Resistencia antimicrobiana de cepas de Bartonella bacilliformis procedentes de regiones endémicas de la enfermedad de Carrión en el Perú / Antimicrobial resistance of Bartonella bacilliformis strains from regions endemic to bartonellosis in Peru

Evaluar la susceptibilidad antimicrobiana in vitro a cloranfenicol (CHL) y ciprofloxacino (CIP) de cepas de Bartonella bacilliformis procedentes de áreas endémicas de la enfermedad de Carrión (EC) en el Perú, mediante tres métodos de laboratorio. Materiales y métodos. Se evaluó la susceptibilidad antimicrobiana a CHL y CIP de 100 cepas de Bartonella bacilliformis, los aislamientos procedieron de pacientes de los departamentos de Ancash, Cusco, Cajamarca, Lima y La Libertad; las cepas se evaluaron mediante: disco difusión, E-Test y dilución en agar. Resultados. El 26% de las cepas de Bartonella bacilliformis evaluadas, presentaron resistencia a CIP y 1% a CHL. Se obtuvieron patrones similares de sensibilidad/resistencia antimicrobiana en los tres métodos utilizados. Conclusiones. Las cepas de Bartonella bacilliformis circulantes en el Perú, presentan elevados niveles de resistencia in vitro a CIP, por lo que se recomienda ampliar la investigación sobre la utilización del fármaco en los esquemas de tratamiento de la EC. Los métodos de E-test y disco difusión resultaron más convenientes para la evaluación de la susceptibilidad antimicrobiana in vitro del microorganismo...

To evaluate in vitro antimicrobial susceptibility to chloramphenicol (CHL) and ciprofloxacin (CIP) in strains of Bartonella bacilliformis from areas that are endemic to Bartonellosis in Peru, through three laboratory methods. Materials and methods. Antimicrobial susceptibility to CHL and CIP from 100 strains of Bartonella bacilliformis isolated in patients from the regions of Ancash, Cusco, Cajamarca, Lima and La Libertad were evaluated. Strains were evaluated by: disk diffusion, E-test and agar dilution. Results. 26% of the strains of Bartonella bacilliformis evaluated were resistant to CIP and 1% to CHL. Similar patterns of antimicrobial sensitivity / resistance were obtained in all three methods. Conclusions. Bartonella bacilliformis strains circulating in Peru have high levels of in vitro resistance to CIP, so it is advisable to expand research on the use of drug treatment regimens of the Bartonellosis. The methods of E-test and disk diffusion were the most suitable for assessment in vitro of antimicrobial susceptibility of the microorganism...

Doxicilina injetável e o cloranfenicol suspensão para terapêutica da febre maculosa brasileira e outras riquetsioses / Doxycycline and chloramphenicol suspension for therapy of Brazilian spot fever and other rickettsial

A febre maculosa brasileira (FMB) é uma doença infecciosa febril aguda, de transmissão vetorial exclusiva, de gravidade variável, cuja apresentação clínica pode variar desde formas leves e atípicas até formas graves, com elevada taxa de letalidade, sendo por isso considerada um problema de saúde pública e doença de notificação compulsória no Brasil. Tendo em vista a limitação das técnicas laboratoriais atuais em possibilitar o diagnóstico específico imediato e a rápida progressão para formas graves da doença, a recomendação formal é de que frente a casos suspeitos da doença, que apresentem os critérios clínicos e laboratoriais compatíveis com os critérios de definição vigentes, a terapêutica específica (doxiciclina ou cloranfenicol), seja em âmbito ambulatorial ou hospitalar, deve ser prontamente instituída. O sucesso do tratamento está relacionado à precocidade e à especificidade de sua instalação. Os únicos fármacos com comprovada ação e eficácia são as tetraciclinas e o cloranfenicol. A escolha entre a tetraciclina (doxiciclina) e o cloranfenicol relaciona-se à gravidade da doença, devendo-se priorizar a tetracilina em função de sua superioridade. Considerando o alto potencial de letalidade da FMB e frente às evidências científicas sob a eficácia do uso da doxiciclina e do cloranfenicol, o Ministério da Saúde, em seu material instrucional (Guia de Vigilância Epidemiológica) da Secretaria de Vigilância em Saúde, recomenda estes medicamentos para o tratamento de pacientes com sinais e sintomas clínicos da febre maculosa brasileira. No entanto, não estão disponíveis a doxiciclina injetável e o cloranfenicol solução, por desinteresse comercial de laboratórios produtores e indisponibilidade de registro dos medicamentos no Brasil, o que motiva a aquisição destas drogas via \r\nimportação e disponibilização como medicamentos do componente estratégico do Ministério da Saúde para o tratamento da FMB e outras riquetsioses. Conforme avaliação realizada pela área técnica de vigilância epidemiológica da FMB e outras riquetsioses e Departamento de Assistência Farmacêutica do MS, estes \r\nmedicamentos poderão ser adquiridos de forma centralizada pelo Ministério da Saúde com recurso próprio e destinados às áreas endêmicas do país. Nesta avaliação, considerando as opções terapêuticas existentes no Brasil (doxiciclina comprimidos e cloranfenicol injetável), será necessária para atender a demanda anual a aquisição do quantitativo de 24.000 mil ampolas de doxiciclina injetável (100 mg) e 4.000 frascos de cloranfenicol solução (125 mg), o que promoverá um impacto orçamentário anual na ordem de US$ 126.000,00 mil dólares, estimativa anual baseada nas notificações de casos da FMB, que deverão ser tratados com os \r\nrespectivos medicamentos. Diante do exposto, os membros da CONITEC, presentes na reunião ordinária do \r\ndia 1º de agosto de 2013, decidiram, por unanimidade, pela incorporação da doxiciclina injetável e cloranfenicol solução para terapêutica antimicrobiana em pacientes com febre maculosa brasileira e outras riquetsioses.

Susceptibilidad antimicrobiana, serotipos capsulares y relación clonal entre cepas invasoras de Streptococcus pneumoniae aisladas de pacientes adultos de la Región del Bío-Bío, Chile: Período 2005-2006 / Antimicrobial susceptibility, capsular serotypes and clonal relationship of invasive Streptococcus pneumoniae isolates in adult population of the Bio-Bio Region, Chile: 2005-2006

Las infecciones ocasionadas por Streptococcus pneumoniae constituyen un problema de salud pública. En nuestro país existe escasa información sobre aislados de procesos bacteriémicos en población adulta. Se estudió la susceptibilidad, serotipos y relación clonal de 56 aislados de S. pneumoniae desde hemocultivos, entre enero 2005 y agosto 2006, de pacientes adultos de la intercomuna Concepción-Talcahuano, Región del Bío-Bío, Chile. Se encontró resistencia a tetraciclina (21,4 por ciento), cotrimoxazol (18 por ciento), eritromicina (18 por ciento), cloranfenicol (7 por ciento) y a penicilina en un solo aislado procedente de un foco meníngeo (2 por ciento). La totalidad mostró susceptibilidad a cefotaxima, levofloxacina, moxifloxacina y vancomicina. Se demostró una amplia variedad de serotipos capsulares, con predominio de los serotipos 1, 5, 23F, 7F y 3. El análisis de macrorestricción y electroforesis en campo pulsado reveló 31 patrones electroforéticos con 12 grupos clona-les, descartando un clon predominante. De acuerdo a los resultados, al menos 80 por ciento de los serotipos de aislados de S. pneumoniae de procesos bacteriémicos están incluidos en la vacuna comercial disponible.

Streptococcus pneumoniae infections constitute a public health problem. In our country there is scarce information regarding isolates from bacteraemic episodes in adult population. The antibiotic susceptibility, sero-types and clonal relationship of 56 isolates of S. pneumoniae from adult patients with bacteraemic infections in Concepcion-Talcahuano, Bio-Bio Region, Chile, were studied. Resistance to tetracycline (21.4 percent), trimethoprim/ sulfamethoxazole (18 percent), erythromycin (18 percent), chloramphenicol (7 percent) and 1 penicillin resistant isolate from a meningeal focus (2 percent) was found. Also, all the isolates were susceptible to cefotaxime, levofloxacin, moxifloxacin and vancomycin. A wide variety of capsular serotypes was demonstrated, with predominance of serotypes 1, 5, 23F, 7F and 3. The macrorestriction analysis by pulse field electrophoresis revealed 31 electrophoretic patterns and 12 clonal groups, discarding a predominant clone. According to the results, at least, 80 percent of the S. pneumoniae serotypes isolated from bacteraemic adult patients are included in the available commercial vaccine.

Inhibition of shrimp pathogenic vibrios by extracellular compounds from a proteolytic bacterium Pseudomonas sp. W3 / Inhibición de vibrios patógenos del camarón por compuestos extracelulares de una bacterias proteolítica Pseudomonas sp.W3

Pseudomonas sp. W3, a bacterium known to produce an extracellular alkaline protease, secreted secondary metabolites that inhibited pathogenic bacteria responsible for shrimp luminous vibriosis disease. Antivibrio compounds in the culture supernatant or culture filtrates (0.45 um and 0.22 um) of the isolate W3 were tested using an agar well diffusion method on a number of pathogenic vibrios. Vibrio harveyi PSU 2015 a pathogenic isolate was the most sensitive strain. The effectiveness of preparations from the isolate W3 against V. harveyi PSU 2015, and V. cholerae PSSCMI 0062 was in the order of culture supernatant > 0.45 um culture filtrate > 0.22 um culture filtrate. These extracellular antivibrio compounds also lysed both dead and living cells of V. harveyi PSU 2015. Results of the partial characterization tests indicated that there was some particulate antivibrio compound that was destroyed by treatment with enzymes particularly alpha-chymotrypsin, autoclaving at 121ºC for 15 min and was mostly removed by filtration through a 0.22 µm filter. Most of the inhibitory compounds were of small molecular weight able to pass through a 0.22 um filter and were resistant to treatment with various enzymes, pH values between 4-8 and temperatures up to 121ºC for 30 min. The optimum pH for the antivibrio activity in the 0.45 um culture filtrate was between pH 6-7.

Primary amebic meningoencephalitis.

We report an 8 month-old infant with primary amebic meningoencephalitis (PAME) due to Naegleria fowleri. The child was treated with amphotericin B, chloramphenicol and rifampicin for 3 weeks. PAME is an almost universally fatal condition with very few survivors till date. Our patient was one of the rare survivors who recovered after treatment and was discharged without any residual neurological deficit.

Clinicobacteriological study of chronic dacryocystitis in adults.

Chronic dacryocystitis is the inflammation of lacrimal sac, frequently caused by bacteria. Obstruction of nasolacrimal duct converts the lacrimal sac a reservoir of infection. It is a constant threat to cornea and orbital soft tissue. Moreover, it causes social embarrassment due to chronic watering from the eye. This study was conducted to find out the current clinicobacteriological profile of chronic dacryocystitis in adults. A total of 56 adult patients were selected from ophthalmology OPD. Detail history and clinical examinations were carried out. All patients underwent either dacryocystorhinostomy or dacryocystectomy. A part of the sac was collected for culture and sensitivity. This study revealed that chronic dacryocystitis is more common in females and left eye is more frequently involved than right eye. It is common among lower socioeconomic strata with habit of pond-bathing. Some form of nasal pathology like hypertrophied inferior turbinate, deviated nasal septum, nasal polyp and allergic rhinitis werefound in 19.6% of the patients. Complications of chronic dacryocystitis like conjunctivitis, corneal ulcer, acute on chronic dacryocystitis, lacrimal abscess and fistula were seen in 25.0% of these patients; 53.6% of the culture samples were positive for bacterial growth. Gram-positive organisms were most common isolate. Unlike other studies, Staphylococcus aureus (40.0%) was found to be most common Gram-positive organism, followed by Staphylococcus epidermidis (10.0%) and Steptococcus pneumoniae (10.0%). Among the Gram-negative organisms, Pseudomonas aeruginosa (16.6%) was the most common, followed by Klebsiella pneumoniae (6.6%) and Haemophilus influenzae (6.6%). Antibiotic sensitivity tests were done. Most of the organisms were resistant to penicillin. Chloramphenicol was effective against most of the Gram-positive organisms. Aminoglycosides, tobramycin in particular, was effective against Staphylococcus epidermidis. Fluoroquinolones, namely ciprofloxacin and ofloxacin were effective against Pseudomonas aeruginosa and Klebsiella pneumoniae.

Post operative penicillin-non-susceptible Streptococcus pneumoniae meningitis and septic shock in a child.

The authors describe a one-year-old girl with a fronto-ethmoidal encephalomeningocele who developed wound infection, purulent meningitis and septic shock 5 hours after operation. The patient was treated with intravenous ceftazidime and vancomycin empirically. The cerebrospinal fluid (CSF) and eye discharge grew Streptococcus pneumoniae (S. pneumoniae). The minimal inhibitory concentration (MIC) by E-test of penicillin and cefotaxime were 1.0 and 0.38 ug/ml respectively so the antibiotics were switched to cefotaxime 300 mg/kg/day. She recovered completely after appropriate treatment. Penicillin-non-susceptible S. pneumoniae should be considered as one of the causes of post-operative serious infection of the face and neck in the era of increasing prevalence of penicillin-resistant S. pneumoniae.

Doença de Whipple: relato de caso / Whipple's disease: a case report

A doença de Whipple é uma doença infecciosa causada pelo bacilo Tropheryma whippelii, caracterizada pela sua apresentação inespecífica, o que dificulta o diagnóstico que, realizado através de biópsia da mucosa do jejuno e ¡leo. Os autores relatam um caso de paciente com doença de Whippie que foi submetido a inúmeros procedimentos até que se chegasse a um diagnóstico definitivo.

Fiebre manchada de las Montañas Rocosas en niños: consideraciones clínicas y epidemiológicas / Rocky Mountain spotted fever in children: clinical and epidemiological features

Objetivo. Comunicar las características clínicas de la fiebre manchada de las Montañas Rocosas (FMMR) en niños del sur de Sonora, México. Material y métodos. Se realizó un estudio de nueve casos atendidos en el Hospital Infantil del estado de Sonora. Un caso de FMMR fue definido por datos clínicos y pruebas serológicas positivas (inmunofluorescencia indirecta o aglutinación a Proteus OX 19). Se recabaron las características clínicas y demográficas de los pacientes. Resultados. La población de estudio se integró con niños de dos a doce años de edad que tuvieron contacto con perros infestados con garrapatas y cursaron con fiebre y exantema petequial. Las alteraciones en los exámenes de laboratorio incluyeron elevación de enzimas hepáticas, hiponatremia y plaquetopenia. El tratamiento consistió en la administración de cloranfenicol y doxiciclina. La mortalidad fue del 22%. Conclusión. Se documenta la presencia de la enfermedad en el estado de Sonora, México. La FMMR debe considerarse como un riesgo de salud pública que requiere acciones para su prevención y control.

OBJECTIVE: To report the clinical features of the Rocky Mountain spotted fever (RMSF) in children of southern Sonora, Mexico. MATERIAL AND METHODS: Nine cases were studied at the Sonora State Children's Hospital. One case was defined by clinical features and positive serological tests (indirect immunofluorescence assay or reaction to Proteus OX 19). Demographic and clinical characteristics of the patients were registered. RESULTS: The study subjects were children from two to twelve years ofage. All patients have had contact with tick-infested dogs and had fever, as well as petechial rash. Laboratory findings included high levels of hepatic aminotransferase, hyponatremia and thrombocytopenia. Therapy with chloramphenicol and doxyciclyne was administered after the first seven days of the onset of illness. The mortality rate was 22%. CONCLUSIONS: This study supports the presence of RMSF in the state of Sonora, Mexico, which should be considered as a public health hazard, requiring immediate actions for prevention and control.

Determinación de la susceptibilidad de Escherichia coli en aislamientos del tracto urinario por el sistema DIRAMIC / Antimicrobial susceptibility of Escherichia coli urinary tract isolates by the DIRAMIC system

Las infecciones del tracto urinario (ITU) constituyen una de las más frecuentes en el hospital y la comunidad siendo Escherichia coli el microorganismo principalmente involucrado en estos procesos. El presente trabajo tuvo como objetivo principal evaluar la susceptibilidad de este patógeno frente a un grupo de antimicrobianos comúnmente empleados en el tratamiento de estas infecciones, a partir de un análisis retrospectivo de los datos acumulados y procesados durante el periodo Enero 2001 a Diciembre 2004 por el sistema DIRAMIC desde 11 hospitales pediátricos ubicados en diferentes regiones del país. Se procesaron 3.300 cepas, 2.401 de la comunidad y 899 hospitalarias. Se encontraron porcentajes de resistencia superiores en los aislados de la comunidad siendo significativos (p = 0,00) para kanamicina (37,7% contra 26,0%) cefazolina, (44,7% contra 28,1%) ácido nalidíxico (34,6% contra 24,7%), sulfametoxazol/trimetoprim (84,5% contra 68,8%) y ciprofloxacina (29,2% contra 15,1%), aunque no se observó incremento en el periodo. Para los aislamientos hospitalarios se encontró una tendencia de incremento significativo en el periodo para kanamicina, gentamicina, amicacina, cefazolina y ciprofloxacina (p = 0,00). Los antibióticos menos efectivos in vitro fueron sulfametoxazol/trimetoprim, ampicilina, tetraciclina y cefazolina y los más efectivos quinolonas, nitrofurantoína, gentamicina y amicacina.

Diagnóstico y tratamiento de la infección orofacial de origen odontogénico de los pacientes ingresados en el servicio de cirugía oral y maxilofacial en el período de abril del 2002 a noviembre 2005 en el Hospital Escuela Dr. Roberto Calderón Gutiérrez / Diagnosis and treatment of the infection orofacial of origin odontogénico d patient elos entered in the service of oral surgery and maxilofacial in the period of April from the 2002 to November 2005 in the Hospital School Dr. Roberto Calderón Gutiérr

Se trata de un estudio descriptivo de corte transversal que tienen como objetivo el profundizar sobre el manejo y tratamiento de las infecciones odontogénicas en los pacientes ingresados por el servicio de cirugía oral y maxilofacial del Hospital Roberto Calderón Gutiérrez. La recolección de la información fue obtenida del expediente clínico evaluándose a través de una ficha clínica las características generales del paciente, así como medios diagnosticos, tratamiento médico y quirúrgico. Se estudiaron 52 pacientes predominado el sexo masculino 65.4 porciento. Las edades mas afectadas fueron de 20 a27 años 32.69 porciento. El mayor procentaje de los pacientes fueron sanos 86.3 porciento. La región anatómica más afectada fue el espacio submandibular por caries dental en las primeras, segundas y terceras molares inferiores. Se obtuvo a través del resultado del cultivo en el 3.8 porciento estreptococo B hemolótico. El antibíotico mas usado intrahospitalario fue penicilina cristalina más cloranfenicol obteniendo una menor estadía con dicho esquema. Al realizar el drenaje y la exodoncia en las primeras 24 horas se logró una menor permanencia de los pacientes hospitalizados, de 1 a 8 días. Las complicaciones más frecuentes fue angina de Ludwig, falleciendo el 80 porcineto de dichos pacientes...

Fiebre manchada de las montañas rocosas: Informe de dos casos / Rocky montain spotted fever: report of two cases

La fiebre manchada de las Montañas Rocosas (FMMR) es una enfermedad febril aguda causada por Rickettsia rickettsii, caracterizada por un exantema petequial. A pesar de conocer su etiología y manifestaciones clínicas y de disponer de un tratamiento eficaz, su letalidad aún es elevada. En sus estadios iniciales, la FMMR puede aparentar muchas otras enfermedades infecciosas y dificultar su diagnóstico. El presente trabajo informa dos casos con FMMR que ilustran la importancia de su diagnóstico oportuno y tratamiento adecuado, así como de considerar a la FMMR como diagnóstico diferencial ante un paciente febril con exantema que resida en área endémica.

Rocky Mountain spotted fever (RMSF) is an acute febrile illness caused by infection with Ricketsia Rickettsii, characterized by the presence of petechial rash. Even though the etiology, clinical characteristics and availability of effective antibiotics are known, RMSF related deaths have a prevalence of 4%. In its early stages RMFS can resemble many others infectious conditions and the diagnosis can be difficult. The present paper reports two patients with RMSF; these cases underscore the importance of prompt diagnosis and appropriate antimicrobial therapy, and consider RMSF as a differential diagnosis in any patient who develops fever and rash in an endemic area.

Scrub typhus during pregnancy: a case report and review of the literature.

Scrub typhus is a rickettsial disease that is uncommon during pregnancy. We report a case of a 33-year-old woman, G1P0, 29 weeks pregnancy who presented to hospital with high fever, chill and headache for two weeks. Her diagnosis of scrub typhus was confirmed by serum immunofluorescent assay. She was successfully treated with chloramphenicol, but preterm delivery occurred. Her infant died from respiratory distress syndrome. No vertical transmission was demonstrated in this case. Scrub typhus should be listed in the differential diagnosis of acute febrile illness in pregnant women, who either live in, or return from, endemic areas. Chloramphenicol can be used safely during pregnancy if it is not circulating at the time of delivery.

Boutonneuse fever in a child: a case report and overview.

A five and half year-old boy presented with an acute febrile illness associated with abdominal pain, generalised myalgia, arthralgia and skin rash. An elder sibling had a similar illness and had expired three days back. Initially crystalline penicillin and chloramphenicol were started. Investigations to diagnose the cause of fever viz, peripheral blood smear for malarial parasite, blood and urine cultures, Widal test and dot-ELISA for leptospirosis were negative. Weil-Felix test revealed a positive OX-2 titre of 1:100. Retrospectively, a history of close contact with dogs was elicited and a tick bite mark on the hand detected. Within five days of antibiotic therapy the fever resolved. Chloramphenicol was given totally for two weeks and the child recovered fully. Rickettsial infection should be considered in a child presenting with an acute febrile illness with skin rash since the response to specific antimicrobial therapy is dramatic and life saving.

Febre tifóide: recaída por resistência antimicrobiana. Relato de caso / Typhoid fever: relapse due to antimicrobial resistance. Case report

Relatamos pela primeira vez na Amazônia Brasileira um paciente com febre tifóide, com resistência clínica e laboratorial ao cloranfenicol, droga de escolha para esta doença em nossa regiäo. A recaída foi observada no 7° dia após o término do tratamento e a paciente foi tratada com ciprofloxacina