Nocardia nova causing empyema necessitatis afterlung re-transplantation: a case report

Abstract: We report herein a case of thoracic infection due to Nocardia nova following lung re-transplantation performed for emphysema related to alpha-1-antitrypsin deficiency. The infection extended from the lung into the pleural space, thoracic wall, and mediastinum, presenting as pericarditis and empyema necessitatis. Nocardia nova was identified by 16S ribosomal deoxyribonucleic acid (rDNA) sequencing and phylogenetic analysis. According to a literature search of PubMed, LILACS and MEDLINE databases, we describe herein the first case of empyema necessitatis caused by N. nova species in a transplanted patient.

Empiema cerebral por Escherichia coli en un lactante de 5 meses: reporte de caso y revisión del tema / Brain empyema due to Escherichia coli in a 5 month-old infant: a case report and literature review

Introducción: el empiema cerebral en pediatría es una rara infección intracraneal que puede ser secundaria a una meningitis, sinusitis, o por mecanismos como trauma craneal, cirugía neurológica o como resultado de la diseminación hematógena desde un sitio remoto. Objetivo: describir un caso de empiema cerebral causado por Escherichia coli en un lactante. Metodología: presentar un caso clínico, con aislamiento de Escherichia coli fuera del periodo gris de la meningitis. Se realiza una revisión acerca de los factores de riesgo, la etiología y tratamiento del empiema cerebral en niños. Resultados: masculino de 5 meses, sin inmunodeficiencia, cráneo con plagiocefalia; antecedente de otitis de 3 semanas de evolución previo a su ingreso al hospital. El paciente manifestó fiebre, crisis convulsivas y deterioro rostro-caudal. El líquido cefalorraquídeo con pleocitosis e hipoglucorraquia. Las imágenes tomográficas revelaron la presencia de empiema cerebral. Se logró el aislamiento de Escherichia coli en el cultivo, requirió drenaje quirúrgico y antibioticoterapia sistémica por 4 semanas. Conclusiones: el empiema cerebral por Escherichia coli en lactantes después del periodo gris es muy raro. Su tratamiento consiste en la evacuación quirúrgica oportuna, la erradicación del foco infeccioso primario y la administración apropiada de antimicrobianos sistémicos.

Introduction: Brain empyema in children is a rare intracranial infection that may result from meningitis, sinusitis, or mechanisms such as head trauma, neurological surgery or hematogenous spread from a remote site. Objective: To describe a case of brain empyema caused by Escherichia coli in an infant. Methodology: A case report is presented with isolation of Escherichia coli arising after the overlap period of meningitis (1-3 months). A literature review of the risk factors, etiology and treatment of brain empyema in children is conducted. Results: The case report is about a 5 month-old male infant with no history of immunodeficiency, plagiocephalic, and with a 3 week-long history of otitis prior to admission. The patient had fever, seizures and rostro-caudal deterioration, cerebrospinal fluid pleocytosis and hypoglycorrhachia. The tomographic images revealed brain empyema. It was posible to isolate Escherichia coli from culture and surgical drainage was required plus systemic antibiotic therapy for 4 weeks. Conclusions: Brain empyema caused by Escherichia coli in infants after the overlap period are very rare. Treatment consists in prompt surgical evacuation, eradication of the primary infection and proper administration of systemic antimicrobials.

Pneumonia estafilocócica adquirida na comunidade / Community-acquired staphylococcal pneumonia

OBJETIVO: A pneumonia estafilocócica geralmente apresenta uma elevada taxa de morbidade e mortalidade. Normalmente ocorre em infecções por influenza (via aerógena) ou durante episódios de bacteremia (via hematogênica). MÉTODOS: Um estudo retrospectivo e descritivo foi realizado com os pacientes que foram admitidos em nosso hospital entre janeiro de 1992 e dezembro de 2003 com diagnóstico de pneumonia adquirida na comunidade causada por Staphylococcus aureus. Todos eles eram maiores de 14 anos e não usuários de drogas endovenosas. RESULTADOS: De um total de 332 casos de pneumonia adquirida na comunidade, foram encontrados 24 pacientes (7,3 por cento) com pneumonia estafilocócica. A idade mínima e máxima eram de, respectivamente, 14 anos e 89 anos. Quinze pacientes eram homens e nove eram mulheres. Doze pacientes preenchiam critérios para pneumonia grave. O radiograma de tórax evidenciou consolidação unilateral em 14 casos, bilateral em 10, derrame pleural em 15, rápida progressão radiológica das lesões pulmonares em 14, presença de cavitação em 6 e pneumotórax em 1 paciente. A maioria dos pacientes apresentou co-morbidades e diabetes mellitus foi a mais freqüente. Doze pacientes apresentaram complicações como empiema e choque séptico. Houve quatro óbitos, o que representou 16,6 por cento da amostra. CONCLUSÕES: A apresentação clínica da pneumonia causada por S. aureus é similar à apresentação das pneumonias originadas por outros agentes etiológicos. Os achados radiológicos, os dados epidemiológicos e os fatores de risco fornecem importantes indícios para o diagnóstico. Estes fatores são importantes para uma suspeição clínica, já que o S. aureus normalmente não é incluído nos tratamentos empíricos.

OBJECTIVE: Staphylococcal pneumonia typically presents high rates of morbidity and mortality. It typically occurs in cases of influenza (airborne transmission) or during episodes of bacteremia (blood-borne transmission). METHODS: A retrospective and descriptive study was conducted in patients admitted to our hospital between January of 1992 and December of 2003. All of he patients included had been diagnosed with community-acquired pneumonia caused by Staphylococcus aureus. All were older than 14 years of age, and none were intravenous drug users. RESULTS: Community-acquired pneumonia was identified in 332 cases, of which 24 (7.3 percent) were identified as cases of staphylococcal pneumonia. Age ranged from 14 to 89 years. Fifteen patients were male, and nine were female. Twelve patients met the criteria for severe pneumonia. Chest X-rays showed unilateral consolidation in 14 cases, bilateral consolidation in 10, pleural effusion in 15, rapid radiological progression of pulmonary lesions in 14, cavitation in 6 and pneumothorax in 1. Most of the patients presented comorbidities, of which diabetes mellitus was the most common. Twelve patients presented complications such as empyema and septic shock. Four patients died, translating to a mortality rate of 16.6 percent in our sample. CONCLUSIONS: The clinical presentation of pneumonia caused by S. aureus is similar to that of pneumonia caused by other etiological agents. Radiological findings, epidemiological data and risk factors provide important clues to the diagnosis. These factors are important for clinical suspicion, since S. aureus is not typically addressed in empirical treatment.

Empyema thoracis: a clinical study

Empyema thoracis is a disease that, despite centuries of study, still causes significant morbidity and mortality. The present study was undertaken to study the age-sex profile, symptomatology, microbiologic findings, etiology and the management and treatment outcome in a tertiary care hospital. A prospective study of empyema thoracis was conducted on 40 consecutive patients with empyema thoracis admitted to the tuberculosis and chest diseases ward of a teaching hospital. The demographic data, clinical presentation, microbiological findings, etiology, the clinical course and management were recorded as per a planned pro forma and analyzed. The peak age was in the range of 21-40 years, the male-to-female ratio was 3.4:1.0 and the left pleura was more commonly affected than the right pleura. Risk factors include pulmonary tuberculosis, chronic obstructive pulmonary diseases, smoking, diabetes mellitus and pneumonia. Etiology of empyema was tubercular in 65% cases and nontubercular in 35% cases. Gram-negative organisms were cultured in 11 cases [27.5%]. Two patients received antibiotics with repeated thoracentesis only, intercostal chest tube drainage was required in 38 cases [95%] and more aggressive surgery was performed on 2 patients. The average duration for which the chest tube was kept in the complete expansion cases was 22.3 days. It was concluded that all cases of simple empyema with thin pus and only those cases of simple empyema with thick pus where size of empyema is small should be managed by aspiration/s. Cases failed by the above method, all cases of simple empyema with thick pus and with moderate to large size of empyema and all cases of empyema with bronchopleural fistula should be managed by intercostal drainage tube connected to water seal. It was also observed that all cases of empyema complicated by bronchopleural fistula were difficult to manage and needed major surgery

Bacterias, numero de colonias y factores de alto riesgo en bilis; experiencia en 49 pacientes / Bacterias, number of colonied and factors of high risk in bile; experience in 49 patiens

La bilis de pacientes con enfermedad calculosa puede estar colonizada por bacterias. Este trabajo busca determinar la frecuencia de cultivos, tipo de germenes, factores de alto riesgo para la colonizacion y numero de bacterias que podria sugerir infeccion biliar. Se llevo a cabo un estudio prospectivo de 49 pacientes consecutivos sometidos a cirugia por enfermedad lisiatica de vesicula y/o via biliar. Los cultivos fueron positivos en 21 pacientes (43//), la bacteria predominante fue Scherichia coli en 48//. La frecuencia de colonizacion biliar en pacientes del grupo de alto riesgo fue de 67//, y de 35// en aquellos pacientes sin factores de riesgo. En 18// de los casos existian 3 o mas factores de riesgo. El recuento de colonias fue menor de 100.000 en 86// de los pacientes. Los resultados sugieren que la colonizacion bacteriana de la bilis podria ser mayor cuando existen factores de riesgo. Los microorganismos aislados son similares a los senalados por otros autores con la exepcion de Salmonella typhi que no fue identificada en este estudio. En el recuento de colonias no se logro determinar una cifra que nos pueda indicar especificamente infeccion biliar

Aspectos clínicos e bacteriológicos do empiema pleural em crianças / Clinical and bacteriological aspects of pleural empyema in children

Os autores relatam a experiência adquirida com o seguimento de 100 casos de empiema pleural em crianças. O agente etiológico mais freqüente foi o Streptococcus pneumoniae. O tempo de drenagem variou de 2 a 39 dias (média = 7,6 + ou - 2,1 dias). A mortalidade foi de 2,0%, inferior aos dados da literatura, o que pode estar relacionado, em parte, com o perfil etiológico encontrado