Pseudomonas aeruginosa-induced bilateral endophthalmitis after bilateral simultaneous cataract surgery: case report / Endoftalmite bilateral induzida por Pseudomonas aeruginosa após cirurgia bilateral simultânea de catarata: relato de caso

ABSTRACT Bilateral simultaneous cataract surgery (BSCS) has gained popularity among eye surgeons in many countries. This study examines the case of a 77-year-old patient who developed bilateral Pseudomonas aeruginosa endophthalmitis following bilateral simultaneous cataract surgery. Immediate bilateral vitrectomy and intravitreal antibiotics injection were performed. Ultimately, both eyes were eviscerated due to pain refractory to treatment and no light perception.

RESUMO A cirurgia bilateral simultânea de catarata ganhou popularidade entre cirurgiões oftalmológicos em muitos países. Este estudo examina o caso de um paciente de 77 anos que desenvolveu endoftalmite bilateral por Pseudomonas aeruginosa após uma cirurgia bilateral simultânea de catarata. Vitrectomia bilateral imediata e injeção de antibióticos intravítreos foram realizadas. Em última análise, ambos os olhos foram eviscerados devido à dor refratária ao tratamento e sem percepção de luz.

Oral infection by Pseudomonas aeruginosa in patient with chronic kidney disease - a case report / Infecção oral por Pseudomonas aeruginosa em paciente com doença renal crônica - um relato de caso

ABSTRACT Chronic renal patients are more susceptible to hospital complications and infections such as urinary tract infections, peritonitis, surgery infections, and bacteremia, which are often caused by Pseudomonas aeruginosa. A case of a HIV-positive girl with chronic kidney disease and with serious oral lesions due to P. aeruginosa septic shock is presented. The patient showed necrotic lesions in the oral mucosa, pathological tooth mobility, bone loss, and hematogenous osteomyelitis in the maxilla. The patient was submitted to systemic antibiotic therapy based on screening culture and treatment of bone lesions by eliminating the causal agent and restoring health conditions. This case report is extremely important for health professionals, since the oral cavity can be affected by this pathogen or serve as a colonization site.

RESUMO Pacientes renais crônicos são mais suscetíveis a complicações e infecções hospitalares, tais como infecções do trato urinário, peritonite, infecções cirúrgicas e bacteremia, muitas vezes causadas por Pseudomonas aeruginosa. O presente relato apresenta o caso de uma menina HIV-positiva com doença renal crônica e lesões orais graves devido a choque séptico por P. aeruginosa. A paciente apresentava lesões necróticas na mucosa oral, mobilidade dentária patológica, perda óssea e osteomielite hematogênica maxilar. A paciente foi submetida a antibioticoterapia sistêmica com base na cultura de triagem e tratamento das lesões ósseas por meio da eliminação do agente causal e restauração das condições de saúde. Este relato de caso é extremamente importante para os profissionais da saúde, uma vez que a cavidade oral pode ser afetada por este patógeno ou servir como local de colonização.

Factores de riesgo para infección por Pseudomonas aeruginosa multi-resistente en un hospital de alta complejidad / Risk factors for multidrug-resistant Pseudomonas aeruginosa infection, in a tertiary hospital in Colombia

Introduction: multi-resistant Pseudomonas aeruginosa (MR) is frequently associated with healthcare infections. Its epidemiology is complex and few studies help to understand it. A study about risk factors associated with this type of bacteria is needed. Objective: To determine risk factors associated with MR P. aeruginosa infection in hospitalized patients from the Hospital Universitario San Vicente Foundation-Medellin. Materials and Methods: case-control study to identify risk factors associated with infection by MR P. aeruginosa. Results: 140 patients were included, 70 in each group. Bivariate analysis found association with previous use of carbapenems (OR 3.12 - IC 1.21 to 8.03, p = 0.02), aminoglycosides (OR 5.09 - CI: 1.38 to 18, 77, p = 0.01) and days of stay prior to isolation of the organism (OR 1.03 - CI: 1.01-1.05, p = 0.01). In multivariate analysis MR P. aeruginosa infection was associated with hospital stay (OR 1.03 - IC 1.01 to 1.05), use of aminoglycosides (OR 1.30 to 19.28) and treatment with two or more antimicrobials in the last 30 days (OR 3.09 - CI: 1.26 to 7.58). The risk of developing infection was 3% per day of hospital stay prior to isolation of the agent. Conclusion: Developing MR P. aeruginosa infection was associated with prior use of antimicrobials and prior hospital stay.

Introducción: Pseudomonas aeruginosa multi-resistente (MR) es causa frecuente de infecciones asociadas al cuidado de la salud, su epidemiología es compleja y hay pocos estudios que permiten comprenderla. El estudio de los factores de riesgo asociados a este tipo de bacterias es necesario para la implementación de estrategias de control de las mismas. Objetivo: Determinar factores de riesgo asociados a infección por P. aeruginosa MR en pacientes hospitalizados en el Hospital Universitario de San Vicente Fundación-Medellín. Materiales y Métodos: Estudio analítico con abordaje como casos y controles para determinar factores de riesgo asociados a infección por P. aeruginosa MR. Resultados: Se incluyó un total de 140 pacientes, 70 en cada grupo. En el análisis bivariado se encontró asociación con el uso previo de carbapenémicos (OR 3,12- IC 1,21-8,03; p: 0,02), aminoglucósidos (OR 5,09- IC: 1,38-18,77; p: 0,01) y el tiempo por día de estancia previo al aislamiento (OR 1,03- IC: 1,01-1,05; p: 0,01). En el análisis multivariado hay asociación entre la estancia hospitalaria (OR 1,03- IC 1,01-1,05), el uso de aminoglucósidos (OR 1,30-19,28) y el uso de dos o más antimicrobianos en los últimos 30 días (OR 3,09- IC: 1,26-7,58) con el desarrollo de infecciones por P. aeruginosa MR. El riesgo de desarrollar una infección por esta bacteria fue de 3% por cada día de estancia hospitalaria previo al aislamiento. Conclusión: El desarrollar infección por P. aeruginosa MR se asoció con el uso previo de antimicrobianos y con el tiempo previo de estancia hospitalaria.

Epidemiological and microbiological profile of infective keratitis in Ahmedabad.

Context: Study of patients attending tertiary care ophthalmology institute at Ahmedabad. Aims: To study the microbiological etiology and epidemiological factors associated with suppurative keratitis. Settings and Design: A total of 150 corneal scrapings were evaluated from patients presenting with corneal ulcers at a tertiary ophthalmology center, Ahmedabad from July 2007 to June 2008. Materials and Methods: Scrapings were subjected to Gram stain, potassium hydroxide preparation and culture for bacterial and fungal pathogens. Socio-demographic data and risk factors were recorded. Results: Ninety percent (135/150) people with corneal ulcers had trauma as predisposing factor for keratitis. Trauma due to wooden objects was the leading cause (46/135) followed by vegetable matter and stone injury (23/135). Microbial etiology was established in 59.3% (89/150) of scrapings. Out of 89 positive isolates, 65.1% (58/89) were bacterial while 34.9% (31/89) were fungal. Among the bacterial isolates, 60.3% (35/58) were Gram-positive cocci while 39.7% (23/58) were Gram-negative bacilli. The most common bacterial isolate was Staphylococus aureus (32.7%, 19/58) followed by coagulase-negative Staphylococci (25.8%, 15/58) and Pseudomonas (18.9%, 11/58). Among the 31 fungal pathogens, Aspergillus species was the most common (35.4%11/31), followed by Fusarium species (22.5%, 7/31). Conclusion: Trauma with wooden material is the most common predisposing factor for suppurative keratitis. Males were more affected than females. Bacterial ulcers were more common than fungal in areas in and around Ahmedabad. Staphylococcus aureus and Aspergillus were the commonest bacterial and fungal isolates respectively. Geographical variation persists in microbial etiology of suppurative keratitis.

Pericondrite pós-piercing / Post-piercing perichondritis

O uso de piercing tem se tornado uma prática muito freqüente entre os jovens. O procedimento na maioria vezes realizado por profissionais não-qualificados não é isento de riscos. O manuseio de material contaminado ou a higiene imprópria predispõem à pericondrite e à celulite. A pericondrite caracteriza-se pelo eritema do pavilhão auricular, dor intensa e febre. Sem tratamento, desenvolve-se um edema generalizado do pavilhão com formação de abscesso subpericondrial, podendo evoluir para necrose isquêmica da cartilagem e a temível deformidade estética conhecida como "orelha em couve flor". O agente responsável mais encontrado é o Pseudomonas aeruginosa. No estágio inicial da doença o tratamento pode ser feito com antibióticos de amplo espectro. Nos casos em que o abscesso está presente, a incisão e drenagem cirúrgica são obrigatórios acompanhado de antibioticoterapia guiado pela cultura e antibiograma. OBJETIVO: O objetivo deste relato de caso é realizar uma revisão bibliográfica dos últimos 10 anos abordando os aspectos anatômicos do pavilhão auricular, a história do uso de piercing e suas mais conhecidas complicações. MÉTODO: Relato de um caso de pericondrite pós-piercing transcartilaginoso onde houve a necessidade de tratamento cirúrgico com praticamente nenhuma deformidade estética. RESULTADO: Aquisição de experiência teórico-prática através de revisão bibliográfica e relato de um caso de evolução favorável para a paciente. CONCLUSÃO: Incidência crescente das complicações de pericondrites na população jovem deve levar à prevenção primária mais elaborada.

Piercing has become more and more popular among adolescents. The procedure is generally performed by unqualified professionals and carries its risk. Non-sterilized material or inappropiate hygiene increases the possibility of perichondritis and celulitis. The disease is characterized by erythema of the auricula pinna, unbearable pain and fever. Left untreated, the condition progresses with edema along the auricula and abscess formation that may result in ischemic necrosis and a cauliflower anesthetic deformation. The most common bacteria is Pseudomonas aeruginosa. In cases with abscesses, drainage is necessary along with antibiotic therapy guided by cultures and antibiogram. AIM: The aim of this case report was to review the past 10 years of published papers dealing with anatomical aspects of the auricular pinna, the history of piercing and its most common complications. METHODS: A case report of perichondritis after "high" ear piercing that required surgical treatment and that progressed with no esthetic loss. RESULTS: Theoretical and practical experience based on a review and a report of a case that progressed satisfactorily. CONCLUSIONS: The increased incidence of perichondritis in adolescents should require more elaborated primary prevention measures.

Bilateral Pseudomonas keratitis without predisposing factors.

Bilateral keratitis usually occurs in predisposed individuals such as contact lens wearers, those suffering from malnutrition and immunodeficiency or patients undergoing bilateral refractive corneal surgery. We report a 30-year-old man without any obvious predisposing factors who presented with complaints of pain and decreased vision in both eyes. Examination revealed corneal ulcers in both eyes, which on microbiological culture grew Pseudomonas aeruginosa. The patient underwent a therapeutic keratoplasty in the right eye while the left eye was managed medically. Bilateral Pseudomonas keratitis can develop in the absence of any obvious predisposing factors.

Microorganismos patógenos aislados en muestras respiratorias de niños con fibrosis quística / Isolated pathogen microorganisms in respiratory samples from children with cystic fibrosis

La fibrosis quística (FQ) se caracteriza por disfunciones en las glándulas de secreción exocrina del organismo. Las primeras manifestaciones suelen observarse en el sistema respiratorio, constituyendo una de las causas más importantes de morbimortalidad en los pacientes afectados. Los microorganismos patógenos que colonizan frecuentemente el tracto respiratorio de estos pacientes son Staphylococcus aureus, Haemophilus spp., y Pseudomonas aeruginosa. Entre noviembre de 2001 y agosto de 2004 se estudiaron 222 muestras respiratorias de pacientes con FQ de entre 4 meses y 11 años de edad. Se aislaron S. aureus (38,7%), P. aeruginosa (37,4%) y Haemophilus spp., (15,3%). En S. aureus la meticilina-resistencia fue del 25,9% y se asoció con altas resistencias a eritromicina (35,0%) y clindamicina (29,4%). El mayor porcentaje de resistencia observado en las cepas de P. aeruginosa fue frente a gentamicina (31,0%). Los aislamientos de Haemophilus spp. fueron resistentes a ampicilina (23,0%) debido a la presencia de beta-lactamasas, y a trimetoprima/sulfametoxazol (59,0%).

Cystic Fibrosis (CF) is characterized by a dysfunction of the exocrine secretion glands. The first symptoms often appear in the respiratory system which constitutes one of the most important morbimortality causes in these patients. Chronic respiratory tract colonization is caused mainly by bacteria such as Staphylococcus aureus, Haemophilus spp. and Pseudomonas aeruginosa. Respiratory samples from patients with CF (age group: 4 months to 11 years) were analyzed from November 2001 to August 2004. The most frequently isolated microorganisms were S. aureus (38.7%), P. aeruginosa (37.4%) and Haemophilus spp (15.3%). A high resistance to erithromycine (35.0%) and clindamicine (29.4%) was observed in S. aureus strains and 25.9% of them were methicillin-resistant. P. aeruginosa strains were mainly gentamicin-resistant (31.0%). The rate of ampicillin-resistant Haemophilus spp. was 23.0% and it was due to the presence of beta-lactamases, but a high trimethoprim-sulfamethoxazole resistance was observed in this microorganism (59.0%).

High ear piercing--a dangerous craze.

Ear piercing is a primitive tradition among the human being. It reflects the culture of many religions, tribes, and communities, predominately adopted by the females. We reported a sixteen years old girl with painful swelling of both pinnas for last one month following piercing the pinna. She was treated locally by general practitioner without significant improvement. On examination frank abscess were detected in both pinna. Under general anesthesia incision drainage and deep curettage was done. She was treated with ciprofloxacin 750 mg 12 hourly for 2 weeks and recovery was uneventful. After one month she developed unsightly cauliflower ear. With this report we want to sensitize our community regards the risk of transmission of needle prick diseases and deformity of pinna following ear piercing

Pacemaker endocarditis caused by Pseudomonas aeruginosa treated successfully.

Infective endocarditis (IE) is a rare but serious complication of permanent cardiac pacemaker placement. Endocarditis in the presence of prosthetic valves and pacemakers is usually due to staphylococci. We present a case of pacemaker endocarditis caused by Pseudomonas aeruginosa that was successfully treated with a combination of antimicrobial therapy and percutaneous removal of the colonized lead.

Pulmonary nocardial infection and pseudomonas infection of the tongue in a patient with dermatomyositis.

Opportunistic infections in immunocompromised patients are common. We report the case of a 63 year old female patient with dermatomyositis who while on oral steroids developed nocardial infection of the lung and pseudomonas infection of the tongue simultaneously. Nocardial infections are not very commonly seen in patients with dermatomyositis. Pseudomonas infection of the tongue is a rarity. We report this case for its rarity as regards the type and site of infections and review the relevant literature.

Infection following orthopaedic implants and bone surgery

Forty-seven patients were investigated for early or late postoperative infections of orthopaedic implants and/or bone. A total of 88 isolates were recovered [64 aerobes and 24 anaerobes]. Pseudomonas aeruginosa and Staphylococcus epidermidis were the most common causative agents. Anaerobic bacteria were isolated from 16 [34%] patients; 50% of patients with late-onset infection and 10.5% with early-onset infection. In 6 [12.8%] patients, infection was with anaerobic organisms alone. All these patients had retained an extramedullary internal fixation device. Anaerobic microorganisms appear to play a significant role in the pathogenesis of late-onset postoperative infection, especially where there is an extramedullary internal fixation device

Pyelonephritic potential of Pseudomonas aeruginosa in ascending mouse model.

The suitability of female BALB/c and Swiss Webster (LACA) strains of mice for an ascending model of pyelonephritis for human uroisolate of Pseudomonas aeruginosa, was assessed. A fresh isolate of Ps. aeruginosa elaborating virulence factors like elastase, protease, phospholipase C, pyochelin and haemolysin was selected and introduced transuretherally in mice without any manipulation of the urinary tract. This isolate was able to colonize and persist in the renal tissue till day 12 post infection. Histopathologically, severe renal lesions i.e., abscesses formation was observed. The LACA strain was found to be more susceptible to infection with the selected Ps. aeruginosa isolate.

Study of Pseudomonas aeruginosa causing ventilator associated pneumonia.

Ps. aeruginosa is a frequent and prominent cause of nosocomial pneumonia especially in persons on assisted ventilation in the intensive care units. In a year long surveillance of ventilator associated pneumonia (VAP) we isolated 42 strains from broncho alveolar lavage samples collected and processed from 102 patients. By pyocin typing 40 of the 42 strains could be typed into 39 types but this designation changed each time the test was repeated. SDS-PAGE analysis of the whole cell proteins grouped the 42 strains of Ps. aeruginosa into 20 groups. After ribotyping, using an 18 mer DIG labelled oligonucleotide to the conserved region of 16S rRNA gene, the strains were designated into 18 types. The major type contained 8 isolates, but there was no clustering of isolates, indicating that each infecting strain was acquired separately and not from a common source. It would, therefore, appear that cross infection with a single clone was not the predominant mode of Ps. aeruginosa infection causing VAP in our ICU.

Modelo experimental para el desarrollo de sinusitis maxilar en conejos / An animal experimental model for maxillary sinusitis

Se acepta la obstrucción de los orificios de drenaje de los senos paranasales trae como consecuencia hipoxia, disminución en el pH, acumulación de secreciones y finalmente infecciones bacterianas. El objetivo de éste estudio fue el de producir de manera experimental la enfermedad inflamatoria sinusual para en un futuro poder estudiar bajo condiciones controladas. Se estuiaron seis conejos obliterándose el ostium de drenaje maxilar con cianocrilato en un solo seno, teniendo al contralateral como control. Después de seis semanas se estudiaron ambas cavidades macro y microscópicamente, así como bacteriológicamente. En todas las cavidades obliteradas se encontró inflamación y edema de mucosas y se cultivaron gérmenes patógenos (Klebsiella en tres, Pseudomonas en dos y estafilococo en una). Nada de esto se observó en los senos maxilares control. Concluimos que la obstrucción en los ostia maxilares favorece la inflamación e infección de la mucosa sinusual y que es posible desarrollar estudios sobre sinusitis bajo condiciones controladas

Study of burn sepsis with special reference to Pseudomonas aeruginosa.

Fifty cases of burn of different degrees were subjected to clinical and microbiological studies. A total of 60 isolates were obtained. Of these, 40 (80.0% incidences) were Ps aeruginosa, 8 (16.0 incidences) Staph pyogenes, 6 (12.0% incidences) Kl pneumoniae, 4 (80.0% incidences) Esch coli and 2 (4.0% incidences) C albicans. Monobacterial cultures showed isolations in 41 cases (82.0%) and 34 (68.0%) of them were Ps aeruginosa. At the time to admission 42 cases (84.0%) were infected and during one week of hospitalisation another 8 cases (16.0%) were infected yielding an overall infection rate of 100%. The commonest organism on admission and after hospitalisation was Ps aeruginosa with isolation rates of 60.0% (30) and 20.0% (10) respectively. Gram-negative bacilli, predominantly Ps aeruginosa were found in the lower part of the body with an incidence of 74.0% (37). Staph pyogenes was found in the upper half showing an incidence of 12.0% (6) next to 20.0% (10) incidence of Ps aeruginosa. The incidence of burn infection was high in patients with deep and major burn wounds, the bacterial isolates being 76.0% (38) and 80.0% (40) respectively. Silver sulphadiazine exhibited antimicrobial action in the range of 14 to 390 microM/ml, while cerium sulphadiazine had no inhibitory effect even up to 667 microM/ml on pseudomonas isolates. Zinc sulphadiazine was effective in inhibiting the growth of 10 isolates tested in 40 to 297 microM/ml range.

Crusted scabies in child with systemic lupus erythematosus

É descrito um caso de sarna crostosa em criança portadora de lupus eritematoso sistêmico em tratamento com prednisona há 3 anos. O raspado das lesöes cutâneas revelou ovos e áscaros adultos de Sarcoptes scabiei. A paciente faleceu por sepsis e insuficiência renal pouco tempo após início da terapêutica tópica com enxofre a 20 por cento. Melhora importante foi observada no quadro dermatológico