ABSTRACT
Las infecciones profundas de cuello ameritan diagnóstico oportuno y terapéutica urgente, debido a potenciales complicaciones y mortalidad. El objetivo del presente estudio fue revisar nuestra experiencia en el manejo de pacientes con esta patología, conocer los gérmenes más frecuentes yanalizar los factores asociados a complicaciones y estancia hospitalaria. Materiales y métodos: Se analizaron retrospectivamente 46 pacientes que acudieron al Hospital Carlos Andrade Marín de Quito, Ecuador, desde enero 2005 a junio de 2009. Resultados: El 63 por ciento fueron hombres y la medianade edad fue 33 años. Tratamiento antibiótico previo recibió un 50 por ciento de pacientes. El espacio más afectado fue el submaxilar 68 por ciento; dos compartimentos se afectaron en 11 por ciento. El 13 por ciento de pacientes presentó co-morbilidades. En el 48 por ciento la causa se relacionó con patología dental. La sintomatología encontrada estuvo conformada de tumor cervical, dolor y fiebre. La tomografía axial computarizada se realizó en el 22 por ciento de casos. Los antibióticos utilizados fueron: B lactámicos + inhibidores de Blactamasa en el 65 por ciento y penicilina cristalina + clindamicina en el 17 por ciento. En el 28 por ciento se utilizó corticoterapia como tratamiento coadyuvante. La estancia hospitalaria fue 9 días. El abordaje quirúrgico se realizó en el 48 por ciento y ninguno necesito re-intervención. La bacteria aislada más frecuentemente fue el estafilococo aureus. Complicaciones se presentaron en el 33 por ciento y no hubo mortalidad. Conclusiones: La infección dental es nuestra principal etiología, lo cual tiene relación topográfica de los compartimentos afectados. El estafilococo aureus fue la bacteria más encontrada. El tratamiento antibiótico utilizado fue de gran eficacia y el uso de corticoide disminuyó la estancia hospitalaria. Encontramos pocas co-morbilidades en nuestros pacientes lo cual podría explicar la ausencia de mortalidad en nuestra serie.
Objective: Deep neck infections need urgent diagnostic and treatment because of potential complications and mortality. The aim of this study was to review our experience in the management of patients with this disease, know the most common germs and analyze the factors associated withcomplications and hospital stay. Methods: We retrospectively analyzed 46 patients who attended the Carlos Andrade Marín Hospital in Quito, Ecuador, from January 2005 to June 2009. Results: 63% were men and median age was 33 years. Previous antibiotic treatment received 50% of patients. The most affected area was the submaxilar 68%, two compartments were affected in 11%. 13% of patientshad co-morbidities. In 48% the cause was related to dental disease. The symptoms found were cervical tumor, pain and fever. Computed tomography was performed in 22% of cases. The antibiotics used were: B-lactamics + B-lactamase inhibitors in 65% and clindamycin + penicillin G in 17%. In 28%received corticosteroids as adjunctive therapy. The hospital stay was 9 days. The surgical approach was performed in 48%. The most frequently isolated bacterium was Staphylococcus aureus.Complications occurred in 33% and we had no mortality. Conclusions: Dental infection is our main etiology, which is related topographic compartments affected. The bacteria staphylococcus aureus was the most found. The antibiotic regimen used was highly effective and steroid use decreasedhospital stay. We found few co-morbidities in our patients which could explain the absence of mortality in our series.
Subject(s)
Neck/abnormalities , Neck/virologyABSTRACT
Rapid diagnosis of rabies in suspected human cases influences post-exposure prophylaxis for potential contacts of the patient and ensures appropriate patient management. Apart from the central nervous system (CNS), rabies virus (RABV) is usually present in small sensory nerves adjacent to hair follicles of infected humans. We used an RT-PCR, with primers targeted to the 3' terminal portion of the nucleoprotein gene (N), to test neck-skin samples of nine patients who had rabies in order to validate a diagnostic method that could serve as an additional tool for rabies diagnosis, particularly in antemortem samples. Six of eight postmortem samples were found to be positive for rabies by RT-PCR, and one of two samples collected antemortem was positive with this same technique. Results were confirmed by DNA sequencing; this validates RT-PCR and neck-skin as a suitable technique and type of sample, respectively, for use in the diagnosis of human rabies. RT-PCR applied to neck-skin biopsies could allow early diagnosis and lead to more effective rabies treatment.
Subject(s)
Animals , Dogs , Humans , Mice , Neck/virology , Rabies virus/genetics , Rabies/diagnosis , Skin/virology , DNA Primers , DNA, Viral/analysis , Fluorescent Antibody Technique , Phylogeny , RNA, Viral/analysis , Rabies virus/immunology , Rabies/virology , Reverse Transcriptase Polymerase Chain Reaction , Sensitivity and Specificity , Sequence Analysis, DNAABSTRACT
Lepidopteran larvae may be attacked by different viruses, many of which belong to the Baculoviridae family. Whilst studying the ultrastructure of the neck gland in Dione junio larvae we found that in later instars the larvae showed symptoms of attack by two types of virus. The glands were prepared for optical and electron microscopy using sodium cacodylate buffer and standard procedures (0.1M, pH 7.2). The neck gland is composed of two oval internal sacks which communicate with the exterior via an extracellular channel. Each sack contains, in its external region, cells with large, irregular nuclei and a dense cytoplasm containing numerous small mitochondria. In infected larvae, the tissues are damaged and the nuclear polyhedrosis virus can be observed in several of the nuclei. In the cytoplasm another "rickettsia type" virus, may be observed. The pathogenic viruses present in D. junio larvae could be studied as potential biological controls of this pest.