Clinical and pathological findings of Rhodococcus equi infection in foals / Achados clínicos e patológicos da infecção por Rhodococcus equi em potros

Infection by Rhodococcus equi is considered one of the major health concerns for foals worldwide. In order to better understand the disease's clinical and pathological features, we studied twenty cases of natural infection by R. equi in foals. These cases are characterized according to their clinical and pathological findings and immunohistochemical aspects. Necropsy, histologic examination, bacterial culture, R. equi and Pneumocystis spp. immunohistochemistry were performed. The foals had a mean age of 60 days and presented respiratory signs (11/20), hyperthermia (10/20), articular swelling (6/20), prostration (4/20), locomotor impairment (3/20) and diarrhea (3/20), among others. The main lesions were of pyogranulomatous pneumonia, seen in 19 foals, accompanied or not by pyogranulomatous lymphadenitis (10/20) and pyogranulomatous and ulcerative enterocolitis (5/20). Pyogranulomatous osteomyelitis was seen in 3 foals, one of which did not have pulmonary involvement. There was lymphoplasmacytic (4/20), lymphoplasmacytic and neutrophilic (1/20) or pyogranulomatous arthritis (1/20), affecting multiple or singular joints. Immunohistochemistry revealed to be a valuable tool for the detection of R. equi, confirming the diagnosis in all cases. Furthermore, pulmonary immunostaining for Pneumocystis spp. demonstrates that a coinfection with R. equi and this fungal agent is a common event in foals, seen in 13 cases.(AU)

Infecção por Rhodococcus equi é considerado um dos maiores problemas sanitários para potros em todo o mundo. Para melhor compreender a apresentação clínica e patológica da enfermidade, foram avaliados vinte casos de infecção natural por R. equi em potros. Os casos são caracterizados de acordo com seus achados clínicos e patológicos e aspectos imuno-histoquímicos. Foram realizados exames de necropsia, histologia, bacteriologia e imuno-histoquímica para R. equi e Pneumocystis spp. Os potros tinham idade media de 60 dias e apresentaram sinais respiratórios (11/20), hipertermia (10/20), aumento de volume articular (6/20), prostração (4/20), distúrbios locomotores (3/20) e diarreia (3/20), entre outros. As lesões mais importantes eram pneumonia piogranulomatosa, vista em 19 potros, acompanhada ou não por linfadenite piogranulomatosa (10/20) e enterocolite ulcerativa (5/20). Osteomielite piogranulomatosa foi constatada em três potros, um dos quais não apresentava envolvimento pulmonar. Artrites afetando uma ou múltiplas articulações eram caracterizadas por infiltrado linfoplasmocítico (4/20), linfoplasmocítico e neutrofílico (1/20) e piogranulomatoso (1/20). A imuno-histoquímica demonstrou ser uma ferramenta valiosa na detecção de R. equi, permitindo confirmar o diagnóstico em todos os casos avaliados. Além disso, a imuno-histoquímica para Pneumocystis spp. demonstra que a coinfecção por R. equi e o agente fúngico é um evento frequente em potros, constatado em 13 casos.(AU)

Susceptibility profile of Brazilian Rhodococcus equi isolates against azithromycin, clarithromycin and erythromycin / Perfil de susceptibilidade de isolados brasileiros de Rhodococcus equi frente à azitromicina, claritromicina e eritromicina

Rhodococcus equi infection treatment is usually a macrolide (azithromycin - AZM, clarithromycin - CLR and erythromycin - ERY) and rifampicin combination. However, resistance cases have been reported, especially for ERY. In view of the need of a study about Brazilian isolates susceptibility profile, this study aimed to characterize the minimum inhibitory concentration (MIC) of the macrolides - AZM, CLR and ERY - against 44 R. equi isolates. It was found all isolates CLR and AZM sensitive; however, for ERY, 27% (12/44) were classified as intermediate sensitivity. R. equi Brazilian isolates used here showed a large susceptibility profile, except against ERY, for which it was observed some resistance evidence. In order to avoid failures in the equine rhodococcosis therapy it was highlighted the importance of microbiological culture and antimicrobial susceptibility testing in vitro before beginning treatment.

No tratamento de infecções por R. equi, usualmente emprega-se uma combinação de macrolídeos (azitromicina - AZI, claritromicina - CLARI e eritromicina - ERI) e rifampicina. Todavia, casos de resistência frente a esses antimicrobianos vêm sendo reportados, especialmente à ERI. Tendo em vista a necessidade de um estudo sobre o perfil de susceptibilidade de isolados brasileiros, buscou-se verificar a concentração inibitória mínima (CIM) de AZI, CLARI e ERI frente a 44 isolados de R. equi de diferentes origens. Todos os isolados analisados demonstraram perfil de sensibilidade à AZI e CLARI; em contraste, frente à ERI, 27% (12/44) apresentaram sensibilidade intermediária. A fim de evitar falhas no tratamento da rodococcse equina, destaca-se a importância da cultura microbiológica e a realização de testes in vitro de susceptibilidade antimicrobiana de R .equi antes do início do tratamento.

Pulmonary rhodococcosis an unrecognized pulmonary infection in AIDS patients.

Pulmonary rhodococcosis is an uncommon pulmonary infection in human beings, but the case reports have been increasing in HIV-infected patients. We report a female AIDS patient presenting with fever, productive cough and weight loss over 6 weeks. Chest x-ray showed a cavitary lesion with air fluid level in the right upper lobe infiltration. Sputa for AFB stain were negative for 3 consecutive days. Fiberoptic bronchoscopy was performed and bronchoalveolar lavage fluid was examined. It showed a gram-positive, weakly acid-fast coccobacilli. The culture grew only Rhodococcus equi. She was treated with erythromycin and rifampin and responded well.