Septic shock caused by the under-recognized bacterium Eggerthella lenta in a 61-year-old male with a periurethral abscess: a case report

Abstract Eggerthella lenta is a gram-positive anaerobic bacillus that has been associated with life-threatening infections. Bacteremia is always clinically significant and is mostly but not always associated with gastrointestinal disease. We present a unique case of abrupt deterioration and rapid development of septic shock secondary to periurethral abscess caused by E. lenta infection. This case highlights the atypical clinical presentation, risk factors, uncommon source of infection, challenges in therapy, and outcome of this infrequent infection. There is still a gap in the understanding of E. lenta pathogenicity, and more literature is needed to establish clear management recommendations.

Effectiveness of syndromic management for male patients with urethral discharge symptoms in Amazonas, Brazil

Abstract: Background: Urethral discharge syndrome (UDS) is characterized by the presence of purulent or mucopurulent urethral discharge.The main etiological agents of this syndrome are Neisseria gonorrhoeae and Chlamydia trachomatis. Objectives: To evaluate the effectiveness of the syndromic management to resolve symptoms in male urethral discharge syndrome cases in Manaus, Amazonas, Brazil. Methods: Retrospective cohort of male cases of urethral discharge syndrome observed at a clinic for sexually transmitted disease (STD) in 2013. Epidemiological and clinical data, as well as the results of urethral swabs, bacterioscopy, hybrid capture for C.trachomatis, wet-mount examination, and culture for N.gonorrhoeae, were obtained through medical chart reviews. Results: Of the 800 urethral discharge syndrome cases observed at the STD clinic, 785 (98.1%) presented only urethral discharge syndrome, 633 (79.1%) returned for follow-up, 579 (91.5%) were considered clinically cured on the first visit, 41(6.5 %) were considered cured on the second visit, and 13(2.0%) did not reach clinical cure after two appointments. Regarding the etiological diagnosis, 42.7% of the patients presented a microbiological diagnosis of N.gonorrhoeae, 39.3% of non-gonococcal and non-chlamydia urethritis, 10.7% of C.trachomatis and 7.3% of co-infection with chlamydia and gonococcus. The odds of being considered cured in the first visit were greater in those who were unmarried, with greater schooling, and with an etiological diagnosis of gonorrhea. The diagnosis of non-gonococcal urethritis reduced the chance of cure in the first visit. Study limitation: A study conducted at a single center of STD treatment. Conclusion: Syndromic management of male urethral discharge syndrome performed in accordance with the Brazilian Ministry of Health STD guidelines was effective in resolving symptoms in the studied population. More studies with microbiological outcomes are needed to ensure the maintenance of the syndromic management.

Uretritis no infecciosa y venéreas / Non-infectious and venereal urethritis

Esta evaluación clínico-microbiológica nos ha permitido confirmar en primer término que la presencia de un exudado uretral no es indicativo de Gonorrea, la cual representó en nuestra casuística un 15% de las uretritis verdaderamente exudativas; el que existe un universo microbiológico muy florido donde se destaca el Enterococo y las Enterobacterias con un 48% y un 18% respectivamente, como agentes etiológicos, lo cual es obviamente debido a los cambios en los hábitos sexuales de tipo oral y anal. En segundo lugar pudimos constatar que un 17% de la población estudiada poceían una UCT no infecciosa, motivada ella a la expresión anterograda y de tipo persistente de la uretra, los que fueron curados al explicar y concientizarle la etiología psíquica de su problema. Por tales motivos recomendamos en todo paciente que consulte por referir la existencia de un exudado uretral, el de tratar de enfocarlo hacia una UCT no infecciosa o una Uretritis infecciosa, mediante el interrogatorio, la evaluación clínica y microbiológica de su exudado o del sedimiento urinario. De igual forma recomendamos sea cual fuera su etiología, las siguientes pautas a cada enfermo: a) No exprimir lauretra, b) No consumo de alcohol durante el tiempo de terapia, c) No contacto sexual durante el mismo tiempo, para favorecer la regeneración de la mucosa uretral y para impedir el implante de una flora oportunista e infectante en una mucosa que no posee por su proceso inflamatorio de tipo infeccioso o traumático un buen mecanismo local de defensa..