Erupción variceliforme de Kaposi en un paciente adulto mayor con desnutrición severa

El eccema herpético o erupción variceliforme de Kaposi, a pesar de ser una infección viral poco frecuente, se considera una urgencia dermatológica, debido a su alto potencial de diseminación, gravedad y mortalidad en adultos. Los pacientes inmunosuprimidos suponen un alto riesgo de colonización cutánea y visceral, además de una mayor probabilidad de presentar otras infecciones causadas por el virus del herpes simple. Se caracteriza por presentar lesiones en piel de tipo vesículas umbilicadas agrupadas o diseminadas que evolucionan a erosiones hemorrágicas perforadas, que se localizan principalmente en cabeza, cuello y tórax; son dolorosas y tardan entre 2-6 semanas en sanar y por lo general se asocian a compromiso sistémico. El diagnóstico es clínico; en caso de duda, se puede utilizar Test de Tzanck, que es una herramienta rápida para confirmar infección por herpes virus; tiene una sensibilidad de 40-80 % y especificidad hasta del 100 %. El manejo consiste en terapia antiviral sistémica; el tratamiento antibiótico está indicado si existe riesgo sobreinfección bacteriana. El tratamiento oportuno de la infección es clave para la evolución hacia la recuperación del paciente.

Eczema herpeticum or Kaposi's varicelliform eruption is a rare viral infection; however, it's considered a dermatologic urgency due to the high potential for dissemination, severity and mortality. Immunosuppressed patients have a high risk of skin and visceral colonization in addition to a higher probability of other infections caused by herpes simplex virus. Kaposi's varicelliform eruption is characterized by vesicopustules, some umbilicated, others eroded and extended in clusters. They may also present hemorrhagic crusts with an erythematous base. The most commonly affected sites are head, neck, and trunk. These lesions are painful, they take from 2 to 6 weeks to heal and are usually associated with systemic signs of infection. Diagnosis is mainly clinical. In case of doubt, the Tzanck allows a rapid diagnostic approach with a sensitivity of 40-80 % and specificity up to 100 % in herpes virus. Antiviral treatment proved to be effective; additional antibiotic treatment is required if there is risk of bacterial infection. The timely treatment of the infection is the key in the evolution towards the recovery of the patient.

Gangrenous mastitis in sheep caused by multidrug-resistant Staphylococcus haemolyticus / Mastite gangrenosa em ovinos causada por Staphylococcus haemolyticus multirresistente

Mastitis is a multifactorial disease and considered one of the most critical problems in the dairy industry worldwide. The condition is characterized by reduced milk and several abnormalities in the mammary gland. This study aimed to report an outbreak of gangrenous mastitis caused by multidrug-resistant Staphylococcus haemolyticus in a Santa Inês sheep herd. Eighteen sheep were affected, and five of them with severe clinical pictures were examined. The clinical and pathological picture were variable and characterized by apathy, anorexia, emaciation, opaque and brittle hair, apparent and congested episcleral vessels, and hyperthermia. These ewes had enlarged, firm, and painful mammary glands. Macroscopically, these lesions consisted of severe gangrenous mastitis, and microscopically, the primary lesions consisted of necrosis, thrombosis, and fibrosis of the mammary parenchyma. Milk samples from one of the five severely affected ewes were collected and cultured under aerobic or microaerophilic incubation at 37°C for 24 hours on sheep blood agar. The obtained colonies were then submitted to MALDI-TOF for speciation. The colonies were also submitted to an antimicrobial susceptibility test, genotyping of virulence factors and resistance genes were also performed. The isolates showed antimicrobial multiresistance since they were resistant to seven out of 13 tested antibiotics. The isolates were also positive for two staphylococcal enterotoxigenic genes (sec and see) and fibronectin-binding protein B (fnbB).(AU)

A mastite é uma doença multifatorial e é considerada um dos problemas mais importantes na indústria de laticínios no mundo todo. A condição é caracterizada pela redução de leite e várias anormalidades na glândula mamária. O objetivo deste estudo foi relatar um surto de mastite gangrenosa causada por Staphylococcus haemolyticus multirresistente em um rebanho ovino Santa Inês. Dezoito ovelhas foram afetadas e cinco delas com quadro clínico severo foram examinadas. O quadro clínico-patológico era variável quanto a severidade e consistia em apatia, anorexia, magreza, pelos opacos e quebradiços e vasos episclerais aparentes e ingurgitados. As ovelhas apresentavam glândulas aumentadas, firmes e dolorosas. Macroscopicamente, as principais lesões consistiam em mastite gangrenosa e microscopicamente havia necrose do parênquima glandular, trombose e fibrose. Amostras de leite de uma das cinco ovelhas severamente afetadas foram coletadas e cultivadas sob incubação aeróbica ou microaerofílica a 37°C por 24 horas em ágar sangue de ovelha. As colônias obtidas foram então submetidas ao MALDI-TOF para especiação. Além disso, as colônias foram submetidas a um teste de suscetibilidade antimicrobiana e foi realizada a genotipagem de fatores de virulência e genes de resistência. Os isolados apresentaram multirresistência antimicrobiana por serem resistentes a sete dos 13 antibióticos testados. Os isolados também foram positivos para dois genes enterotoxigênicos estafilocócicos (sec e see) e proteína B de ligação à fibronectina (fnbB).(AU)

Síndrome de Waterhouse-Friderichsen por Staphylococcus haemolyticus / Waterhouse-Friderichsen syndrome by Staphylococcus haemolyticus / Síndrome de Waterhouse-Friderichsen por Staphylococcus haemolyticus

Resumen: Presentamos el caso de una paciente afectada por un síndrome de Waterhouse-Friderichsen presentando falla orgánica múltiple y datos en relación a insuficiencia suprarrenal aguda, el cual fue fulminante y se concluyó secundario a Staphylococcus haemolyticus.

Abstract: We present the case of a patient affected by a Waterhouse-Friderichsen syndrome presenting multiple organ failure and data in relation to acute adrenal insufficiency, which was fulminant and was concluded secondary to Staphylococcus haemolyticus.

Resumo: Apresentamos o caso de uma paciente com síndrome de Waterhouse-Friderichsen que apresentou falência múltipla de órgãos e dados em relação à insuficiência supra-renal aguda, que foi fulminante e concluiu-se que foi secundária ao Staphylococcus haemolyticus.

The induction, purification, whole genome sequencing and comparative genome analysis of a novel staphylococcus haemolyticus bacteriophage IME-SA4 / 中国医师杂志

Objective To induce a novel temperate bacteriophage from staphylococcus haemolyticus strain SA98,observe the morphology and size,complete the whole genome sequencing,analyse the structure of genome and evolutionary relationship.Methods The mitomycin C was used to induce the temperate phage from staphylococcushaemolyticus strain SA98,the induced phage was observed by transmission electron microscopy after be concentrated and purified.The genome DNA was extracted and high through sequenced.The feature of whole genome and evolutionary relationship was analyzed.Results A temperate phage IME-SA4 was successfully induced from staphylococcus haemolyticus strain SA98.Transmission electron microscopy analysis indicated that IME-SA4 had an isometric head and a non-contractile long tail.The whole genome of IME-SA4 was long as 41 843 bp,and the whole genome blast result indicated IME-SA4 shared only 13％ homology with most related strain phiRS7.Conclusions A novel staphylococcus haemolyticus temperate phage with low homology with other staphylococcusphages was successfully induced from staphylococcus haemolyticus strain SA98.The research of its morphology,whole genome sequencing and comparative genome analysis make the foundation for further study of staphylococcus phages' properties and practical application.

Sphygmomanometers and thermometers as potential fomites of Staphylococcus haemolyticus: biofilm formation in the presence of antibiotics

BACKGROUND The association between Staphylococcus haemolyticus and severe nosocomial infections is increasing. However, the extent to which fomites contribute to the dissemination of this pathogen through patients and hospital wards remains unknown. OBJECTIVES In the present study, sphygmomanometers and thermometers were evaluated as potential fomites of oxacillin-resistant S. haemolyticus (ORSH). The influence of oxacillin and vancomycin on biofilm formation by ORSH strains isolated from fomites was also investigated. METHODS The presence of ORSH on swabs taken from fomite surfaces in a Brazilian hospital was assessed using standard microbiological procedures. Antibiotic susceptibility profiles were determined by the disk diffusion method, and clonal distribution was assessed in pulsed-field gel electrophoresis (PFGE) assays. Minimum inhibitory concentrations (MICs) of oxacillin and vancomycin were evaluated via the broth microdilution method. Polymerase chain reaction (PCR) assays were performed to detect the mecA and icaAD genes. ORSH strains grown in media containing 1/4 MIC of vancomycin or oxacillin were investigated for slime production and biofilm formation on glass, polystyrene and polyurethane catheter surfaces. FINDINGS ORSH strains comprising five distinct PFGE types were isolated from sphygmomanometers (n = 5) and a thermometer (n = 1) used in intensive care units and surgical wards. ORSH strains isolated from fomites showed susceptibility to only linezolid and vancomycin and were characterised as multi-drug resistant (MDR). Slime production, biofilm formation and the survival of sessile bacteria differed and were independent of the presence of the icaAD and mecA genes, PFGE type and subtype. Vancomycin and oxacillin did not inhibit biofilm formation by vancomycin-susceptible ORSH strains on abiotic surfaces, including on the catheter surface. Enhanced biofilm formation was observed in some situations. Moreover, a sub-lethal dose of vancomycin induced biofilm formation by an ORSH strain on polystyrene. MAIN CONCLUSIONS Sphygmomanometers and thermometers are fomites for the transmission of ORSH. A sub-lethal dose of vancomycin may favor biofilm formation by ORSH on fomites and catheter surfaces.

Clinical Distribution and Antibiotic Resistance Analysis of Staphylococcus Haemolyticus / 现代检验医学杂志

Objective To understand clinical specimen hemolysis Staphylococcus (SHA)distribution characteristics and re-sistance and sensitivity to 20 kinds of antibiotics,reasonable to guide the clinical treatment of SHA infection.Methods Rou-tinely cultured and isolated bacteria.Used the United States BD Phoenix-100 automated microbial identification and suscepti-bility instrument to identify bacteria and susceptibility testing,and susceptibility testing all used the instrument broth dilu-tion method,according to the USA CLSI2015 [1]regulations standards.Results 162 strains of SHA from the distribution of age,children under the age was one of the highest (30.9%),and from the distribution department,mainly distributed in ped-iatrics (30.9%),department of critical care medicine (22.2%),medicine (17.3%),surgery (12.3%).From the specimen type distribution,were mainly distributed in the blood (33.3%),sputum (25.9%),wound (11.1%) and discharge (9.9%).In the 162 strains of SHA,the proportion of the MRSH was 93.8%,of which 152 strains of MRSH incidence of multiple drug resistance (MDR)was as high as 61.8%.Compared with MSSH,antibiotic resistance rate of MRSH was sig-nificantly higher.The resistance rate of MRSH to ampicillin,cefoxitin,penicillin G,erythromycin was extremely high,more than 98.7% the former of cefoxitin,penicillin G,ampicillin,erythromycin resistance was extremely high,more than 98.7%. The sensitive rate of both to rina thiazole amine,vancomycin,amikacin was 100%,and the rate to Fusidic acid,teicoplanin, nitrofurantoin was also high,more than 9 5.5%.Conclusion Linezolid,Vancomycin,Amikacin,Fusidic acid,Teicoplanin and Nitrofurantoin because all can be used as empiricaluse of SHA infection,other antibiotics chooses to in addition to drug sen-sitivity tests results.

Drug resistance and elinical distribution of Staphylococcus haemolyticus / 国际检验医学杂志

Objective To investigate the drug resistance of Staphylococcus haemolyticus and provide basis for selection of clini‐cal drugs .Methods A total of 59 strains of Staphylococcus haemolyticus were isolated from patients ,and analyzed the clinical dis‐tribution and drug resistance of them .Results Staphylococcus haemolyticus were mainly isolated from the sputum and oropharyn‐geal swabs in pediatric and ICU .The patients were mainly newborns .Staphylococcus haemolyticus mainly included methicillin re‐sistant Staphylococcus haemolyticus (MRSH) ,accounting for 89 .8% (53 strains) .MRSH showed high‐drug resistance and multi‐drug resistance .However ,it was sensitive to vancomycin ,teicoplanin and linezolid ,the antibiotic sensitive rate was 100 .0% .Conclu‐sion Staphylococcus haemolyticus is an important coagulase negative staphylococci ,mainly including MRSH ,which shows high‐drug resistance and multi‐drug resistance .

Influence of papain in biofilm formed by methicillin-resistant Staphylococcus epidermidis and methicillin-resistant Staphylococcus haemolyticus isolates

Methicillin-resistant Staphylococcus epidermidis (MRSE) and methicillin-resistant Staphylococcus haemolyticus (MRSHa) are important coagulase-negative staphylococci. They are often isolated from bacteremia in humans mainly due to their ability to form biofilm on the surfaces of medical devices. Papain is a complex mixture of proteolytic enzymes and peroxidases extracted from the latex of Carica papaya and it is recognized by accelerating the healing process of wounds. This study aimed to evaluate the ability of the MRSE and MRSHa isolates to produce biofilms. Besides this, the ability of papain to inhibit the formation of biofilms or to disrupt the ones already formed by those bacteria was analyzed. Thirty MRSHa and 30 MRSE were isolated from bacteremia and used in this study. It was observed that papain has ability to reduce biofilms formed by MRSE (p < 0.06) and by MRSHa (p = 0.0005). In addition, papain was able to disrupt mature biofilms made by MRSE (p = 0.014). No antibacterial activity of papain was observed for any isolates of MRSE and MRSHa tested. Papain has been demonstrated as a potential product for reducing biofilm.

Staphylococcus epidermidis resistente à meticilina (MRSE) e Staphylococcus haemolyticus resistente à meticilina (MRSHa) são importantes estafilococos coagulase negativa. São frequentemente isolados em bacteremia humana, principalmente devido à capacidade de formar biofilmes nas superfícies de dispositivos médicos introduzidos no organismo. A papaína é mistura complexa de enzimas proteolíticas e peroxidases extraídas do látex de Carica papaya, reconhecida por acelerar os processos de cura de feridas. Este estudo teve como objetivo avaliar a capacidade dos MRSE e MRSHa em produzir biofilmes e analisar a capacidade da papaína em inibir a formação de biofilme ou desintegrar biofilmes já formados por essas bactérias. Observou-se que a papaína tem capacidade de reduzir a formação de biofilme por MRSE (p < 0,06) e MRSHa (p = 0,0005). Além disso, a papaína foi capaz de desintegrar biofilme maduro formado por MRSE (p = 0,014). Nenhuma atividade antibacteriana da papaína foi observada para qualquer das duas espécies de bactérias testadas. A papaína mostrou-se produto potencial para reduzir biofilme.

Be alert to the alterations in the biological characteristics in heterogeneous vancomycin-intermediate Staphylococcus aureus.

The development of reduced vancomycin susceptibility in Staphylococcus aureus in many cases appears to be associated with characteristic changes. These changes may have pitfall of identifying S. aureus by automated testing methods like Vitek 32. In this study, we retested 24 heterogeneous vancomycin-intermediate Staphylococcus haemolyticus (h-VISH) collected in 2008-2010 at the Department of Clinical Microbiology by conventional biochemical tests and polymerase chain reaction (PCR). The heterogeneous vancomycin-intermediate S. aureus (hVISA) reversion test and electron microscopic examination were also used. Six isolates of 24 h-VISH possessed nuc, coa, and 16S rRNA genes, and could be reversed into S. aureus. It suggested that biochemical and morphological changes in hVISA and vancomycin-intermediate S. aureus (VISA) should be considered, and the detection of S. aureus, especially reduced vancomycin susceptibility isolates, requires more attention and different techniques.

Contamination of X-ray Cassettes with Methicillin-resistant Staphylococcus aureus and Methicillin-resistant Staphylococcus haemolyticus in a Radiology Department

BACKGROUND: We performed surveillance cultures of the surfaces of X-ray cassettes to assess contamination with methicillin-resistant Staphylococcus aureus (MRSA). METHODS: The surfaces of 37 X-ray cassettes stored in a radiology department were cultured using mannitol salt agar containing 6 microg/mL oxacillin. Suspected methicillin-resistant staphylococcal colonies were isolated and identified by biochemical testing. Pulsed-field gel electrophoresis (PFGE) analysis was performed to determine the clonal relationships of the contaminants. RESULTS: Six X-ray cassettes (16.2%) were contaminated with MRSA. During the isolation procedure, we also detected 19 X-ray cassettes (51.4%) contaminated with methicillin-resistant Staphylococcus haemolyticus (MRSH), identified as yellow colonies resembling MRSA on mannitol salt agar. PFGE analysis of the MRSA and MRSH isolates revealed that most isolates of each organism were identical or closely related to each other, suggesting a common source of contamination. CONCLUSIONS: X-ray cassettes, which are commonly in direct contact with patients, were contaminated with MRSA and MRSH. In hospital environments, contaminated X-ray cassettes may serve as fomites for methicillin-resistant staphylococci.

Meticillin-resistant Staphylococcus haemolyticus and Resistance in 103 Isolates of S.haemolyticus / 中华医院感染学杂志

OBJECTIVE To investigate the prevalence of meticillin-resistant Staphylococcus haemolyticus(MRSH)and resistance in S.haemolyticus isolates. METHODS MRSH was detected by cefoxitin disc test and susceptibilities were tested by agar dilution method. RESULTS There were 86.4% of MRSH isolates.MRSH was highly resistant to penicillin,cefazolin,cefuroxime,ceftriaxone,tetracycline,ciprofloxacin,and clindamycin.The resistance rate to amikacin,rifampicine and chloramphenicol was 16.9%,11.2% and 28.1%,respectively.All isolates were susceptible to vancomycin and teicoplanin.Except for tetracycline,amikacin,rifampicin,and chloramphenicol,the resistant rate to other antimicrobial agents was significantly higher in MRSH than in MSSH. CONCLUSIONS MRSH is mostly occupied in S.haemolyticus isolates and resistant to most of antimicrobial agents.More attention should be paid to survey and detect these strains.

Multidrug Resistance Genotype among Clinical Isolates of Staphylococcus haemolyticus / 中华医院感染学杂志

OBJECTIVE To investigate the prevalence of multidrug resistance(MDR) mechanisms of Staphylococcus haemolyticus against oxacillin,gentamycin and erythromycin.METHODS Agar dilution method was performed to detect the minimal inhibition concentration(MIC) of 3 antimicrobial agents against 63 strains of S.haemolyticus,and the resistance genes of mecA,aac(6′)+aph(2″),ermA,ermB,ermC and msrA/msrB were investigated by PCR in all clinical isolates.RESULTS mecA Gene was detected in 62 isolates of meticillin-resistant S.haemolyticus(MRSH),and aac(6′)+aph(2″) gene was found in 50 isolates resistant to gentamicin,and the most prevalence erythromycin resistance gene in S.haemolyticus was msrA/msrB(58.7%),followed by ermC(31.7%).Among the 43 MDR strains,the more commonly encountered three genes were mecA,aac(6′)+aph(2″) and msrA/msrB(58.1%)or ermC(20.9%),and 8 isolates(18.6%) were found harboring four genes of mecA,aac(6′)+aph(2″),ermC and msrA/msrB.CONCLUSIONS The mecA,aac(6′)+aph(2″),msrA/msrB and ermC genes are main resistance mechanisms against oxacillin,gentamicin and erythromycin in mutidrug resistant S.haemolyticus.