RESUMO
La mastitis granulomatosa neutrofílica quística (MGNQ) es una entidad recientemente caracterizada, con detalles histopatológicos específicos que la diferencian de otros tipos de mastitis crónicas idiopáticas. La presencia de bacilos grampositivos dentro de espacios de apariencia quística rodeados de neutrófilos, en un contexto de inflamación granulomatosa supurativa, definen esta entidad. La importancia de su reconocimiento en el reporte diagnóstico recae en su asociación a la infección por especies de corinebacterias, de esa manera se puede direccionar el tratamiento con antibióticos, más allá del tratamiento antiinflamatorio que suele administrarse en mastitis idiopáticas. Se describe el caso de una paciente de sexo femenino, de 35 años de edad, sin antecedentes relacionados, con dolor mamario intermitente, asociado a la presencia de múltiples nodulaciones palpables, duras, en ambas mamas, con resultados de múltiples biopsias particulares previas que describieron mastitis crónica granulomatosa con reacción de tipo tuberculoso, por lo cual recibió tratamiento antituberculoso. Pese a ello, las tumoraciones cedieron sólo parcialmente. Se revisó las láminas histológicas en la institución y se estableció el diagnóstico de MGNQ. Se consideró importante la presentación de este caso debido a su escaso reconocimiento entre patólogos, pese a presentar características ya definidas en estudios previos.
Cystic neutrophilic granulomatous mastitis (CNGM) is a recently characterized entity, with specific histopathological details that differentiate it from other types of chronic idiopathic mastitis. The presence of gram-positive bacilli within cystic-like spaces surrounded by neutrophils, in a context of suppurative granulomatous inflammation, define this entity. The importance of its recognition in the diagnostic report lies in its association with infection by corynebacterial species, so that treatment with antibiotics can be targeted, beyond the anti-inflammatory treatment that is usually administered to idiopathic mastitis. We describe the case of a 35-year-old female patient with no related history, with intermittent breast pain, associated with the presence of multiple hard, palpable nodules in both breasts, with results from multiple previous private biopsies that described chronic granulomatous mastitis with a tubercular reaction, for which she received treatment for tuberculosis. Despite this, the clinical response was partial. Histological slides were reviewed at the institution and the diagnosis of CNGM was then established. The presentation of this case was considered important due to its low recognition among pathologists, despite presenting characteristics already defined by previous studies.
RESUMO
La mastitis granulomatosa neutrofílica quística (MGNQ) es una entidad recientemente caracterizada, con detalles histopatológicos específicos que la diferencian de otros tipos de mastitis crónicas idiopáticas. La presencia de bacilos grampositivos dentro de espacios de apariencia quística rodeados de neutrófilos, en un contexto de inflamación granulomatosa supurativa, definen esta entidad. La importancia de su reconocimiento en el reporte diagnóstico recae en su asociación a la infección por especies de corinebacterias, de esa manera se puede direccionar el tratamiento con antibióticos, más allá del tratamiento antiinflamatorio que suele administrarse en mastitis idiopáticas. Se describe el caso de una paciente de sexo femenino, de 35 años de edad, sin antecedentes relacionados, con dolor mamario intermitente, asociado a la presencia de múltiples nodulaciones palpables, duras, en ambas mamas, con resultados de múltiples biopsias particulares previas que describieron mastitis crónica granulomatosa con reacción de tipo tuberculoso, por lo cual recibió tratamiento antituberculoso. Pese a ello, las tumoraciones cedieron sólo parcialmente. Se revisó las láminas histológicas en la institución y se estableció el diagnóstico de MGNQ. Se consideró importante la presentación de este caso debido a su escaso reconocimiento entre patólogos, pese a presentar características ya definidas en estudios previos.
Cystic neutrophilic granulomatous mastitis (CNGM) is a recently characterized entity, with specific histopathological details that differentiate it from other types of chronic idiopathic mastitis. The presence of gram-positive bacilli within cystic-like spaces surrounded by neutrophils, in a context of suppurative granulomatous inflammation, define this entity. The importance of its recognition in the diagnostic report lies in its association with infection by corynebacterial species, so that treatment with antibiotics can be targeted, beyond the anti-inflammatory treatment that is usually administered to idiopathic mastitis. We describe the case of a 35-year-old female patient with no related history, with intermittent breast pain, associated with the presence of multiple hard, palpable nodules in both breasts, with results from multiple previous private biopsies that described chronic granulomatous mastitis with a tubercular reaction, for which she received treatment for tuberculosis. Despite this, the clinical response was partial. Histological slides were reviewed at the institution and the diagnosis of CNGM was then established. The presentation of this case was considered important due to its low recognition among pathologists, despite presenting characteristics already defined by previous studies.
RESUMO
Techniques to decrease losses from bacterial diseases are always important to improve the fish production. The use of antagonistic substances (bacteriocins) has been proven to be a viable option. The aim of this study was to evaluate different methods of purification for bacteriocin like inhibitory substances (BLIS). For the purification process, we isolated and used two Gram-positive bacilli that produce antagonistic substances for pathogens in aquaculture. Tests for detection of interfering factors were also performed. After the confirmation that the antagonistic action was due the BLIS activity, we carried out the purification methods. The methods tested were: cell free supernatant, acid extraction and ammonium sulfate precipitation at two concentrations (20 and 50%). Salmonella Tiphy CFP/IAL1472 and Aeromonas hydrophila (isolated in a tilapia production environment) were used as indicators of the efficiency of extracts in controlling pathogenic potentials. Ammonium sulfate precipitation at 50% was the most appropriate for purifying the antagonistic substance for both indicators. The extracts of the two isolates remained active for 22 days at 25ºC. These are promising results regarding the water and fish health without the use of antibiotics, in this manner being a safer environmental practice.
Técnicas para diminuir as perdas causadas por doenças bacterianas são importantes para melhorar continuamente a produção de pescado. O uso de substâncias antagônicas (bacteriocinas) tem-se mostrado uma opção viável. O objetivo do trabalho foi avaliar diferentes métodos de purificação de bacteriocinas como substâncias inibidoras (BLIS). Dois bacilos Gram-positivos, produtores de substâncias antagonistas para agentes patogênicos da aquicultura, foram utilizados em processos de purificação. Depois de confirmada a ação antagônica pela atividade de BLIS, os métodos de purificação foram realizados. Os métodos testados foram: células livres de sobrenadante, extração ácida e precipitação por sulfato de amônia em duas concentrações (20 e 50%). Salmonella Typhi PCP/IAL1472 e Aeromonas hydrophila (isolada de um ambiente de tilapicultura) foram utilizadas como indicadores de eficiência dos extratos. O precipitado por sulfato de amônio a 50% foi o mais adequado para purificar a substância antagonista para ambos os isolados indicadores. Os extratos dos dois isolados permaneceram ativos por 22 dias em 25ºC. Estes resultados são promissores do ponto de vista da manutenção da sanidade da água e dos peixes, sem uso de antibióticos, constituindo uma prática ambientalmente mais segura.
Assuntos
Bacilos Gram-Positivos/isolamento & purificação , Bacteriocinas/isolamento & purificação , Pesqueiros/análise , AquiculturaRESUMO
BACKGROUND: Although most of aerobic gram-positive bacilli have been considered to be contaminants, gram-positive bacilli should be identified to the species level if they are isolated from sterile body sites such as blood, and from adequately collected clinical specimens if they are the predominant organisms. However, identification of gram-positive bacilli are difficult due to the enormous diversity of these organisms and the small number of readily available commercial identification systems in clinical laboratories. Gram-positive bacilli and coccorods isolated from blood cultures were tested with BBL Crystal Gram-Positive (GP) Identification (ID) system in order to evaluate the system's usefulness of identifying these bacteria. METHODS: Thirty-seven stock strains of aerobic gram-positive bacteria isolated from blood cultures between October 1998 and November 1999 at Wonju Christian Hospital were simultaneously tested by BBL Crystal GP ID system and API system. Three kinds of API system (API Coryne, API 50 CHB, and API 20 Strep) were tested according to gram stain results. Gram-positive bacilli or gram-positive coccorods consecutively isolated from blood cultures from May to November in 2000 were identified by BBL Crystal GP ID system. RESULTS: Among the 37 stock strains of aerobic gram-positive bacteria, agreement rate of identification between Crystal GP ID system and API system were 88% to the genus level and 63% to the species level in Bacillus species, and 90% to the genus level in Corynebacterium species. The isolation rate of gram-positive bacteria from blood cultures from May to November in 2000 to the genus level were: Bacillus; 41.9%(18/43), Corynebacterium; 37.2%(16/43), and the other grampositive coccorods; 20.9%(9/43). CONCLUSIONS: Crystal GP ID system is a useful identification system which, when combined with basic microbiological tests, should lead to satisfactory identification results for gram-positive bacteria isolated from blood cultures.
Assuntos
Bacillus , Bactérias , Corynebacterium , Bactérias Gram-PositivasRESUMO
Bifidobacterium longum, indigenous bacteria of the gastrointestinal tract, is a species of anaerobic non-spore-forming gram-positive bacilli, and appears to play an important role in preventing overgrowth of pathogenic bacteria. This organism is very rarely isolated from clinical specimens. It is known to be very difficult to identify Bifidobacterium longum due to not only the variability in aerotolerance, colony morphology and stainability on gram staining, resulting the failure of distinguishing from other anaerobic non-spore-forming gram-positive bacilli by the conventional biochemical tests. Definitive identification of genus Bifidobacterium requires the analysis of the end-products of metabolism, volatile and non-volatile fatty acids, by gas-liquid chromatography (GLC). We report a case of sepsis caused by Bifidobacterium longum in a 19-year-old male who developed high fever, jaundice and hepatomegaly after he had been introduced with many small gold needles. Anaerobic non-spore-forming gram-positive bacilli were isolated from his blood and identified as Bifidobacterium longum by performing biochemical tests and the analysis of the metabolic end-products by GLC. He has been completely recovered after ticarcillin and metronidazole therapy. To our knowledge, this is the first report of incidental sepsis by Bifidobacterium longum in the world.