Acute kidney injury caused by rhabdomyolysis which is induced by intestinal infection: a case report and literature review / 中国基层医药

Objective:To report a case of acute kidney injury caused by rhabdomyolysis and summarize its etiology, pathogenesis, and treatment strategy.Methods:The clinical data of a case of rhabdomyolysis complicated by acute kidney injury admitted to Affiliated Huadu Hospital of Southern Medical University on August 30, 2020, were collected, including clinical manifestation, auxiliary examination, and disease outcome. Referring to the previous literature reports of rhabdomyolysis complicated by acute kidney injury, this paper discusses its etiology, monitors and analyzes some indicators such as serum creatinine, blood urea nitrogen, creatine kinase, myoglobin, and 24-hour urine volume during the treatment, and summarizes the clinical diagnosis and treatment ideas of the disease.Results:This case developed an intestinal infection after an unclean diet, which induced rhabdomyolysis and acute kidney injury. Renal pathology after renal biopsy showed that renal biopsy result was consistent with an acute tubulointerstitial injury caused by myoglobin tubular nephropathy. The biochemical indexes such as creatine kinase and myoglobin decreased rapidly after ordinary hemodialysis, but the levels of serum creatinine and blood urea nitrogen did not decrease markedly, and there was continuous oliguria. After switching to hemodialysis filtration and continuous intensive dialysis treatment, the levels of serum creatinine and blood urea nitrogen decreased rapidly, the amount of urine increased gradually, and finally, the renal function recovered.Conclusion:For acute kidney injury caused by rhabdomyolysis, early sufficient blood purification can accelerate the clearance of myoglobin, promote the recovery of the injured kidney, and improve the prognosis of the disease.

Brote familiar por el nematodo Trichostrongylus colubriformis en una zona rural de la provincia de Valdivia: una zoonosis de rara ocurrencia / Family outbreak caused by the nematode Trichostrongylus colubriformis in a rural area of the province of Valdivia: a rare occurrence zoonoses

Resumen La trichostrongylosis es una zoonosis de rara ocurrencia causada por nematodos intestinales, favorecida por el consumo de vegetales crudos o agua contaminada con larvas infectantes de Trichostrongylus spp. En 2015, se registró un brote familiar transmitido por alimentos en una zona rural de Valdivia, afectando a una mujer de 51 años de edad y su pareja e hija de 56 y 12 años; respectivamente. Solo la mujer adulta, el caso índice, presentó síntomas como diarrea, dolor abdominal, astenia y náuseas. Los pacientes eliminaron huevos de Trichostrongylidae gen. sp. en sus deposiciones, identificándose en dos de ellos, adultos de Trichostrongylus colubriformis. Tuvieron una buena respuesta a albendazol. En Chile, se han registrado prevalencias de infección de 0,1 a 3,5%, incluyendo un total de 93 casos diagnosticados entre las provincias de Concepción y Llanquihue.

Abstract Trichostrongylosis is a rare occurrence zoonosis caused by intestinal nematodes, favored by the consumption of raw vegetables or water contaminated with infective larvae of Trichostrongylus spp. In 2015, a family outbreak of foodborne disease was registered in a rural zone of Valdivia, affecting to 51-year-old woman and her 56-year-old partner and her 12-year-old daughter. Only the adult woman, the index case, presented symptoms such as diarrhea, abdominal pain, asthenia, and nausea. The patients revealed Trichostrongylidae gen. sp. eggs in their stools, identifying Trichostrongylus colubriformis adults in two of them. They had a good response to treatment with albendazol. In Chile, 0.1 to 3.5% prevalence of infection has been reported, including a total of 93 cases recorded between the provinces of Concepción and Llanquihue.

Epidemic characteristics and drug resistance of non-typhoid salmonella in Zhongshan city from 2013 to 2015 / 中国小儿急救医学

Objective To investigate the epidemiological characteristics and drug sensitivity of non-typhoid salmonella in Zhongshan city.Methods We collected the positive cases of non-typhoid salmonella in children of Zhongshan city from 2013 to 2015.The sex,age,place of residence,onset time and main serum type of these cases were collected.The characteristics of the cases were described by descriptive epidemiologi-cal study.Results From 2013 to 2015,3 040 stool specimens from patients with enteritis were collected and 402 strain of non-typhoid salmonella were separated out. The total detection rate was 13.22%,the annual detection rate were 10.26%,12.21% and 16.76%,respectively.The peak period was from July to August every year.Of the 402 children,240 were male,162 were female,and the ratio was 1.48:1.The minimum age was 1 month,the maximum was 5 years and 8 months,the mean age was 13.62 months.All patients were characterized by diarrhea and fever,including 64 cases of bloody stool and 1 case of sepsis.The most com-mon serotypes were 4,5,12:i:-and 4,12:i:-.The resistant strains were salmonella typhimurium and variety salmonella typhimurium strains.From 2013 to 2015,the resistance rate of ceftriaxone and ceftazidime in non-typhoid salmonella isolates increased linearly (ceftriaxone: 17.35%, 26.23%, 39.01%; ceftazidime:12.24%,17.21%,30.77%).The differences were statistically significant(χ2=30.3,P<0.01;χ2=26.3, P<0.01).Conclusion The positive rate of nontyphoid salmonella increased year by year from 2013 to 2015.The most common serotype was salmonella typhimurium, and the resistant strains were salmonella typhimurium and salmonella typhimurium variety.The resistance rate of non-typhoid salmonella to ceftriaxone and ceftazidime increased year by year,and the highest rate of ceftazidime resistance was in July 2015.Non-typhoid salmonella was more resistant to ceftriaxone than ceftazidime.

Etablishment and phenotypic analysis of a C57BL/6 mouse model of S.Typhimurium infection / 中国比较医学杂志

Objective To establish a C57BL/6 mouse model of intestinal infection induced by S.Typhimurium.Methods In order to improve the infectious sensitivity of S.Typhimurium, C57BL/6 mice were intragastrically given 5% (w/v) NaHCO3.Then mice were challenged with S.Typhimurium.The health condition, survival and body weight of mice were observed from day 0 to day 7 after the bacterial infection.The pathological changes were also examined.Results the mice challenged with S.Typhimurium showed decreased body weight and typical clinical signs, including in appetence, piloerection and low survival rate.Macroscopic dissection revealed that intestinal hyperemia and swelling were founded in the mice challenged with S.Typhimurium.Histopathology showed intestinal epithelial and mucosal damages.Conclusions We have successfully established a C57BL/6 mouse model of S.Typhimurium infection.This model may be of crucial significance for studying the biological functions of associated immunological molecules or cytokines in the process of inflammatory bowel disease induced by S.Typhimurium.

Clinical analysis of intestinal infection in patients with acute leukemia after chemotherapy / 白血病·淋巴瘤

Objective To analyze the clinical features of intestinal infection in patients with acute leukemia (AL) after chemotherapy. Methods The data of 103 cases of AL patients after chemotherapy from January 2014 to April 2016 were retrospectively analyzed, and categorical variables were compared by using chi-square test. Results A total of 364 cycles of chemotherapy was conducted among 103 patients, of which 66 times (18.13 %) in 59 cycles occurred intestinal infections, including twice intestinal infections in one cycle of chemotherapy in 7 cases. The incidence of intestinal infection was 27.48%(36/131) in group without complete remission (CR), and 9.87%(23/233) in CR group. There was a statistical difference between the two groups (P 0.5 × 109/L. There was no significant difference (P> 0.05). After chemotherapy, some patients with intestinal infection occurred acute abdomen, with high mortality rate. Conclusions Intestinal infection may occur in the procession of chemotherapy and myelosuppression. Special attention should be paid on intestinal infection, including reduction of blood stream infection and risk factors, as well as timely intervention.

Pelvic radiotherapy induces dysbiosis of gut microbiota and enteric infection in mice / 中华放射医学与防护杂志

Objective To explore the changes of gut microbiota in response to abdominal and pelvic radiotherapy and its potential relationship with intestinal infection.Methods Irradiation was delivered to the abdominal region of BALB/c mice,following the regular human pelvic-radiotherapy protocol,2.0 Gy/d,continuous 5 d/week.Samples of ileum tissue and the intestinal content were collected at different time points of irradiation procedure,including after 3 and 5 weeks,and at 1 week after 6 weeks of irradiation.Quantitative RT-PCR was used to measure the mRNA level of antimicrobial peptides and pro-inflammtory factors.Bacterial translocation was determined by PCR.The gut microbiota was characterized by the denaturing gradient electrophoresis assay.Results The expressions of cryptdin-1 and cryptdin-4 were decreased after 3 weeks of irradiation and at 1 week after 6 weeks of irradiation(t =-7.43,-3.54,-4.72,-4.27,P ＜ 0.05),while they were significantly increased at the 5 weeks of radiation (t =6.15,5.75,P ＜ 0.05).The diversity index and richness of gut microbiota after 3 or 5 weeks irradiation were significantly decreased (t =-3.49,-4.19,-3.44,-4.97,P ＜ 0.05).The gut microbiota dysbiosis of the irradiated mice was characterized with the decrease of probiotics of Lactobacillus and the increasing of opportunistic pathogen of Escherichia coli,Shigella flexneri,et al.Bacterial translocation episodes were more frequently in the irradiated mice than that of control animal.The mRNA levels of IL-1β、IL-6 and TNF-α were significantly increased after 3 or 5 weeks of irradiation (t =4.85,6.16,7.71,4.60,4.86,5.97,P ＜ 0.05).Compared with the control,the expression levels of IL-1β and TNF-α at the 1 week after 6 weeks of irradiation ending was also obviously enhanced (t =3.67,5.88,P ＜0.05).Conclusions Pelvic radiotherapy can induce abnormality of enteric antimicrobial peptides and may result in gut microbiota dysbiosis.The disturbed gut microbial flora may further trigger an incurrence of bacterial translocation and enteritis.Therefore,the gut microbiota may be a potential interfering target to alleviate radiotherapy adverse effect.

A Lactobacillus rhamnosus strain induces protection in different sites after Salmonella enterica subsp. enterica serovar Typhimurium challenge in gnotobiotic and conventional mice / Uma cepa de Lactobacillus rhamnosus induz proteção em diferentes sítios em camundongos gnotobióticos e convencionais após desafio com Salmonella enterica subsp. enterica sorovar Typhimurium

The ability of a Lactobacillus rhamnosus strain isolated from a healthy breast-fed human newborn to reduce the pathological consequences for the host due to an experimental oral infection with Salmonella enterica subsp. enterica serov. Typhimurium in vivo was determined using gnotobiotic and conventional mice. Conventional mice received 0.1mL probiotic milk (8.0 log colony-forming unit) daily for 10 days before the oral pathogenic challenge (5.0 log colony-forming unit). Then probiotic treatment was continued until the end of the experiment. Probiotic treatment in germ-free mice consisted of a single dose of the probiotic milk at the beginning of the experiment and a challenge with S. Typhimurium 10 days later (3.0 log colony-forming unit). A protective effect was observed in both gnotobiotic and conventional animals in terms of histopathologic and morphometric data, but in different anatomical sites. This protection was observed in liver and intestines, respectively, for gnotobiotic and conventional mice. However, S. Typhimurium populations were similar in the feces of both treated and control gnotobiotic mice. We conclude that a protective effect of L. rhamnosus against experimental S. Typhimurium was observed. This protection was not due to the reduction of the population of pathogenic bacteria in the intestine...

A habilidade de uma cepa de Lactobacillus rhamnosus isolada de um recém-nascido saudável de reduzir as consequências patológicas para o hospedeiro após infecção experimental por Salmonella enterica subsp. enterica sorov. Typhimurium foi avaliada em camundongos gnotobióticos e convencionais. Os camundongos convencionais receberam 0,1mL de leite probiótico por dia (0,8 log unidade formadora de colônia), 10 dias antes do desafio oral com S. Typhimurium (5,0 log unidade formadora de colônia), e continuaram recebendo probiótico até o término do experimento. O tratamento com probiótico nos camundongos gnotobióticos consistiu em uma única dose de leite probiótico no início do experimento e desafio oral após 10 dias (3,0 log unidade formadora de colônia). Em termos histopatológicos e morfométricos, a proteção foi observada no fígado e nos intestinos nos animais gnotobióticos e convencionais, respectivamente. No entanto, a população de S. Typhimurium foi similar em ambos os grupos tratado e controle de animais gnotobióticos. Desta forma, conclui-se que a proteção conferida pela cepa de L. rhamnosus contra o desafio experimental S. Typhimurium foi observada em diferentes sítios anatômicos nos animais convencionais e gnotobióticos e que essa proteção não foi devido à redução da população de S. Typhimurium nos intestinos...

Comparison and evaluation of three methods to establish mouse models of intestinal infection with multidrug-resistant Pseudomonas aeruginosa / 中国实验动物学报

Objective To explore the establishment methods of animal models of intestinal multidrug-resistant bacterial (Pseudomonas aeruginosa, PA) infection, and to provide a good model for experimental research and treatment for infection caused by drug-resistant bacteria .Methods Male BALB/c mice were divided into four groups:Normal con-trol group, MDR-PA group, MDR-PA +antibiotics group, and MDR-PA +fasting group.They were given saline, PA suspension, PA suspension after free drinking with ceftriaxone water and PA suspension after fasting , respectively , by ga-vage.Colon tissues were collected for pathological examination and inflammation scoring .The expressions of TNF-αand INF-γin the colon tissue was assessed at the end of the experiment .Results Pathology showed different degrees of inflam-matory changes in the colon tissues .Compared with the normal control group , the expressions of TNF-αand INF-γhad sig-nificant differences with that of experimental groups .Conclusions All the three methods used in this experiment can be successfully used to establish mouse models with intestinal infection caused by multidrug-resistant Pseudomonas aeruginosa, and may be chosen for experimental studies according to different research purposes .

Aeromonas spp asociada a enfermedad diarreica aguda en Cuba: estudios de casos y controles / Aeromonas spp asociated to acute diarrheic disease in Cuba: case-control study

The members of the genus Aeromonas are currently considered important gastrointestinal pathogens in different geographical areas. From February 1985 to January 2005 several case-control studies were coordinated by the National Reference Laboratory for Diarrheal Diseases from the Pedro Kouri Institute. The study purpose was to analyze a possible pathogenic role for Aeromonas spp in Cuban children with acute diarrhea. In that period 2,322 children less than 5 years old with acute diarrhea were studied for diarhoeal pathogens and another group of 2,072 non hospitalized children without diarrhea during the similar time from the same geographical areas and matched by ages were recruited. In the group of children with diarrheas (cases), Aeromonas spp. was isolated in 166 (7.15%) and in the control group the microorganism was found in only 35 (1.76%). When Aeromonas isolation rates were compared between both groups, we found that probability to isolate this specie was significantly higher in cases than in controls (OR = 4.48, 95% IC: 3.05-6.60; P < 0.001). The Aeromonas species more frequently isolated were A. caviae, A. hydrophila, and A. veronii bv sobria. Other enteric pathogens detected in children with diarrhea were: Shigella spp in 418 (18%) (P < 0.0001), Salmonella spp in 53 (2.3%) (P < 0.01), and enteropathogenic E. coli in 58 (2.49%) (P < 0.05).

Los miembros del género Aeromonas son considerados patógenos importantes del tracto gastrointestinal en diferentes áreas geográficas. De febrero de 1985 a enero de 2005 se realizaron estudios de casos y controles en el Laboratorio Nacional de Referencia de Enfermedades Diarreicas Agudas del Instituto Pedro Kourí con el objetivo de conocer el comportamiento de los microorganismos pertenecientes al género Aeromonas en niños con diarreas en Cuba. La muestra estuvo constituida por 2.322 niños bajo 5 años de edad, ingresados por enfermedad diarreica aguda y como grupo control se estudió un total de 2.072 niños con edades y áreas geográficas similares que acudieron a los hospitales correspondientes en ese mismo período de tiempo. En el grupo de niños que presentaron diarreas, Aeromonas spp fue aislada en 166 (7,15%), y en los controles fue encontrada en 35 (1,76%). Al comparar la positividad para Aeromonas entre ambos grupos, la probabilidad de diagnosticar este microorganismo fue 4,28 veces mayor en los casos que en los controles (OR = 4,28; IC al 95%: 2,96-6,20; P < 0,001). Las especies más frecuentemente aisladas fueron A. caviae, A. hydrophila, y A. veronii bv sobria. Otros enteropatógenos aislados en niños que presentaban diarrea fueron: Shigella spp. en 418 (18%) (P < 0,0001, Salmonella spp en 53 (2,3%) (P < 0,01),) y E. coli enteropatógena en 58 (2,49%) (P < 0,05).

Necrotizing enteritis associated with Clostridium perfringensType B in chinchillas (Chinchilla lanigera) / Enterite necrosante associado a infecção por Clostridium perfringenstipo B em chinchilas (Chinchilla lanigera)

Four 3-4 month-old chinchillas (Chinchilla lanigera) from a commercial flock of 395 chinchillas, were found dead with evidence of previous diarrhea and prolapsed rectum. A fifth 8 month-old chinchilla died 8 hours after being found recumbent, apathetic, diarrheic and with a prolapsed rectum. Two chinchillas were necropsied and observed gross lesions consisted of extensive hemorrhagic enteritis, mild pulmonary edema and enlarged and yellow liver; this latter finding was particularly prominent in the chinchilla presenting longer clinical course. Histologically there was necrotizing enteritis associated with abundant bacterial rods aggregates in the intestinal surface epithelium and within the lamina propria. In the lungs there were small amounts of pink proteinaceous material (edema) in the interstitium and marked vacuolar hepatocellullar degeneration (lipidosis) in the liver. Anaerobic cultures from the intestinal contents of one of the affected chinchillas yielded Clostridium perfringens. Genotyping of this C. perfringens isolate was achieved by multiplex polymerase chain reaction (mPCR) as C. perfringenstype B due to detection of alpha, beta and epsilon-toxin genes. These findings suggest C. perfringens type B as an important cause of sudden or acute death in chinchillas.

Quatro chinchilas (Chinchilla lanigera) com 3-4 meses de idade, pertencentes a um criadouro comercial com 395 chinchilas, foram encontradas mortas com evidências de diarreia prévia e prolapso de reto. Uma quinta chinchila, de oito meses de idade, foi encontrada em decúbito, apática, com diarreia e prolopaso de reto, e morreu após oito horas. Duas chinchilas foram submetidas à necropsia. As lesões macroscópicas consistiam de extensa enterite hemorrágica, moderado edema pulmonar e fígado pálido e aumentado de volume; este achado foi particularmente proeminente na chinchila que apresentou curso clínico mais longo. Histologicamente foi observado enterite necrosante associada a numerosos agregados bacterianos na superfície epitelial com invasão da lâmina própria. Nos pulmões foi observada pequena quantidade de material proteináceo róseo amorfo (edema) no interstício e marcada degeneração hepatocelular vacuolar (lipidose). Cultura anaeróbica do conteúdo intestinal de uma chinchila afetada revelou crescimento de Clostridium perfringens. A genotipificação de C. perfringensisolado, realizada por reação em cadeia de polymerase multiplex(mPCR), revelou C. perfringenstipo B pela detecção das tóxinas alfa, beta e épisilon. Estes achados sugerem que infecção por C. perfringenstipo B é uma importante causa de morte súbita ou aguda em chinchilas.

Experimental Study of Rotavirus Infection in Whole Body of Newborn Mouse / 实用儿科临床杂志

Objective To explore the hurt of susceptibility organs and critical orgens followed by rotavirus (RV) infection of whole body in newborn mouse.Methods RV strain was derived from the stool samples of patients with RV diarrhea and was proved to be long type by methods of ELISA and polyacrylamide gel electrophoresis (PAGE). RV was inoculated by the pathways of taking orally and injected to abdominal cavities,respectively. The pathological changes of the newborn mouse model infected with human natural RV by light microscope and electron microscope. The gene probe was marked by digoxin.The direct prove of RV infection in these organs was got by the detection of in situ PCR. Results Pathological changes were found in the small intestinal villus,lamina propria of the stomach and the heart cells of the mice taken RV orally.The mice with intraabdominal RV injection showed pathological changes of the cells in the small intestinal villus,liver and kidneys observed by electron microscope.Shortened small intestinal villus,nuclear membrane disorganization,massive vacuolization,mitochondrial swelling and rough endoplasmic reticulum dilation were observed in the cells of small intestinal.In the liver of the mice,marked mitochondrial swelling and agglutination,cell nucleus pyknosis or collapse,presence of numerous lipid droplets and vacuoles were found in the li-ver cells,with lymphocyte and plasmacyte infiltration.Obvious dilatation and shedding of the microvillus were found in cholangioles.The mitochondria of the proximal convoluted renal tubule showed mild swelling,but the cells in the heart and lung did not display obvious changes.Conclusion RV can damage lots of extra intestinal organs of the newborn mice if RV diffuses to the whole body of the mice.

Presentación del primer caso humano de parasitismo por Macracanthorhynchus hirudinaceus en el Perú y breve revisión

Se reporta un caso humano portador de Macracanthorhynchus hirudinaceus. Se trata de un varón de 45 años de edad, natural de la provincia de Chota, departamento de Cajamarca, Perú; con molestias digestivas. El diagnóstico se hizo por el hallazgo de huevos de Macracanthorhynchus hirudinaceus en las heces. Además se encontró Trichuris trichiura, Ancylostoma duodenale, Trichostrongylus sp, Blastocystis hominis y Entamoeba coli. Esta es la primera comunicación de un caso humano de M. hirudinaceus para el Perú.

A Macracanthorhynchus hirudinaceus human case is reported. He is a male of 45 years old native of Chota province, department of Cajamarca (Perú), with digestive symptoms. The diagnosis was made by eggs in the faecal examination. Beside Macracanthorhynchus hirudinaceus, he carried Trichuris trichiura, Ancylostoma duodenale y Trichostrongylus sp, Blastocystis hominis y Entamoeba coli. This is the first human case by M. hirudinaceus reported in Perú.