ABSTRACT
Infective endocarditis caused by Abiotrophia defectiva is rarely encountered. A 67-year-old male transferred from a local hospital presented with severe dyspnea and pulmonary edema. Preoperative transthoracic echocardiography revealed severe mitral regurgitation with large vegetation. Blood cultures grew A. defectiva, a gram positive, nutritionally deficient streptococcus variant. Emergent mitral valve replacement through right thoracotomy was performed, and after completing six weeks of antibiotic combination therapy (vancomycin, ampicillin, and gentamicin), the patient recovered fully. Because of the need for prompt surgical treatment and long-term antibiotic therapy and lack of laboratory experience with the organism, physicians and laboratory workers should pay close attention to the possibility of A. defectiva infective endocarditis when gram positive cocci are detected in blood cultures.
Subject(s)
Adult , Aged , Humans , Male , Abiotrophia , Ampicillin , Dyspnea , Echocardiography , Endocarditis , Endocarditis, Bacterial , Gram-Positive Cocci , Mitral Valve , Mitral Valve Insufficiency , Pulmonary Edema , Streptococcus , ThoracotomyABSTRACT
Um caso de abiotrofia cerebelar em um gato com 45 dias de idade foi diagnosticado no Laboratório de Patologia Animal, Hospital Veterinário da Universidade Federal de Campina Grande. O animal apresentava, havia 15 dias, apatia, anorexia, desidratação, ataxia, hipermetria, espasticidade dos membros torácicos e pélvicos, tremores de intenção, nistagmo, opistótono, déficit proprioceptivo e ausência de resposta de ameaça. Clinicamente, havia a suspeita de hipoplasia cerebelar, e, devido ao prognóstico desfavorável, o animal foi eutanasiado. Na necropsia, não foram observadas alterações macroscópicas. Microscopicamente, as lesões estavam restritas ao cerebelo e caracterizavam-se por alterações neurodegenerativas e necróticas, com desaparecimento segmentar dos neurônios de Purkinje. Nessas áreas, também se verificaram espaços em branco, denominado aspecto de cesto vazio, resultantes da perda dos neurônios de Purkinje, além de raros esferoides axonais e proliferação dos astrócitos de Bergmann. Em algumas áreas, a camada granular estava hipocelular e havia moderada gliose multifocal na camada molecular. O diagnóstico de abiotrofia cerebelar foi realizado com base nos dados epidemiológicos, clínicos e, principalmente, pelas alterações histopatológicas dos neurônios de Purkinje características da doença.(AU)
The aim of this report was to describe a case of cerebellar abiotrophy in cat with 45-year-old diagnosed at the Animal Pathology Laboratory, Veterinary Hospital of the Federal University of Campina Grande. The animal had presented 15-day apathy, anorexia, dehydration and neurological signs, characterized by ataxia, hypermetria, spasticity of fore and hindlimbs, intention tremor, nystagmus, opisthotonos, proprioceptive deficits, and absence of threat response. Clinically, cerebellar hypoplasia was suspected and the animal was euthanized due to poor prognosis. During necropsy, gross lesions were not observed. Microscopically the lesions were restricted to the cerebellum and were characterized by neurodegenerative and necrotic damage with segmental disappearance of the Purkinje cells. In these areas, there were also empty spaces, called the empty basket aspect, resulting from the loss of Purkinje cells, as well as rare axonal spheroids and proliferation of Bergmann's astrocytes. In some areas, the granular layer was hypocellular and there was moderate multifocal gliosis in the molecular layer. The diagnosis of cerebellar abiotrophy was based on epidemiological, clinical and mainly on histopathological changes in neurons of Purkinje disease characteristics.(AU)
Subject(s)
Animals , Cats , Abiotrophia , Cerebellar Diseases/veterinary , Nerve Degeneration/veterinary , Purkinje Cells/pathologyABSTRACT
We report the case of a 63-year-old woman with congestive heart failure due to a bicuspid aortic valve and severe aortic stenosis. The patient had a febrile syndrome with positive blood cultures for Abiotrophia defectiva, Transesophageal echocardiogram revealed the presence of paravalvular abscess, which was treated by a successful valve replacement. The patient received appropriate antibiotic therapy with intravenous vancomycin, leading to a successful response. The use of MALDI-TOF MS as a rapid and specific method for the microbiological diagnosis is discussed in the following report.
Se presenta el caso clínico de una mujer de 63 años de edad con antecedentes de una aorta bicúspide y estenosis aórtica grave, con una insuficiencia cardíaca descompensada. La paciente tuvo un síndrome febril con hemocultivos positivos para Abiotrophia defectiva. Se constató por un ecocardiograma transesofágico la presencia de un absceso paravalvular, por lo cual se realizó un reemplazo valvular en forma exitosa. Recibió terapia antimicrobiana intravenosa con vancomicina, con buena respuesta terapéutica. Se discute la utilización del MALDI-TOF MS como un método rápido y específico para el diagnóstico microbiológico.
Subject(s)
Humans , Female , Middle Aged , Gram-Positive Bacterial Infections/diagnostic imaging , Endocarditis, Bacterial/diagnostic imaging , Abiotrophia/isolation & purification , Vancomycin/therapeutic use , Gram-Positive Bacterial Infections/drug therapy , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Endocarditis, Bacterial/drug therapy , Anti-Bacterial Agents/therapeutic useABSTRACT
Abiotrophia defectiva, a nutritionally variant streptococci can cause bacteremia, brain abscess, septic arthritis and in rare cases, infective endocarditis, which accounts for 5-6% of all cases. A. defectiva is characteristically difficult to diagnose and the mortality, morbidity and complication rates are high. Here, we discuss a case of infective endocarditis caused by A. defectiva. A 62-year-old female had previously undergone prosthetic valve replacement 6 years prior to admission. She developed infective endocarditis after tooth extraction. Her endocarditis was successfully treated with antimicrobial therapy and mitral valve replacement surgery. This is the first case of infective endocarditis caused by A. defectiva reported in Korea. This case shows that A. defectiva could be considered as a causative organism of infective endocarditis in Korea.
Subject(s)
Female , Humans , Middle Aged , Abiotrophia , Arthritis, Infectious , Bacteremia , Brain Abscess , Endocarditis , Korea , Mitral Valve , Mortality , Tooth ExtractionABSTRACT
William Richard Gowers (1845-1915) was one of the most prolific and insightful neurologists of all times. He gave major contributions to the development of the medicine through the presentation of signs, syndromes, new concepts and many publications, mainly based on his thorough examination of his patients at the National Hospital, London. In this paper, they were enrolled several Gowers' contribu-tions, besides, it is discussed his concept of abiotrophy. Gowers at his time already recognized what is now most deeply understood and called programmed cell death or apoptosis that occurs normally du-ring the development or aging, but also under a range of stimuli and conditions, physiological or pathological, on the dependence of a cell selective vulnerability.
William Richard Gowers (1845-1915) foi um dos mais prolíficos e perspicazes neurologistas de todos os tempos. Ele deu grandes contribuições para o desenvolvimento da medicina, por meio da apresentação de sinais, síndromes, novos conceitos e muitas publicações, principalmente com base em sua análise aprofundada de seus pacientes no National Hospital, em Londres. Neste trabalho, foram registradas várias contribuições, além disso, discute-se o seu conceito de abiotrofia. Gowers, na sua época, já reconheceu o que agora é mais profundamente compreendido e denominado de morte celular programada ou apoptose, que ocorre normalmente durante o desenvolvimento ou envelhecimento, mas também sob uma gama de estímulos e condições, fisiológicas ou patológicas, na dependência de uma vulnerabilidade seletiva de células.
Subject(s)
Humans , History, 19th Century , History, 20th Century , Cell Death , Apoptosis , Abiotrophia , Neurology/history , Biographies as Topic , London , Nervous System Diseases/historyABSTRACT
Granulicatella adiacens was first described as nutritionally variant streptococci, and named as Streptococcus adjacens and Abiotrophia adiacens. Granulicatella species are flora of oral cavity, upper respiratory, urogenital, and gastrointestinal tracts, and are normal often isolated from patients with infective endocarditis. G. adiacens endocarditis is associated with high mortality, but the species hardly grow in the ordinary growth media. We report a case of septicemia caused by G. adiacens in a 52-year-old woman with liver cirrhosis and chronic renal failure.
Subject(s)
Female , Humans , Middle Aged , Abiotrophia , Endocarditis , Gastrointestinal Tract , Kidney Failure, Chronic , Liver Cirrhosis , Mortality , Mouth , Sepsis , StreptococcusABSTRACT
Granulicatella adiacens was first described as nutritionally variant streptococci, and named as Streptococcus adjacens and Abiotrophia adiacens. Granulicatella species are flora of oral cavity, upper respiratory, urogenital, and gastrointestinal tracts, and are normal often isolated from patients with infective endocarditis. G. adiacens endocarditis is associated with high mortality, but the species hardly grow in the ordinary growth media. We report a case of septicemia caused by G. adiacens in a 52-year-old woman with liver cirrhosis and chronic renal failure.