Endocarditis infecciosa nativa en pediatría: enfoque clínico cardiológico / Native valve infective endocarditis in children: From the focus of clinical cardiology

Objetivos: Analizar las características demográficas, clínicas, microbiológicas, evolución y factores de riesgo de morbimortalidad asociados a la endocarditis de válvula nativa (EIN) en pacientes (p) pediátricos. Población y métodos: Se evaluaron 176 p con EIN, divididos en grupo I: <3meses (27p) y grupo II: >3meses (149p). Resultados: Grupo I: el 66% tenía corazón sano. El microorganismo más frecuente fue Staphylococcus aureus (44,4%). Afectación derecha (77,8%-p<0,0001). Evento principal: infección no controlada (INC) (52%, p=0,0009) y asociada a Candida (p<0,00001). Se indicó tratamiento quirúrgico a 10 p (37%). Mortalidad 29,6%(8p). Grupo II: el 57% presentaba cardiopatía previa. Microorganismos prevalentes: S.aureus (49,1%) y estreptococos del grupo viridans (22,5%). Hubo compromiso predominantemente izquierdo (p=0,001). Eventos: embolias sistémicas (36,2%-p=0,01), perforación valvular (51%-p=0,0005), insuficiencia cardíaca (26%-p=0,03) e INC (21,5%). La embolia sistémica se asoció a S.aureus (p=0,01). El 36,2% requirió cirugía. Mortalidad 6,7% (10p). En el análisis univariado la mortalidad se asoció a edad <3meses (p=0,0003), INC (p=0,002) y S.aureus (p=0,03). En el multivariado la mortalidad se relacionó a edad < 3meses (OR:7,50 ­IC95%:1,77­31,69) y a INC (OR:4,2-IC95%:1,16­15,29). Conclusiones: La EN se presentó en pacientes con corazón sano en el 50% de los casos. El microorganismo más frecuente fue S.aureus. En los <3 meses la infección no controlada fue la complicación más frecuente asociada a Candida, con afectación predominante de cavidades derechas. Los >3meses tuvieron mayor prevalencia de perforación valvular izquierda asociada a embolias sistémicas e insuficiencia cardíaca. El 35% de los p requirió cirugía. Los predictores de mortalidad fueron la edad <3meses y la INC.

Objectives: To analyze demographic, clinical, and microbiological, outcome, and morbidity and mortality risk factors associated with native valve endocarditis (NVE) in pediatric patients (p). Population and methods: 176 p with NVE were evaluated and divided into group I: <3 months (27p) and group II: >3 months (149p). Results: Group I: 66% had a healthy heart. The most common microorganism was Staphylococcus aureus (44.4%). Right-sided involvement (77.8%-p<0.0001). Main event: Uncontrolled infection (UCI) (52%, p-0.0009) and association with Candida (p<0.00001). Surgical treatment was indicated in 10 p (37%). Mortality was 29.6% (8p). Group II: 57% had previous heart disease. Prevalent microorganisms: S. aureus (49.1%) and viridans group streptococci ( (22.5%). Left-sided involvement predominated (p-0.001). Events: systemic embolism (36.2%-p-0.01), valve perforation (51%-p-0.0005), heart failure (26%-p-0.03), and UCI (21.5%). Systemic embolism was associated with S. aureus infection (p-0.01). 36.2% required surgery. Mortality was 6.7% (10p). In univariate analysis, mortality was associated with age <3 months (p-0.0003), UCI (p-0.002), and S. aureus infection (p-0.03). In multivariate analysis, mortality was related to age <3 months (OR:7.50 ­ 95% CI:1.77­31.69) and UCI (OR:4.2 -95% CI:1.16­15.29). Conclusions: NVE was observed in patients with a healthy heart in 50% of cases. The most common microorganism found was S. aureus. In the <3 months group, uncontrolled infection was the most common complication associated with Candida, predominantly affecting the right side. The >3 months group had a higher prevalence of left-valve perforation associated with systemic embolism and heart failure. 35% of p required surgery. Predictors of mortality were age <3 months and UC (AU)

Identificación y sensibilidad a los antimicrobianos de aislados de estreptococos del grupo viridans provenientes de pacientes internados en un hospital universitario de la ciudad de Buenos Aires / Identification and antibiotic susceptibility of viridans group streptococci isolates recovered from patients hospitalized at a teaching hospital in Buenos Aires City

Los estreptococos del grupo viridans (EGV) son agentes causales de infecciones localizadas e invasivas. Dada la gravedad de las infecciones producidas por EGV sumada a las escasas comunicaciones actuales en nuestro país, los objetivos de este trabajo fueron la identificación y el estudio de la sensibilidad a los antibióticos de aislados caracterizados como EGV, recuperados de pacientes internados, para actualizar el conocimiento sobre el perfil de resistencia y la epidemiología de las infecciones ocasionadas por EGV. Se recuperaron 132 aislados de EGV en el Hospital de Clínicas «José de San Martín¼ en el período 2011-2015. La identificación se realizó mediante pruebas convencionales y espectrometría de masas (Matrix Assisted Laser Desorption Ionization - Time of Flight Mass Spectrometry). El grupo Streptococcus anginosus fue el más frecuente (42%) seguido por el grupo Streptococcus mitis (33%). Dentro del grupo S. mitis se excluyó a Streptococcus pneumoniae. El 100% de los aislados fue sensible a ertapenem, linezolid y vancomicina; el 96,9% a cef-triaxona y cefepima. Se encontró un 25,8% de resistencia a penicilina (I+R) fundamentalmente en aislados de grupo S. mitis. La resistencia a tetraciclina fue del 27,2% y solo 2/132 aislados fueron resistentes a levofloxacina. Los valores de CIM de gentamicina oscilaron entre 0,5 y 32 -og/ml. El 17,4% de los aislados presentó resistencia a eritromicina sin diferencia significativa en la distribución de fenotipos M y MLS. Los resultados muestran la importancia de la vigilancia continua de las infecciones producidas por estos microorganismos con el fin de generar aportes para la elección de la terapia antibiótica adecuada.

Members of the viridans group streptococci (VGS) are the cause of local and invasive infections. Due to the severity of these infections and taking into account that reports regarding epidemiological aspects are scarce, the aims of this work were the identification and the study of the antibiotic susceptibility profiles of the isolates recovered from patients that were hospitalized in order to find out about the resistance level and the epidemiology of infections in which VGS are involved. A hundred and thirty two isolates identified as VGS were isolated at Hospital de Clínicas «José de San Martín¼ during the period 2011-2015. The identification was performed by biochemical test and mass spectrometry by Matrix Assisted Laser Desorption Ionization -Time of Flight Mass Spectrometry. Streptococcus anginosus group was prevalent (42%) followed by Streptococcus mitis group (33%). In the latter, isolates of Streptococcus pneumoniae were excluded. All the VGS isolates were susceptible to ertapenem, meropenem, linezolid and vancomycin; 25.8% were resistant (I+R) to penicillin, being prevalent in the S. mitis group. Regarding ceftriaxone and cefepime 96.9% of the isolates were susceptible. Only two isolates were resistant to levofloxacin, 27.2% to tetracycline and it was not found high level resistance to gentamycin (MIC range 0.5-32 µg/ml). Resistance to erythromycin was 17.4% with no significant difference between M and MLS phenotypes. The most active antibiotics were in addition to ceftriaxone and cefepime, vancomycin, ertapenem, meropenem and linezolid. These results highlight the importance of the continuous surveillance of the infections caused by VGS in order to predict a correct antibiotic therapy.

Diagnostic value of pediatric blood culture bottles for acute postoperative endophthalmitis

OBJECTIVE: To report our experience using conventional culture methods (CM) and pediatric blood culture bottles (PBCBs) for vitreous sample culture of acute postoperative endophthalmitis. METHODS: A retrospective study was conducted at the Department of Ophthalmology, Hospital das Clinicas, HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BR, from January 2010 to December 2015, and it included 54 patients with clinically suspected acute postoperative endophthalmitis. Vitreous samples were obtained by vitreous tap or vitrectomy. Samples from January 2010 to December 2011 were cultivated in CM, whereas samples from January 2012 to December 2015 were inoculated in PBCBs. The measured outcome was the yield of positive cultures. RESULTS: Twenty cases were included in the CM group, and 34 cases were included in the PBCB group. The yield of positive cultures in PBCBs (64.7%) was significantly higher than that in conventional CM (35%, p=0.034). Staphylococcus epidermidis and Streptococcus viridans were the two most commonly found agents. CONCLUSION: PBCBs can be used successfully in clinically suspected endophthalmitis. The method showed a higher yield of positive cultures than the conventional method. This technique appears to have several advantages over the traditional method: it saves time, as only one medium needs to be inoculated; transportation to a laboratory is easier than in the traditional method, and there is no need to maintain a supply of fresh agar media. The use of PBCBs may be recommended as the primary method for microbiological diagnosis and is especially suitable for office settings and remote clinics.

Bacteriology of peritonsillar abscess: the changing trend and predisposing factors / Bacteriologia do abscesso peritonsilar: tendência de mudança e fatores predisponentes

Abstract Introduction: Peritonsillar abscess is the most common deep neck infection. The infectious microorganism may be different according to clinical factors. Objective: To identify the major causative pathogen of peritonsillar abscess and investigate the relationship between the causative pathogen, host clinical factors, and hospitalization duration. Methods: This retrospective study included 415 hospitalized patients diagnosed with peritonsillar abscess who were admitted to a tertiary medical center from June 1990 to June 2013. We collected data by chart review and analyzed variables such as demographic characteristics, underlying systemic disease, smoking, alcoholism, betel nut chewing, bacteriology, and hospitalization duration. Results: A total of 168 patients had positive results for pathogen isolation. Streptococcus viridans (28.57%) and Klebsiella pneumoniae (23.21%) were the most common microorganisms identified through pus culturing. The isolation rate of anaerobes increased to 49.35% in the recent 6 years (p = 0.048). Common anaerobes were Prevotella and Fusobacterium spp. The identification of K. pneumoniae increased among elderly patients (age > 65 years) with an odds ratio (OR) of 2.76 (p = 0.03), and decreased in the hot season (mean temperature > 26 °C) (OR = 0.49, p = 0.04). No specific microorganism was associated with prolonged hospital stay. Conclusion: The most common pathogen identified through pus culturing was S. viridans, followed by K. pneumoniae. The identification of anaerobes was shown to increase in recent years. The antibiotics initially selected should be effective against both aerobes and anaerobes. Bacterial identification may be associated with host clinical factors and environmental factors.

Resumo Introdução: O Abscesso Peritonsilar é a infecção cervical profunda mais comum. O microrganismo infeccioso pode ser diferente de acordo com os fatores clínicos. Objetivo: Identificar o principal agente causador do abscesso peritonsilar e investigar a relação entre o patógeno causador, os fatores clínicos do hospedeiro e a duração da hospitalização. Método: Este estudo retrospectivo incluiu 415 pacientes hospitalizados diagnosticados com abscesso peritonsilar que foram internados em um centro médico terciário de junho de 1990 a junho de 2013. Coletamos dados através da análise dos arquivos médicos dos pacientes e analisamos variáveis como características demográficas, doença sistêmica subjacente, tabagismo, alcoolismo, hábito de mascar noz de betel, bacteriologia e duração da hospitalização. Resultados: Um total de 168 pacientes apresentaram resultados positivos para isolamento de patógenos. Streptococcus viridans (28,57%) e Klebsiella pneumoniae (23,21%) foram os microrganismos mais comuns identificados pela cultura da secreção. A taxa de isolamento de anaeróbios aumentou para 49,35% nos últimos 6 anos (p = 0,048). Os anaeróbios comuns foram Prevotella e Fusobacterium spp. A identificação de K. pneumoniae aumentou em pacientes idosos (idade > 65 anos) com razão de chances (Odds Ratio - OR) de 2,76 (p = 0,03) e diminuiu na estação do calor (temperatura média > 26 °C) (OR = 0,49, p = 0,04). Nenhum microrganismo específico foi associado à hospitalização prolongada. Conclusão: O patógeno mais comumente identificado através da cultura de secreção foi S. viridans, seguido por K. pneumoniae. A identificação de anaeróbios mostrou ter aumentado nos últimos anos. Os antibióticos selecionados inicialmente devem ser efetivos contra aeróbios e anaeróbios. A identificação bacteriana pode estar associada a fatores clínicos e fatores ambientais do hospedeiro.

Microbiology and clinical characteristics of viridans group streptococci in patients with cancer

ABSTRACT This study assessed the microbiology, clinical syndromes, and outcomes of oncologic patients with viridans group streptococci isolated from blood cultures between January 1st, 2013 and December 31st, 2016 in a referral hospital in Mexico using the Bruker MALDI Biotyper. Antimicrobial sensitivity was determined using BD Phoenix 100 according to CLSI M100 standards. Clinical information was obtained from medical records and descriptive analysis was performed.Forty-three patients were included, 22 females and 21 males, aged 42 ± 17 years. Twenty (46.5%) patients had hematological cancer and 23 (53.5%) a solid malignancy. The viridans group streptococci isolated were Streptococcus mitis, 20 (46.5%); Streptococcus anginosus, 14 (32.6%); Streptococcus sanguinis, 7 (16.3%); and Streptococcus salivarius, 2 (4.7%). The main risk factors were pyrimidine antagonist chemotherapy in 22 (51.2%) and neutropenia in 19 (44.2%) cases, respectively. Central line associated bloodstream infection was diagnosed in 18 (41.9%) cases. Septic shock occurred in 20.9% of patients, with an overall mortality of 18.6%. Only four S. mitis revealed penicillin-resistance.Our results are similar to those of other series, identifying these bacteria as emerging pathogens with significant morbidity and mortality in oncologic patients. The MALDI-TOF system increased the rate of viridans group streptococci isolation in this population.

Avaliação da atividade antimicrobiana do alho (Allium sativum Liliaceae) e de seu extrato aquoso / Evaluation of the antimicrobial activity of garlic (Liliaceae Allium sativum) and its aqueous extract

Objetivou-se avaliar a atividade antimicrobiana do alho (Allium sativum Liliaceae), in natura, e do extrato aquoso, frente à Candida albicans (Ca) e a Estreptococos do grupo B (EGB). O alho in natura e os extratos aquosos 30% e 170%, foram submetidos à avaliação da atividade antimicrobiana usando os métodos de Difusão em Ágar pela técnica do disco e do poço. Os resultados mostraram que o alho, in natura, apresentou halo de inibição de 55,3 ± 2,6 milímetros (mm) frente a Ca e de 27,1 ± 2,6 mm frente à EGB, enquanto o halo de inibição do miconazol foi de 24 ± 0,5 mm e o da Penicilina G de 29,8 ± 0,3 mm. O extrato aquoso de alho a 30% não apresentou atividade antimicrobiana frente à Ca e à EGB Já o extrato aquoso de alho a 170% apresentou halo de inibição frente a Ca, de 11,3 ± 0,7 mm na técnica do disco e de 14,5 ± 0,9 mm na técnica do poço, porém não inibiu o crescimento da EGB Conclui-se que o alho in natura apresentou melhor efeito inibitório frente às cepas de Ca e de EGB.

This study aimed to evaluate the antimicrobial activity of fresh garlic (Liliaceae Allium sativum) and its aqueous extracts against Candida albicans (Ca) and group B Streptococcus (GBS). Fresh garlic and its aqueous extract in concentrations of 30% and 170% were evaluated for their antimicrobial activity using the agar diffusion technique. The results showed that fresh garlic showed a halo of inhibition of 55.3 ± 2.6 millimeters (mm) towards Ca and 27.1 ± 2.6 mm towards GBS while the inhibition halo of miconazole was 24 ± 0.5 mm and the inhibition halo of Penicillin G was 29.8 ± 0.3 mm. The aqueous extract of garlic in the concentration of 30% showed no antimicrobial activity towards Ca and GBS The aqueous extract of garlic at 170%, showed a halo of inhibition towards Ca, of 11.3 ± 0.7 mm in the disk technique and 14.5 ± 0.9 mm in the well technique, but did not inhibit the growth OF GBS We conclude that the fresh garlic showed a better inhibitory effect against the strains of Ca and GBS.

Clinical Features of Right-Sided Infective Endocarditis Occurring in Non-Drug Users

Right-sided infective endocarditis (RIE) occurs predominantly in intravenous drug users in western countries, and it has a relatively good prognosis. Clinical features and prognosis of RIE occurring in non-drug users are not well known. We investigated the clinical findings of RIE in non-drug users. We retrospectively reviewed 345 cases diagnosed with IE. Cases with RIE or left-sided infective endocarditis (LIE) defined by the vegetation site were included and cases having no vegetation or both-side vegetation were excluded. Clinical findings and in-hospital outcome of RIE were compared to those of LIE. Among the 245 cases, 39 (16%) cases had RIE and 206 (84%) cases had LIE. RIE patients were younger (40+/-19 yr vs 50+/-18 yr, P=0.004), and had a higher incidence of congenital heart disease (CHD) (36% vs 13%, P<0.001) and central venous catheter (CVC) (21% vs 4%, P=0.001) compared to LIE patients. A large vegetation was more common in RIE (33% vs 9%, P<0.001). Staphylococcus aureus was the most common cause of RIE, while Streptococcus viridans were the most common cause of LIE. In-hospital mortality and cardiac surgery were not different between the two groups. CHD and use of CVC were common in non-drug users with RIE. The short-term clinical outcome of RIE is not different from that of LIE.

Septic Pylephlebitis as a Rare Complication of Crohn's Disease / 대한소화기학회지

Thrombophlebitis of the portal venous system (PVS) with superimposed bacterial infection (septic pylephlebitis) is an extremely rare complication of Crohn's disease (CD), and therefore diagnosis of septic pylephlebitis is difficult without high clinical suspicion. A 16-year old male patient who was diagnosed with CD 3 months earlier was admitted with recurrent fever and abdominal pain. CD activity had been well controlled with conventional medical treatment during a follow-up period. Abdominal contrast-enhanced computed tomography showed massive thrombosis in the PVS without evidence of intra-abdominal infection, and blood cultures were positive for Streptococcus viridians. There was no evidence of deep vein thrombosis or pulmonary thromboembolism, and all laboratory tests for thrombophilia were normal. Based on these findings, the patient was diagnosed with septic pylephlebitis complicated with CD, and was successfully treated with intravenous antibiotic therapy combined with anticoagulation. This case suggests that early comprehensive evaluation is crucial for immediate diagnosis and proper treatment of septic pylephlebitis in patients with CD who present with fever and abdominal pain of unknown origin, even with stable disease activity and absence of other intra-abdominal infections.

Perfil clínico-epidemiológico de pacientes con endocarditis infecciosa, período 2003-2010 en el hospital de Temuco, Chile / Profile of patients with infective endocarditis admitted to a Chilean regional hospital

Background: Mortality due to infective endocarditis (IE) in Chile is close to 30%. Aim: To report the experience with patients admitted with the diagnosis of IE in a regional tertiary hospital. Material and Methods: Retrospective study of 107 patients aged 50 ± 16years (75% males) discharged with a definitive diagnosis of IE according to modified DUKE criteria, between years 2003 and 2010. Demographic variables, severity scores, clinical characteristics, bacteriology and hospital evolution were recorded. Results: Fifty nine percent of patients had concomitant cardiovascular problems. APACHE II and Sequential Organ Failure Assessment (SOFA) scores on admission were 8.4 ± 4.7 and 2.7 ± 2.8 respectively. Native valves were affected in 91% of cases (aortic and mitral valves in 62% and 50% of cases respectively). Prosthetic valves were affected in 9.3% of cases. Rheumatic heart disease was the predominant primary lesion in 10% of patients. Antibiotics were used in 45.1% before blood cultures were performed. In 68% of patients blood cultures were positive. S. viridans (30.8%), S.aureus (18.6%) and coagulase negative Streptocicci (5.6%) were the identified microorganisms. Intensive care unit admission was required in 48% of patients. Renal, heart and neurological deterioration was observed in 53, 34 and 14% of patients, respectively. Twenty percent of patients developed systemic embolism and 37% required heart surgery. Mean hospital stay was 28.3 ± 19.1 days and 27% of patients died. Conclusions: In this series of patients, IE has a high mortality. Most patients studied were admitted in bad conditions.

Spondylodiscitis and endocarditis caused by S. vestibularis

Streptococcus vestibularis is a recently described member of the viridans group that was first isolated from the vestibular mucosa of the human oral cavity and described as a new species in 1988. It has been rarely associated with human infections. In few papers, it has been reported as a causal agent of systemic infection in immunosupressed adults and in those with other severe underlying diseases, like coronary valve diseases. A 65-year-old woman was admitted to the hospital with complaints of fever for three months, general malaise, effort dyspnea, weight loss, back pain and myalgia. Both native aortic valve endocarditis and spondylodiscitis due to Streptococcus vestibularis were detected. The patient was successfully treated with intravenous potassium penicillin G and gentamicin for six weeks, followed by oral amoxicillin for three months, in addition to aortic valve replacement. In all patients with spondylodiscitis, infective endocarditis should be considered, particularly in patients with heart valve disease history, since spondylodiscitis may be the presenting sign of an infective endocarditis. Cardiac valve replacement surgery should be performed if the course of fever and inflammatory syndrome is unfavorable after appropriate antibiotic treatment. We report the first case with both native aortic valve endocarditis and spondylodiscitis due to Streptococcus vestibularis.

Perfil de patógenos nas exacerbações agudas da doença pulmonar obstrutiva crônica: resultados preliminares / Pathogenic profile in acute exacerbations of chronic obstructuve pulmonary disease: preliminary results

Objetivo: Descrever os patógenos isolados em cultura quantitativa de escarro, nas exacerbações agudas de doença pulmonar obstrutiva crônica, em pacientes internados no Hospital Nossa Senhora da Conceição – Tubarão/SC e no Hospital Nereu Ramos – Florianópolis/SC. Metodologia: Foi realizado um estudo de delineamento transversal, utilizando escarro coletado em pacientes internados, o qual foi submetido à cultura quantitativa. Foi utilizada como ponto de corte a presença de 106 ufc/mL. O uso da antibioticoterapia foi confrontado com o isolamento em cultivo de agente etiológico bacteriano, através do índice de concordância Kappa. Resultados: Foram avaliados consecutivamente 13 pacientes, sendo 69,2% pertencentes ao gênero masculino, com média de idade de 67,15. A cultura de escarro evidenciou o crescimento de 53,8% de Streptococcus viridans e 7,7% de Haemophilus influenzae. Em 38,5% das culturas, não houve crescimento bacteriano. Quantificou-se 38,5%(n = 5) das culturas com mais de 106 UFC e 23,1% (n = 3) com menos de 106 UFC. O índice de concordância Kappa entre o uso de antibioticoterapia e a presença de infecção foi de -0,519. Conclusão: Houve um predomínio de pacientes do gênero masculino, e o agente mais comumente isolado nas culturas foi o Streptococcus viridans. Ocorreu discordância entre o uso de antimicronianos e a presença ou ausência de infecção.

Objective: To describe the pathogens isolated through quantitative sputum culture, in acute exacerbations of chronic obstructive pulmonary disease in patients admitted to the Hospital Nossa Senhora da Conceição, Tubarão/SC and Hospital Nereu Ramos, Florianópolis/SC. Methodology: A cross-sectional study was conducted using sputum collected from hospitalized patients, which was subjected to quantitative culture. The presence of 106 cfu/mL was used as a cutoff point. The use of antibiotics was compared with isolation of bacterial culture from the etiologic agent by Kappa index of agreement. Results:Thirteen patients were consecutive evaluated, 69.2% out of them were male, mean age 67.15. Sputum culture showed 53.8% growth of Streptococcus viridans and 7.7% of Haemophilus influenzae. There was no bacterial growth in 38.5% of the cultures. Of the total, 38.5% (n = 5) contained more than 106 CFU and 23.1% (n = 3) contained less than 106 CFU. The Kappaindex of concordance between antibiotic use and the presence of infection was -0.519. Conclusion: There was a predominance of male patients, and the agent most commonly isolated in cultures was Streptococcus viridans. There was disagreement between antimicrobial use and the presence or absence of infection.

Detection of oral streptococci in dental biofilm from caries-active and caries-free children / Detecção de estreptococos orais em biofilme dental de crianças cárie-ativas e livres de cárie

This work correlated the presence of oral streptococci in dental biofilm with clinical indexes of caries and oral hygiene in caries-active and caries-free children. S. mutans and/or S. sobrinus in the dental biofilm does not indicate a direct risk for developing dental caries.

Este trabalho correlacionou a presença de estreptococos orais no biofilme dental com índices clínicos de cárie dentária e higiene oral em crianças com alta e baixa atividade de cárie. S. mutans e/ou S. sobrinus no biofilme dental não significa o imediato desenvolvimento de lesões cariosas

Capacitação dos laboratórios para a pesquisa adequada da colonização pelo estreptococo B-hemolítico-grupo B em Jundiaí e região / Laboratory ability for the research of group B streptococcus in Jundiaí - Brazil and surrounding areas

Objetivo: avaliar a capacitação dos laboratórios da região de Jundiaí para diagnosticar o estreptococo beta-hemolítico do grupo B (EGB) no pré-natal. Metadologia: foram contatados, a partir da lista telefônica e do contato telefônico com as Secretarias de Saúde dos municípios de Jundiaí e da microrregião, todos os laboratórios de análises clínicas existentes, os quais normalmente prestam serviços de diagnóstico microbiológico por cultura, e perguntados pela técnica utilizada, técnica de coleta do material e custo do exame. Resultados: foram encontrados 21 laboratórios de análises clínicas. Apenas três (14,3 porcento) referiram utilizar um meio seletivo para o diagnóstico de EGB. Apenas um (4,8 porcento)laboratório realiza a coleta do material de forma recomendada. O custo do procedimento variou de R$4,70 a R$122,00, com média de R$53,00 (IC 95 porcento - 29,4 a 76,6). Conclusão: os laboratórios de análises clínicas na microrregião de Jundiaí, de modo geral, não estão capacitados para a coleta de material e diagnóstico microbiológico do estreptococo do grupo B. A mera solicitação do exame pelo obstetra ou profissional que assiste o pré-natal não garante que o exame solicitado seja realizado da forma mais adequada.

Infective endocarditis in hypertrophic cardiomyopathy--mural and aortic valve vegetations: a case report.

Hypertrophic cardiomyopathy (HCM) is infrequently complicated by infective endocarditis (IE). The authors report the case of a 46-year-old woman developing IE in asymptomatic HCM. Blood cultures were positive for Streptococcus viridans. Echocardiography demonstrated: 1) a mobile (1.2 x 1 cm2) vegetation attached to the septal endocardium at the site of contact between the mitral valve leaflet and the hypertrophic septum; 2) two large (2.7 x 1.7 cm2 and 1.6 x 1.1 cm2) vegetations at NCC and RCC respectively of aortic valve, causing moderate valve regurgitation, and, 3) a mural (1 x 0.8 cm2) vegetation on the posterior wall of the left ventricle. On the third day of hospitalization, the patient underwent aortic valve replacement and removal of the vegetations. Antibiotics were continued for another four weeks. The patient recovered and follow-up was uneventful. Thus, chronic endocardial trauma of the septum, a common finding in HCM with outflow tract obstruction, may provide a fertile nidus for the development of vegetation, which in turn would play the major role in the pathogenesis of IE.

Características laboratoriais das ceratites e conjuntivites causadas por Streptococcus sp / Laboratorial findings of Streptococcus keratitis and conjunctivitis

OBJETIVOS: Analisar os resultados laboratoriais de conjuntivites e ceratites com cultura positiva para Streptococcus sp, avaliando a incidência das diferentes espécies e os dados dos antibiogramas. MÉTODOS: Estudo retrospectivo de revisão de prontuários de pacientes encaminhados ao laboratório de Doenças Externas do Departamento de Oftalmologia da UNIFESP com resultado de cultivo bacteriano positivo de córnea ou conjuntiva e com identificação de alguma cepa do gênero Streptococcus sp, no período de janeiro de 1995 a dezembro de 2001. Analisou-se idade do paciente, espécie de Streptococcus e os testes de sensibilidade aos seguintes antibióticos: cefalotina, amicacina, gentamicina, tobramicina, ciprofloxacina, lomefloxacina, ofloxacina, norfloxacina e vancomicina. RESULTADOS: As espécies mais encontradas foram Streptococcus pneumoniae e Streptococcus viridans. Com relação aos antibióticos, a sensibilidade foi maior à cefalotina, às quinolonas e à vancomicina. CONCLUSÕES: Considerando-se os antibióticos tópicos comercialmente disponíveis, as quinolonas apresentam melhor espectro de ação quando comparadas aos aminoglicosídios.