Tuberculosis de mama: reporte de un caso / Breast tuberculosis: a case report

RESUMEN Presentamos caso de mastitis en mujer de 45 años sin antecedentes de infección en otras regiones corporales. Presentó cuadro clínico, estudios de imágenes y baciloscopia inespecíficos, sin embargo, mediante muestras histológicas obtenidas por punción aspirativa se encontró células epiteliodes gigantes, necrosis y formaciones granulomatosas, lo cual justificó el pensamiento clínico en tuberculosis. En ausencia de evidencias confirmatorias de lesión en otros tejidos, la existencia de mastitis de evolución tórpida es un indicativo clínico para sospechar tuberculosis mamaria, pues usualmente las características del proceso suelen plantear diagnósticos erróneos con otras entidades tumorales de la mama como cáncer. La tuberculosis en mama, representa una rara enfermedad cuyo diagnóstico es difícil por las bajas evidencias clínicas, microbiológicas y la inespecificidad de los resultados imagenológicos, por lo que la sospecha de su real posibilidad diagnóstica es una condición primordial para su determinación, aun cuando no se confirme el agente causal.

ABSTRACT We present a case of mastitis in a 45-year-old woman with no history of infection in other areas of the body, with unspecific clinical picture, imaging studies, and bacilloscopy. However, histological samples obtained by aspiration showed giant epithelial cells, necrosis, and granulomatous formations, which justified a clinical inclination toward tuberculosis. In the absence of confirmatory evidence of any lesions in other tissues, the existence of mastitis of torpid evolution is a clinical indication to suspect mammary tuberculosis, since the characteristics of the process usually lead to erroneous diagnoses with other breast tumors such as cancer. Tuberculosis in the breast is a rare disease with a difficult diagnosis due to the low clinical and microbiological evidence and the lack of specificity of the imaging results, so the suspicion of its real diagnostic possibility is a fundamental condition for its determination, even when the causal agent is not confirmed.

Rapid identification of bovine mastitis pathogens by MALDI-TOF Mass Spectrometry / Rápida identificação de agentes causadores de mastite por espectrometria de massas MALDI-TOF

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been shown to be an alternative method for identification of bacteria via their protein profile spectra, being able to identify bacteria at the genus, species and even at subspecies level. With the aim of large-scale identification of pathogens causing mastitis by this platform, a total of 305 isolates of bacteria identified from cows with subclinical mastitis were analyzed by conventional microbiological culture (MC) as well as by MALDI-TOF MS coupled with Biotyper data processing. Approximately 89% of the identifications performed by MALDI-TOF MS were consistent with results obtained by MC. From the remaining isolates (11%), 6.3% of isolates were classified as misidentified (discordance for both genus and species level), and 4.7% showed identification agreement at the genus level but not at the species level, being classified as unidentified at species level. The disagreement results were mostly associated with identification of Streptococcus and Enterococcus species probably due to the narrow phenotypic similarity between these two genera. These disagreement results suggest that biochemical assays might be prone to identification errors and, MALDI-TOF MS therefore may be an alternative to overcome incorrect species-specific identification. Standard microbiological methods for bovine mastitis diagnosis are time consuming, laborious and prone to errors for some bacteria genera. In our study, we showed that MALDI-TOF MS coupled with Biotyper may be an alternative method for large-scale identification of bacteria isolated from milk samples compared to classical microbiological routine protocols.(AU)

A espectrometria de massas (MALDI-TOF MS) tem mostrado ser um método alternativo para a identificação de bactérias, sendo capaz de identificar as bactérias causadoras de mastite em gênero, espécie ou até mesmo subespécie. Com o objetivo de identificar os patógenos causadores de mastite em grande-escala por esta plataforma, um total de 305 isolados bacterianos oriundos de vacas com mastite subclínica foram analisados pela cultura microbiológica convencional (CM) e pela MALDI-TOF MS acoplada ao software Biotyper. Aproximadamente 89% das identificações realizadas pela MALDI-TOF MS foram consistentes com os resultados obtidos pela CM. Do restante de isolados bacterianos (11%), 6,3% foram classificados como identificação errônea (discordância de gênero e espécie), e 4,7% apresentaram concordância de gênero, mas discordância da espécie. Os resultados que apresentaram divergência estavam mais associados com a identificação das espécies de Streptococcus spp. e Enterococcus spp. devido à similaridade fenotípica entre os dois gêneros. Estes resultados divergentes sugerem que os ensaios bioquímicos podem ser propensos a erros de identificação, por isso a MALDI-TOF MS pode ser considerada um método alternativo para superar os erros de identificação da CM. A cultura microbiológica padrão e os ensaios bioquímicos utilizados na identificação de agentes causadores de mastite são demorados, trabalhosos e propensos a erros quando utilizados na identificação em nível de espécie. No presente estudo, demonstramos que a MALDI-TOF MS acoplada ao software Biotyper pode ser considerada um método alternativo de identificação de bactérias causadoras de mastite em grande-escala quando comparado com a cultura microbiológica convencional.(AU)

Hemangioma mamario en una lactante con aparente mastitis: Caso clínico / Mammary hemangioma in an infant with apparent mastitis: Case report

La patología mamaria en pediatría es infrecuente. El hallazgo de una masa a nivel mamario en un lactante es una situación poco común. Los posibles diagnósticos a esta edad son absceso mamario, mastitis, ingurgitación mamaria por estimulación hormonal materna y hemangioma. Es importante llegar al diagnóstico adecuado para emplear un tratamiento acorde y evitar la aparición de complicaciones de dichas patologías. Se presenta un caso de una lactante con una masa en la mama derecha detectada desde el nacimiento. Inicialmente, se trató como una mastitis, pero dada la mala evolución, se plantearon diagnósticos diferenciales y se concluyó que se trataba de un hemangioma. Debido a la ulceración de la lesión, junto con el riesgo existente de desarrollar hipoplasia mamaria, se decidió iniciar tratamiento con propanolol, con resolución casi completa de la tumoración.

Mammary pathology is infrequent during childhood. It is rare the probability of finding a breast mass in an infant. The most frequent possible diagnoses at this age are breast abscess, mastitis, breast engorgement due to maternal hormonal stimulation and hemangioma. Reaching the proper diagnosis is essential in order to apply a suitable treatment and avoid the potential disease complications. We present the case of a female infant having a mass in the right breast from birth. Initially the entity was treated as mastitis. Nevertheless, the bad evolution made necessary considering the differential diagnosis. It was concluded to be a hemangioma. Due to the lesion ulceration and the potential risk of developing breast hypoplasia, treatment with propranolol was started. The tumor was almost completely resolved.

Microbiological analysis and sensitivity profile of Staphylococcus spp. in subclinical mastitis of dairy goats / Análise microbiológica e perfil de sensibilidade do Staphylococcus spp. em mastite subclínica de caprinos leiteiros

Subclinical mastitis in goats causes economic losses and risks to public health. Given the need for research that shows the most isolated staphylococci species and sensibility tests comparing the resistance between coagulase-negative (CNS) and positive Staphylococcus (CPS) goats with subclinical mastitis, the aim of this study was to identify the microorganisms isolated from milk samples of goats with subclinical mastitis, as well as define the staphylococci species and determine the sensitivity profile of Staphylococcus spp. to antimicrobials. To collect samples, tests were performed for mug of black background and California mastitis test (CMT), collecting milk from CMT positive animals. A total of 226 samples from seven herds of dairy goats was collected and forwarded to the laboratory, where they were seeded for the isolation of the microorganism and implementing the antibiotic sensibility test. Of these, 122 samples had bacterial growth and the most isolated staphylococci species were: S. epidermidis (24.55%), S. lugdunensis (15.40%) and S. intermedius (13.64%). Samples showed increased resistance to antimicrobials: penicillin (81.8%), oxacillin (60.0%) and ampicillin (55.5%). Greater sensitivity to: enrofloxacin (99.1%), erythromycin (98.2%), gentamicin (98.2%) and vancomycin (98.2%) were observed. The S. epidermidis showed higher antimicrobial resistance to amoxicillin and penicillin than S. lugdunensis and S. intermedius. Similar resistance in vitro between CNS and CPS was observed to most antimicrobials. It is important to control the overuse of antibiotics to prevent the emergence of resistant strains.

A mastite subclínica em caprinos acarreta prejuízos econômicos e riscos à saúde pública. Tendo em vista a necessidade de pesquisas que demonstrem as espécies de estafilococos mais isoladas e os testes de sensibilidade que comparem a resistência entre Staphylococcus coagulase negativa (SCN) e positiva (SCP) de cabras com mastite subclínica, os objetivos do presente estudo foram identificar os microrganismos isolados de amostras de leite de cabras com mastite subclínica, bem como definir as espécies de estafilococos e determinar o perfil de sensibilidade de Staphylococcus spp. aos antimicrobianos. Para realizar a coleta das amostras, foram executados os testes da caneca de fundo preto e California mastitis test (CMT) com o leite dos animais reagentes ao CMT. Coletaram-se 226 amostras provenientes de sete rebanhos de caprinos leiteiros, as quais foram encaminhadas para o laboratório, onde foram semeadas para o isolamento do microrganismo e a realização do teste de antibiograma. Dessas amostras, 122 tiveram crescimento bacteriano e as espécies mais isoladas de estafilococos foram: S. epidermidis (24,55%), S. lugdunensis (15,40%) e S. intermedius (13,64%). As amostras apresentaram maior resistência aos antimicrobianos penicilina (81,8%), oxacilina (60,0%) e ampicilina (55,5%). Observou-se maior sensibilidade para enrofloxacina (99,1%), eritromicina (98,2%), gentamicina (98,2%) e vancomicina (98,2%). O S. epidermidis apresentou maior resistência antimicrobiana para a amoxicilina e a penicilina do que o S. lugdunensis e o S. intermedius. Foi verificada uma resistência in vitro semelhante entre os estafilococos coagulase negativa e positiva para a maioria dos antimicrobianos testados. É importante o controle do uso abusivo de antimicrobianos para evitar o surgimento de cepas resistentes.

Conventional and Doppler ultrasonography on a goat with gangrenous mastitis / Ultrassonografia convencional e Doppler em cabra com mastite gangrenosa

Objetivou-se descrever os achados clínicos e ultrassonográficos de uma cabra leiteira apresentando mastite gangrenosa. Com a ultrassonografia convencional, observaram-se alterações consistentes com o avanço do quadro clínico, como alterações na ecogenicidade do leite e parênquima mamário. A ultrassonografia Doppler revelou aumento da velocidade de pico sistólico nos três momentos estudados, passando de 15 para 17 e 29cm/s. Houve redução, também, dos valores do índice de resistência, de 0,71 para 0,61 e 0,43. O índice de pulsatividade sofreu redução entre o segundo e o terceiro dia de observação, passando de 0,98 para 0,71. Foi possível estabelecer relação direta entre os achados ultrassonográficos e a gravidade da doença. A ultrassonografia convencional e Doppler podem ser utilizadas para o estudo hemodinâmico do úbere de cabras leiteiras, favorecendo diagnóstico e prognóstico de alterações nesse órgão...

Fatores de risco, etiologia e aspectos clínicos da mastite em ovelhas de corte no Paraná / Risk factors, etiology and clinical aspects of mastitis in meat ewes of Parana, Brazil

A mastite em ovelhas da raça Santa Inês apresenta-se como um problema de grande proporção e gravidade e é dificilmente tratada com sucesso. O objetivo deste estudo foi caracterizar aspectos clínicos, epidemiológicos e etiológicos da mastite clínica em ovelhas de corte criadas no norte do Paraná. O presente estudo foi realizado entre os meses de outubro de 2009 a setembro de 2010 envolvendo 54 rebanhos de ovinos de corte de diferentes raças. Durante as visitas às propriedades, um questionário foi preenchido com a finalidade de caracterizar o problema. Setenta ovelhas com mastite clínica foram examinadas e amostras de secreção láctea foram colhidas para exame microbiológico. A mastite foi considerada um problema relevante em 39 propriedades (72,3%), com frequência média de 6,74%. Casos crônicos e agudos de mastite foram observados em 69% e 31% das ovelhas examinadas, respectivamente. Em ambos os casos, a mastite flegmonosa foi a forma mais encontrada (65,5% dos casos). O agente etiológico mais prevalente foi Staphylococcus coagulase negativo (54,5%), seguido por S. aureus e A. pyogenes (11,5% cada). Mannheimia haemolytica foi isolada em dois casos. Sistema de criação não extensivo e raça Santa Inês foram identificados como fatores de risco para o desenvolvimento de mastite clínica. Secagem das fêmeas após 120 dias de lactação e separação de fêmeas doentes do rebanho foram associadas com menor ocorrência da doença. Recomenda-se a limpeza adequada das instalações e a secagem mais tardia, principalmente em rebanhos Santa Inês.

Mastits is infrequent in meat ewes. However Santa Ines ewes have a high incidence of this disease and it is severe and difficult to treat. The goal of this study was to characterize clinical, epidemiological and etiological aspects of clinical mastitis in meat ewes reared in the north of Parana, Brazil. Fifith four farms were visited from October 2009 to September 2010. The surveyed data included frequency, breeds of sheep affected, lamb mortality rates, main clinical signs, attempts and outcome of treatment, method and period of weaning and management features. Seventy ewes with clinical mastitis were fully examinated and samples of mammary secretion were asseptically taken for bacteriological culture. Mastitis was identified in 39 farms (72.3%) as a relevant problem (mean frequency was 6,74%). Chronic and acute mastitis were observed in 69% and 31% of the examinated ewes, respectively. In both cases, phlegmonous mastitis was the most prevalent form (65.5%). Coagulase negative Staphylococccus (CNS) was the main isolated microorganism (54.5%), followed by Staphylococcus aureus and Arcanobacterium pyogenes (11.5%, each one). Mannheimia haemolytica was found in two cases. The risk factors for clinical mastitis were intensive management system and Santa Ines breed. Weaning after 120 days of lactation and isolation of affected ewes were associated with lower frequency of mastitis. Preventive measures recommended are daily cleaning of facilities and delayed weaning, mainly in Santa Ines flocks.

Siliconoma mamario / Breast Siliconomas

Nuestra Unidad recibe por su área programática de influencia, pacientes de bajos recursos socioeconómicos y culturales que fueron sometidos a prácticas ilegales de inclusión de materiales de uso no médico por vía infiltrativa en las mamas y que requirieron trtamiento quirúrgico como consecuencia de haber causado procesos inflamatorios inespecíficos con deformidad y dolor invalidante. En el período comprendido entre el 26/10/2009 al 26/10/2010 en la Unidad de Cirugía Plástica del HZGA Dr. Lucio A. Meléndez de Adrogué tres pacients intervenidos quirúrgicamente por presentar siliconomas mamarios. El procedimiento de elección fue adenomastectomia subcutánea bilateral con reconstrucción posterior con implantes, con buenos resultados estéticos. El desconocimiento y las consecuencias por la aplicación infiltrativa de siliconas industriales en las mamas obligan al equipo de cirugía plástica a desarrollar nuevas tácticas para solucionr las consecuencias devastadoras que las mismas producen en los pacientes

Our Unit received for its program area of influence, patients with low socioeconomic and cultural resources that were subjected to illegal practices including non-medical use materials via infiltration in the breast and needed surgery as a consequence of nonspecific inflammatory processes caused by deformity and crippling pain. In the period from 26/10/2009 to 26/10/2010 in the Unit of Plastic Surgery Dr. Lucio A. HZGA Melendez Adrogué three patients undergoing surgery for breast siliconomas present. The election procedure was adenomastecty reconstruction after bilateral subcutaneous implants, with good aesthetic results. The ignorance and the consequences for the application infiltrative industrial silicone breast forces the plastic surgery team to develop new tactics to adress the devstating consequences that they produce in patients

Mastitis tuberculosa / Tuberculosis of the breast

Se informa un caso de mastitis granulomatosa causada por Mycobacterium tuberculosis en una paciente inmunocompetente con lesiones inflamatorias crónicas de la mama, diagnosticada por la detección de ADN de la micobacteria mediante la técnica de reacción en cadena de la polimerasa de la secuencia de inserción IS6110 presente en el complejo M. tuberculosis , en una biopsia de mama embebida en parafina. La tuberculosis primaria de la mama es rara, incluso en países con alta prevalencia de tuberculosis, y debe sospecharse en pacientes con mastitis granulomatosa crónica de causa no clara. El pilar del tratamiento es la quimioterapia antituberculosa y, ocasionalmente, la cirugía.

We report a case of granulomatous mastitis caused by Mycobacterium tuberculosis in an immunocompetent woman with chronic inflammatory lesions of the breast. It was diagnosed by detection of mycobacteria DNA using polymerase chain reaction technique targeting IS6110 insertion element of M. tuberculosis complex in a paraffin-embedded histological specimen. The primary breast tuberculosis is rare, even in countries where the incidence and prevalence of pulmonary and extra pulmonary tuberculosis are high. It should be suspected in female patients with chronic granulomatous mastitis with no apparent cause. The cornerstone of treatment is antituberculous chemotherapy, and surgery is rarely required.

Estudo dos métodos de rotina diagnóstica de mastite no leite de éguas / Study of routine diagnosis methods of mastitis in mares

Routine diagnosis methods used in bovine mastitis were studied in 55 mares in lactation. The findings of strip cup test, California Mastitis Test-CMT, electronic somatic cell count-CCS, microbiological culture, and in vitro antimicrobial susceptibility profile of isolates were discussed. Streptococcus spp., Staphylococcus spp, and enterobacteria were the most common microorganisms isolated in health and CMT-positive mammary glands. Staphylococcus aureus and Arcanobacterium pyogenes were identified in two mares presenting clinical mastitis. Mean somatic cell count of eight mares without presence of microorganisms in milk was 247.57x10³/mL and 1.621,86x10³/mL in 47 mares with positive microbiological culture. Moderate concordance (63.8 percent) between positive reactions in CMT (1 to 3+) and microbiological culture was observed. Amicacin (78.9 percent), ceftiofur (74.7 percent), sulpha-trimetoprim (69,0 percent) and norfloxacin (69.0 percent), were the most effective drugs, while resistance of isolates was mainly observed against penicillin (64.8 percent), gentamycin (35.2 percent), azithromycin (35.2 percent), enrofloxacin (28.2 percent), and florfenicol (28.2 percent).

Breast tuberculosis: report of nine cases of extra pulmonary tuberculosis with breast mass

To explain the difficulties in diagnosing Breast tuberculosis [BT], especially in the absence of other specific clinical signs, and to emphasize the efficacy of anti-tuberculosis [TB] therapy. We report nine cases of BT retrieved from the files of the TB patients in Khuzestan a province located in the south west of Iran during 5 years period of time [2005-2009]. Data of fine needle aspiration [FNA] cytology, Ziel-Nelson stains, microbiological analysis, routine fungal and culture for tuberculosis were reviewed. Age range was 25 to 51 years with a mean of 34.1 years. Two patients were lactating, and one patient was pregnant. Seven patients had a lump in the breast and four of these patients had a discharging sinus in association with the lump. Another two patients had multiple sinuses. Two patients had breast abscess. Cytology of the patients presented with breast lump or abscess showed granulomatus reaction with or without caseous. Culture was negative for M. tuberculosis in all cases. Cases with breast mass despite clinical suspicion of cancer, histologically presented with granulomatous mastitis even with culture negative results for TB are appropriate candidates for anti TB therapy

Etiologia e perfil de sensibilidade antimicrobiana dos isolados bacterianos da mastite em pequenos ruminantes e concordância de técnicas empregadas no diagnóstico / Etiology and profile of antimicrobial sensitivity of bacteria from small ruminant mastitis and relationship of diagnostic techniques

A mastite é a inflamação da glândula mamária que acomete raças de aptidão leiteira como também aquelas voltadas para produção de carne. Esta enfermidade ocasiona sérias alterações na produção de leite e na sua qualidade, redução no ganho de peso e mortalidade de cordeiros. O presente estudo teve por objetivo conhecer os principais agentes causadores de mastite em ovinos e caprinos, bem como a sua susceptibilidade aos agentes antimicrobianos, além de avaliar o grau de concordância entre testes diagnósticos. Foram visitadas 25 propriedades durante a realização do experimento, sendo criatórios de caprinos, ovinos e rebanhos mistos, nos estados de Pernambuco e Bahia. Coletou-se leite de 439 caprinos e 76 ovinos. Foi realizada lactocultura, o California Mastitis Test (CMT) e o teste de sensibilidade aos antimicrobianos. Além disso, determinou-se o grau de concordância entre os testes diagnósticos empregados. Foi constatada uma maior freqüência de Staphylococcus spp. nos casos de mastite em caprinos e ovinos, sendo observado ainda, isolados de Streptococcus spp., Corynebacterium spp. e bacilos gram negativos (BGN). Os isolados apresentaram alta sensibilidade aos antimicrobianos testados, sendo o menor percentual de sensibilidade observado para o ácido nalidíxico. Em relação ao diagnóstico da mastite caprina, a análise comparativa entre o exame microbiológico e o CMT demonstrou um grau de concordância igual a K=0,17, enquanto que para a espécie ovina, este valor foi de K=0,22. A utilização do CMT para o diagnóstico da mastite subclínica em cabras e ovelhas deverá ser associado à técnica da lactocultura.

Mastitis is an inflammation of mammary gland, that are important in milking breed as well in meat ones. It is associated with serious reduction in milk production and quality, lambs weight gain reduction and mortality The goal of this work was determine the major etiologic agents of goat and sheep mastitis, as well as antimicrobial drug-resistance patterns and the agreement between two different diagnostic tools. We visit 25 goat, sheep, and goat and sheep farms in Pernambuco and Bahia State, and a total of 439 goats and 76 sheep milk samples were collected. To diagnose of small ruminant mastitis were compared two tests: Milk culture and California Mastitis Test (CMT). The bacterial drug-resistance pattern was determined by Kirby Bauer test. Staphylococcus spp. was the most frequent bacteria isolated from goat and sheep mastitis cases. Streptococcus spp., Corynebacterium spp. and gram-negative bacilli were isolated. It was possible to observe the high sensitivity to antimicrobial drugs in all tested bacteria, being the lower sensitivity percentage determined to nalidixic acid. Considering caprine mastitis diagnostic the comparative analysis between microbiologic culture and shown a concordance degree of K=0,17, although to ovine species these value was K=0,22. The use of CMT to subclinical mastitis diagnostic in goat and ewes must be associated to milk bacterial culture.

Mastite em pequenos ruminantes no Brasil / Small ruminant mastitis in Brazil

Este artigo objetivou revisar as informações recentes sobre mastite em pequenos ruminantes, abrangendo etiologia, epidemiologia, aspectos de controle e profilaxia. Houve a preocupação em reunir resultados de estudos desenvolvidos no Brasil, uma vez que a mastite tem a interferência de uma série de fatores, como fatores ambientais e outros decorrentes dos sistemas de manejo empregados, condições essas determinantes para etiologia e epidemiologia da enfermidade. A prevalência da mastite em caprinos varia entre 22 e 75 por cento, sendo que os casos de mastite subclínica são os mais frequentes. Existe uma carência de trabalhos voltados para os aspectos epidemiológicos da enfermidade no nosso país. Contudo, observa-se que a mastite vem assumindo importância cada vez maior nos rebanhos voltados para produção de carne, sendo encontrados resultados de pesquisa, principalmente na espécie ovina. A mastite estafilocócica corresponde à maior fração nas infecções intramamárias em pequenos ruminantes. O caráter zoonótico de alguns patógenos, a exemplo do Staphylococcus aureus ressalta a importância da implantação de programas de controle em propriedades leiteiras. Algumas das ferramentas de diagnóstico ainda necessitam de padronização, principalmente para espécie caprina que apresenta uma série de particularidades. Ainda são discutidas as principais estratégias de controle como o manejo de fêmeas e suas crias, os procedimentos de ordenha e a utilização de vacinas.

The present reviews mastitis in small ruminants, focusing important aspects of etiology, epidemiology, diagnose, control, and prophylaxis. There was a special concern in review studies developed in Brazil, since mastitis results from a combination of many factors such as environmental and management conditions that concur for the action of etiological agents and for the epidemiology of this relevant disease. The prevalence mastitis in goats varies from 22 to 75 percent, with higher frequency of subclinical cases. In Brazil there are few studies about epidemiologic aspects of mastitis in small ruminants. In the other hand, the disease has growing in importance in meat producing small ruminants, mainly sheep. The mastitis caused by staphylococci is the most prevalent in small ruminants. The zoonotic importance of some milk pathogens such as Staphylococcus aureus emphasizes the importance of the elimination this bacteria by carriers between goat and sheep milk farms. Some diagnostic techniques need more standardization, especially those used in goats that demonstrated some peculiarities. Mastitis control strategies will be discussed include the management of the females and their offspring, milking procedures and vaccination protocols.

Etiologia e perfil de sensibilidade antimicrobiana dos isolados bacterianos da mastite em pequenos ruminantes e concordância de técnicas empregadas no diagnóstico / / Etiology and profile of antimicrobial sensitivity of bacteria from small ruminant mastitis and relationship of diagnostic techniques

A mastite é a inflamação da glândula mamária que acomete raças de aptidão leiteira como também aquelas voltadas para produção de carne. Esta enfermidade ocasiona sérias alterações na produção de leite e na sua qualidade, redução no ganho de peso e mortalidade de cordeiros. O presente estudo teve por objetivo conhecer os principais agentes causadores de mastite em ovinos e caprinos, bem como a sua susceptibilidade aos agentes antimicrobianos, além de avaliar o grau de concordância entre testes diagnósticos. Foram visitadas 25 propriedades durante a realização do experimento, sendo criatórios de caprinos, ovinos e rebanhos mistos, nos estados de Pernambuco e Bahia. Coletou-se leite de 439 caprinos e 76 ovinos. Foi realizada lactocultura, o California Mastitis Test (CMT) e o teste de sensibilidade aos antimicrobianos. Além disso, determinou-se o grau de concordância entre os testes diagnósticos empregados. Foi constatada uma maior freqüência de Staphylococcus spp. nos casos de mastite em caprinos e ovinos, sendo observado ainda, isolados de Streptococcus spp., Corynebacterium spp. e bacilos gram negativos (BGN). Os isolados apresentaram alta sensibilidade aos antimicrobianos testados, sendo o menor percentual de sensibilidade observado para o ácido nalidíxico. Em relação ao diagnóstico da mastite caprina, a análise comparativa entre o exame microbiológico e o CMT demonstrou um grau de concordância igual a K=0,17, enquanto que para a espécie ovina, este valor foi de K=0,22. A utilização do CMT para o diagnóstico da mastite subclínica em cabras e ovelhas deverá ser associado à técnica da lactocultura.

Mastitis is an inflammation of mammary gland, that are important in milking breed as well in meat ones. It is associated with serious reduction in milk production and quality, lambs weight gain reduction and mortality The goal of this work was determine the major etiologic agents of goat and sheep mastitis, as well as antimicrobial drug-resistance patterns and the agreement between two different diagnostic tools. We visit 25 goat, sheep, and goat and sheep farms in Pernambuco and Bahia State, and a total of 439 goats and 76 sheep milk samples were collected. To diagnose of small ruminant mastitis were compared two tests: Milk culture and California Mastitis Test (CMT). The bacterial drug-resistance pattern was determined by Kirby Bauer test. Staphylococcus spp. was the most frequent bacteria isolated from goat and sheep mastitis cases. Streptococcus spp., Corynebacterium spp. and gram-negative bacilli were isolated. It was possible to observe the high sensitivity to antimicrobial drugs in all tested bacteria, being the lower sensitivity percentage determined to nalidixic acid. Considering caprine mastitis diagnostic the comparative analysis between microbiologic culture and shown a concordance degree of K=0,17, although to ovine species these value was K=0,22. The use of CMT to subclinical mastitis diagnostic in goat and ewes must be associated to milk bacterial culture.

Composition and bulk tank somatic cell counts of milk from dairy goat herds in Southeastern Brazil / Composição e contagem de células somáticas no leite de rebanhos caprinos do Sudeste do Brasil

The milk composition and somatic cell count (SCC) are requirements for assessment milk quality and mastitis in goat herds. Studies conducted with dairy goat herds indicated that the milk composition differed among them to due to factors such as genetic, feeding, system of production, stage of lactation, year and year-season. The objective of this study was to assess SCC and other milk quality indicators (fat, protein, lactose, and total solids) for goat milk bulk tank. The influence of the herd and year-season on the milk composition as well as herd, milking system and year-season on SCC was also evaluated. Thirteen Brazilian dairy goat herds with about 1,400 dairy goats were included in the study. Six herds were milked by hand and in the remaining seven machine milking was used. Herds were sampled at weekly intervals during two lactations. A total of 913 bulk milk samples were analysed using a automated equipment. The general average percent values for fat, protein, lactose and total solids were, respectively,3.44, 2.95, 4.45 and 11.69. The effect of herd and season was significant for all milk components and bulk milk goat somatic cell count (SCC).The SCC average of all 13 herds was 779,000 cells/ml. The average SCC values of herds milked by hand and by machine were 1,121,000and 848,000 cells/ml respectively. In both groups, the SCC was lowerin the winter and higher in the autumn. Herd characteristics were responsible for higher variability on components and SCC in

A composição do leite bem como a contagem de células somáticas (CCS) são requisitos para avaliar a qualidade do leite e mastite em rebanhos caprinos. Estudos conduzidos indicaram que a composição do leite varia entre os rebanhos devido a fatores genéticos, alimentação, sistema de produção, estágio de lactação, ano e estação do ano. O objetivo do estudo foi avaliar a CCS e outros indicadores de qualidade(gordura, proteína, lactose e sólidos totais) no leite de rebanhos caprinos. A influência do rebanho e estação do ano sobre a composição bem como a influência de rebanho, tipo de ordenha e estação do ano sobre a CCS também foi avaliado. Treze rebanhos caprinos localizados no Brasil, com aproximadamente 1.400 matrizes foram incluídos no estudo, Sendo ordenhados manualmente e os outros sete com equipamento de ordenha. As amostras de leite dos rebanhos foram coletadas semanalmente durante duas lactações. O total de 913 amostras foi analisado no equipamento automatizado. A média dos valores percentuais para gordura, proteína, lactose e sólidos totais foram, respectivamente; 3,44; 2,95; 4,45 e 11,69. O efeito de rebanho e estação do ano foi significante para todos os componentes do leite e CCS. A média para CCS de todos 13 rebanhos foi 779.000 células/ml. As médias para CCS dos rebanhos ordenhados manualmente e mecanicamente foram, respectivamente, 1.121.000 e 848.000 células/ml. Em ambos grupos, a CCS foi menor no inverno e maior no outono. As características de rebanho foram responsáveis pela maior variação dos componentes e CCS no leite de rebanhos caprinos

Idiopathic granulomatous mastitis

To discuss the clinical and radiological features and treatment approaches in 14 patients diagnosed with idiopathic granulomatous mastitis [GM]. We retrospectively evaluated the clinical features, radiological findings, and treatment approaches in 14 patients with idiopathic GM in the General Surgery Department, Gulhane School of Medicine, Ankara, Turkey between April 2000 and June 2006. The mean age of the patients was 34.5 years [range 27-41 years]. The complaints at admission were a mass in the breast in 7 [50%] patients, an abscess and a mass in 6 [42.8%], and a skin fistula in one [7.2%]. Granulomatous mastitis was unilateral in all subjects [on the right in 5 patients and on the left in 9]. All of the patients underwent ultrasonographic evaluation. Mammography was performed in 8 and magnetic resonance imaging in 5 patients. Seven patients [50%] were suspected to have breast carcinoma according to radiological findings. We performed large excision in 11, incisional biopsy plus abscess drainage in one, and incisional biopsy plus abscess drainage plus medical treatment [prednisolone, methotrexate] in 2 patients. Due to the development of abscess after 9 months, drainage and large excision were also performed in one patient who received medical treatment. Idiopathic GM is a disease that generally affects young women of reproductive age and may be mistaken for breast carcinoma in clinical and radiological evaluations. The gold standard for the diagnosis is histopathologic evaluation

Mastite granulomatosa em mulher jovem / Granuloneatous mastitis in young woman

Mulher de 26 anos apresentou tumor de crescimento rápido em mama esquerda, doloroso. Odiagnóstico da lesão, que simulava câncer de mama, só foi possível após biópsia do tecido mamárioque diagnosticou mastite granulomatosa.

A woman, 26-years old, was attended complaining of increased and painful enlargement of the left breast.The clinic diagnosis was breast cancer. The definitive diagnosis (histopathology) was granulomatosismastitis.

Breast tuberculosis--a case report.

Breast tuberculosis is a rare disease. It usually mimics carcinoma breast in its presentation both clinically as well as radiologically. Since breast conservation is possible in tuberculous mastitis and it may be a presenting feature of HIV, it is important to recognise this condition. One case of a 50-year female despite strong clinical suspicion of malignancy though could not be histologically proven is reported here. Following a breast conserving surgery, Langhans' giant cells were seen on histopathology. Patient was started on antituberculous therapy and responded well.

Tuberculosis of the breast

Tuberculosis of the breast is an uncommon disease even in countries where the incidence of pulmonary and extrapulmonary tuberculosis is high. Clinical presentation is usually of a solitary, ill-defined, unilateral hard lump situated in the upper outer quadrant of the breast. This disease can present a diagnostic problem on radiological and microbiological investigations, and thus a high index of suspicion is needed. Incorporating a highly sensitive technique like polymerase chain reaction [PCR] may be helpful in establishing the usefulness of such technology and can aid in conforming the diagnosis early. The disease is curable with antitubercular drugs, and surgery is rarely required

Mastitis granulomatosa idiopática: diagnóstico y tratamiento en 14 casos / Idiopathic granulomatous mastitis: report of 14 cases

Introducción: La mastitis granulomatosa idiopática es una enfermedad inflamatoria benigna, infrecuente, de etiología desconocida. Puede simular carcinoma mamario, por lo cual su diagnóstico definitivo es histopatológico. No existe consenso respecto a su tratamiento. Realizamos una caracterización clínica de esta patología considerando su forma de presentación, métodos diagnósticos y tratamiento con especial énfasis en la efectividad de la corticoterapia. Material y método: Estudio retrospectivo realizado mediante protocolo tipo. Se revisaron los registros y fichas clínicas de los pacientes manejados con diagnóstico de mastitis granulomatosa idiopática en el Hospital Regional Valdivia entre los años 1995-2006. Resultados: La serie corresponde a 14 pacientes de sexo femenino. El promedio de edad fue de 31,6 años. La presentación clínica más frecuente fue absceso mamario en 9/14. Se realizó estudio imagenológico en 11/ 14 casos mediante mamografía en 7/14 y ecotomografía en 10/14. Las muestras para estudio histopatológico fueron obtenidas por biopsia percutánea en 8/14 y quirúrgica en 6/14. Se realizó tratamiento corticoidal con prednisona en 12/14 pacientes logrando buena respuesta en todos los casos. Se presentaron 2 recidivas durante el seguimiento que comprende un promedio de 28 meses. Conclusiones: La presentación clínica de las mastitis fue similar a la reportada en la literatura. La respuesta al tratamiento corticoesteroidal logró el control de la enfermedad en todos los casos. Las reacciones adversas al tratamiento fueron menores y las 2 recidivas fueron de menor magnitud y duración respecto al cuadro inicial.

Contagem de células somáticas e isolamento de agentes causadores de mastite em búfalas (Bubalus bubalis) / Somatic cell count and mastitis causing pathogens isolation in water buffaloes (Bubalus bubalis)

The research was accomplished in eight dairy water buffalo herds, randomically choosen in Região do Alto São Francisco, State of Minas Gerais, Brazil. Information was collected from March to November, 2003 during 270 days of observation. In order to determine the somatic cell count (SCC) in presence or absence of microbial isolation, 1,393 samples were collected from 285 lactating females and microbiological exams and SCC were done. Samples obtained from udders without evidence of clinical or subclinical inflammation showed infection for a great variety of microbial mastitis pathogens. The low SCC did not necessarily indicate the absence of intramammary infection, suggesting that SCC patterns used for bovine cannot be appropriate in order to control mastitis in buffalo herds.