceae. P. shigelloides has been implicated as the causative agents of gastroenteritis as well as extraintestinal infections such as septicemia, neonatal meningitis, cellulitis, and cholecystitis. Septicemia due to P. shigelloides is very rare but is severe and has been associated with a high mortality rate. We report a case of septicemia caused by P. shigelloides in a 66-year-old male with diabetes mellitus who had diagnosed as liver cirrhosis 7 years before.

A Case of Bacteremia by Plesiomonas shigelloides / 대한임상미생물학회지

Plesiomonas shigelloides was isolated from blood culture of a 53-year-old man with fever, who had treatment history of gastrointestinal malignancy. The patient showed neither clinical features nor hematological finding which suggest bacteremia. Identification of the isolate was delayed because of its similar characteristics with Aeromonas spp. and other gram-negative bacilli. The isolate was misinterpreted as susceptible to ampicillin by the first disk diffusion test. It may not always easy to identify P. shigelloides by conventional tests and to determine its antimicrobial susceptibility accurately, as laboratorians rarely have experience with the organism and as the organism may show unusual inhibition pattern when tested by disk diffusion method or Etest.

A Case of Bacteremia by Plesiomonas shigelloides / 대한임상미생물학회지

Plesiomonas shigelloides was isolated from blood culture of a 53-year-old man with fever, who had treatment history of gastrointestinal malignancy. The patient showed neither clinical features nor hematological finding which suggest bacteremia. Identification of the isolate was delayed because of its similar characteristics with Aeromonas spp. and other gram-negative bacilli. The isolate was misinterpreted as susceptible to ampicillin by the first disk diffusion test. It may not always easy to identify P. shigelloides by conventional tests and to determine its antimicrobial susceptibility accurately, as laboratorians rarely have experience with the organism and as the organism may show unusual inhibition pattern when tested by disk diffusion method or Etest.

A Case of Septicemia by Plesiomonas shigelloides / 대한임상병리학회지

Plesiomonas shigelloides with positive reactions of oxidase and indole production is a species of facultative anaerobic gram-negative bacilli. It is an inhabitant of fresh surface water and has been isolated from surface water, fresh water fish, oysters, and various animals. It is not considered to be a part of normal human intestinal flora. In human, P. shigelloides has been associated with gastroenteritis and extraintestinal infection. There have been no previous reports of extraintestinal disease due to P. shigelloides in Korea. Rare extraintestinal infections include neonatal meningitis and septicemia, cellulitis pyometra and acute cholecystitis. The patients may take fatal courses even though they receive antiboiotic therapy. We report a case of sepsis caused by P. shigelloides in a 60-year-old male with diabetes mellitus who had undergone subtotal gastrectomy 8 years before. The patient presented with diarrhea, abdominal cramps, high fever and jaundice. Enlargement of the gallbladder was noted in an abdominal ultrasonogram. He had a history of drinking surface water 5 days ago. P. shigelloides was isolated from his blood, but he recovered after cephalosporin and aminoglycoside infusion and supportive therapy. To our knowledge, this is the first report of septicemia due to P. shigelloides in Korea.