Regulação da expressão de pioverdina dependente de contato em pseudomonas aeruginosa / Regulation of surface-dependent pyoverdine expression in Pseudomonas aeruginosa

A gama-proteobactéria Pseudomonas aeruginosa é um patógeno oportunista humano frequentemente associado a pacientes com queimadura grave e aos portadores de fibrose cística. O estabelecimento de infecção depende de uma série de fatores que contribuem para a virulência deste patógeno, dentre eles a produção de sideróforos e outros sistemas de captação de ferro. Pioverdina é o principal sideróforo sintetizado por bactérias do gênero Pseudomonas e linhagens deficientes na sua produção são incapazes de estabelecer infecção em modelos animais. A regulação da biossíntese deste sideróforo envolve a agregação entre as células, indicando a dependência de contato para completa indução da sua produção. O contato com uma superfície altera o comportamento das células e diversos fenótipos são dependentes deste sinal mecânico. PrlC é uma oligopeptidase A putativamente envolvida na degradação de peptídeo-sinais e PA14_00800, uma pequena proteína com domínio de função desconhecida, codificada por um gene imediatamente à jusante de prlC. Existem poucos trabalhos na literatura sobre PrlC e seus homólogos e nenhuma informação sobre PA14_00800. Este trabalho teve como objetivo elucidar o envolvimento de PrlC e PA14_00800 na regulação da produção de pioverdina por células em contato com uma superfície. Para estabelecer uma correlação na expressão destes genes, um estudo da organização gênica foi realizado por RT-PCR, confirmando que eles fazem parte do mesmo operon e, portanto, que a expressão destes genes é regulada pelos mesmos fatores. Ensaios classicamente modulados pelo segundo mensageiro c-di-GMP, como formação de biofilme e motilidade, não apresentaram variações nas linhagens mutantes ΔprlC, ΔPA14_00800 ou Δoperon, indicando que a deleção destes genes não altera significativamente os níveis de c-di-GMP nas células. A motilidade do tipo swarming é, no entanto, severamente afetada na linhagem ΔPA14_00800 quando o meio de cultura não contém cloreto de cálcio e glicose, indicando um defeito na sinalização celular ou requerimento energértico desta linhagem nestas condições. PA14_00800 regula a fluorescência de P. aeruginosa em meio sólido e semissólido, mas não em meio líquido. Esta fluorescência depende tanto de pioverdina quanto de PQS, umamolécula de comunicação celular fluorescente, e a possibilidade de outros fatores estarem envolvidos neste fenótipo ainda está sob investigação. Análise do transcritoma por RNASeq com a linhagem ΔPA14_00800 comparada à linhagem parental foi realizada a partir de colônias destas linhagens crescidas em M9 modificado. Genes envolvidos no sistema de secreção do tipo III e do tipo VI e na biossíntese de PQS apareceram dentre os genes diferencialmente expressos, bem como genes para o catabolismo de glicose. Este trabalho foi o primeiro a investigar o papel de PA14_00800 na fisiologia de P. aeruginosa, e os conhecimentos adquiridos aqui podem ser transpostos, com cautela, para compreensão da função dos homólogos de PA14_00800 em outras bactérias

The gamma-proteobacterium Pseudomonas aeruginosa is a human opportunistic pathogen frequently associated with patients with severe burns and those with cystic fibrosis. The establishment of infection depends on several factors that contribute to the virulence of this pathogen, among them siderophore production and other iron uptake systems. Pyoverdine is the main siderophore synthesized by the bacteria of the genus Pseudômonas and pyoverdinedeficient strains are unable to establish infection in animal models. The regulation of biosynthesis of this siderophore involves cell aggregation, indicating contact dependency for complete induction of pyoverdine production. Surface contact alters cell behavior and several phenotypes are dependent on this mechanical cue. PrlC is an oligopeptidase A putatively involved in peptide-signals degradation and PA14_00800, a small protein with a domain of unknown function, encoded by a gene immediately downstream of prlC. There are few papers in the literature on PrlC and its homologues and no information on PA14_00800. This work aimed to elucidate the role of PrlC and PA14_00800 in surface-dependent regulation of pyoverdine production. To establish a correlation in the expression of these genes, a study of the gene organization was performed by RT-PCR, confirming that they are part of an operon and therefore the expression of these genes is regulated by the same factors. Traits classically modulated by the second messenger c-di-GMP, such as biofilm formation and motility, did not show variations in the ΔprlC, ΔPA14_00800 or Δoperon, indicating that the deletion of these genes does not significantly alter the levels of c-di-GMP within the cells. Swarming motility is, however, severely affected in the strain ΔPA14_00800 when the culture medium does not contain calcium chloride and glucose, indicating a cell signaling defect or energetic requirement under these conditions. PA14_00800 regulates surface-dependent fluorescence of P. aeruginosa, in solid and semi-solid medium. This fluorescence depends on both pyoverdine and PQS, a fluorescent cell-to-cell communication molecule, and the investigation of other putative factors involved in this phenotype is still under study. Transcriptomic analysis by RNASeq with the strain ΔPA14_00800 compared to PA14 was performed from colonies ofthese strains grown in modified M9 1% agar. Genes involved in the type III and type VI secretion systems, in PQS biosynthesis and glucose catabolism were differentially expressed. This work was the first to investigate the role of PA14_00800 in the physiology of P. aeruginosa, and the knowledge obtained here can be cautiously transposed to understanding the role of PA14_00800 homologues in other bactéria

Infección crónica por Pseudomonas aeruginosa en pacientes con bronquiectasias no fibrosis quística / Chronic infection by Pseudomonas aeruginosa in patients with non-cystic fibrosis bronchiectasias

Resumen Introducción: La infección crónica por Pseudomonas aeruginosa (PA) es frecuente en pacientes con bronquiectasias (BQ) y representa un quiebre en la historia natural de la enfermedad, asociándose a mal pronóstico y mayor severidad. Objetivo: Caracterizar la población portadora de BQ no fibrosis quística (BQ no-FQ) del Instituto Nacional del Tórax (INT) infectados crónicamente con PA comparándolos con pacientes que mantienen cultivos de expectoración negativos para este germen. Metodología: Revisión retrospectiva de fichas clínicas de pacientes portadores de BQ del INT entre julio de 2007 y abril de 2017. Se caracterizó la población y se comparó score de FACED y otros índices de gravedad. Resultados: El promedio de edad fue de 55 ± 17,3 años, 81% de los pacientes fue de género femenino. De acuerdo a aislamiento de Pseudomonas en cultivo esputo se clasificaron como infectados crónicamente (BQ con PA; n = 61) y no infectados con PA (BQ sin PA; n = 59). No hubo diferencias entre los grupos en edad y sexo. El VEF1 fue más bajo en el grupo con PA los que tienen más hospitalizaciones. Se calculó el índice de riesgo FACED siendo mayor en los pacientes colonizados. La etiología más frecuente es la postinfecciosa, principalmente secuelas de TBC, con 30,8% de etiología no identificada. Conclusiones: Los pacientes con bronquiectasias con infección crónica por Pseudomonas aeruginosa tienen una enfermedad más severa, con VEF1 más bajo, y con mayor índice de severidad de FACED. Destaca en nuestro grupo la etiología postinfecciosa.

Introduction: Chronic airways infection with Pseudomonas aeruginosa (PA) is a common situation in patients with Bronchiectasis (BQ) and constitutes a breakdown in the natural history of the latter. Moreover, BQ is also associated with a poor prognosis and an increased severity of the disease. Objective: To describe the characteristics of the population diagnosed with non-Cystic Fibrosis Bronchiectasis (non-CFB) who are chronically infected with PA, and to perform a comparison with patients with negative sputum cultures. Methodology: We performed a retrospective analysis of the clinical files of patients diagnosed with non-CFB who were attended at the 'Instituto Nacional del Tórax' (Chile) between July 2007 and April 2017. The characteristics of the population were described and the FACED scores and other severity indexes were compared. Results: The average age of patients was 55 ± 17.3 years-old, and 81% of them were female. According to PA isolation in sputum culture, they were classified as "chronically infected" (non-CFB with PA, n = 61) and "not infected with PA" (non-CFB without PA, n = 59). There were no differences in age and gender between the two groups. On the other hand, FEV1 was lower in the non-CFB PA group. The calculated FACED score was higher in colonized patients. The most frequent etiology was post-infectious, mainly TB sequels, with a 30.8% unidentified etiology. Conclusions: Patients with bronchiectasis chronically infected with Pseudomonas aeruginosa show increases in the severity of the disease, with a lower FEV1 and a higher FACED score. The postinfectious etiology is highlighted in our group.

Ecthyma gangrenosum: a report of eight cases

Abstract: Ecthyma gangrenosum is a rare skin infection classically associated with Pseudomonas aeruginosa. We performed a retrospective study of all cases diagnosed with ecthyma gangrenosum from 2004-2010 in a university hospital in Mexico (8 cases, 5 female patients and 3 male patients, ages between 4 months and 2 years). The most common risk factor for ecthyma gangrenosum is neutropenia in immunocompromised patients. In previously healthy patients, immunological evaluation is important to rule out underlying immunodeficiency. Ecthyma gangrenosum in healthy patients has a high mortality rate and early diagnosis and aggressive antibiotic treatment is imperative as it can improve patients' prognosis.

Ectima gangrenoso y osteoartritis por pseudomonas aeruginosa en un paciente previamente sano / Ecthyma gangrenosum and osteoarthritis by pseudomonas aeruginosa in a previously healthy patient

Las infecciones por pseudomonas aeruginosa se presentan habitualmente en individuos con factores predisponentes, siendo excepcional su ocurrencia en los previamente sanos. Se describe el caso de un lactante de 2 meses sin antecedentes patológicos a destacar que presentó una infección grave por pseudomonas aeruginosa, presentando al momentode la consulta en emergencia lesiones en piel características de ectima gangrenoso. El reconocimiento de estas lesiones permite adecuar el tratamiento antibiótico empírico a la susceptibilidad antimicrobiana de este germen. La presencia de una infección por esta bacteria obliga al clínico a la búsqueda de inmunodeficiencias no diagnosticadas previamente...

Ocular necrotizing fasciitis due to Pseudomonas aeruginosa in a non-neutropenic patient

Eyelid necrosis is a very rare disease, usually secondary to trauma or infections. Pseudomonas aeruginosa [PA] eyelid necrosis remains principally a clinical diagnosis and it is often missed early in its presentation because of the difficulty in differentiating it from more common soft tissue infections. However, when the diagnosis is made we must act quickly due to the fatal evolution if not handled properly. We present the case of a non-neutropenic 53-year-old male patient with a history of alcoholism, smoking habit and lung cancer under chemotherapy treatment who developed ocular necrotizing fasciitis due to PA with perforation of his left eye and severe bilateral sclera ischemia despite intensive antibiotic treatment and surgical debridement.

Multiple myeloma complicated with pseudomonas endocartiditis / Mieloma múltiplo complicado com endocardite infecciosa por pseudomonas

Patients diagnosed with multiple myeloma are more susceptible to infections which are the major causes of morbidity and mortality associated to this disease. The main infectious agents involved are Gram-positive bacteria. However, after chemotherapy an increase in the incidence of Gram-negative strains is observed. These bacteria are also responsible for most cases of urinary tract infections. Here is reported a rare case in a 73-year-old man with multiple myeloma who developed endocarditis due to pseudomonas.

Pacientes diagnosticados com mieloma múltiplo são mais suscetíveis a infecções, que é a principal causa de morbidade e mortalidade associadas a essa doença. Os principais agentes infecciosos envolvidos são as bactérias Gram-positivas, mas, após a quimioterapia, pode haver aumento na incidência de Gram-negativos, que são responsáveis, na maioria dos casos, por infecções do trato urinário. Assim, descrevese um raro caso de um paciente de 73 anos de idade, com mieloma múltiplo diagnosticado com endocardite por pseudomonas.

Effect of a cholesterol rich diet, recurrent infection and possible treatment modalities on the pulmonary vascular system: an experimental study / Efecto de la dieta rica en colesterol, la infección recurrente, y las posibles modalidades de tratamiento sobre el sistema vascular pulmonar: un estudio experimental

OBJECTIVE: Infection may lead to inflammation, atherosclerosis and thrombotic vascular events. The atherosclerotic effect of hypercholesterolaemia on the vascular system is well-known. However, limited studies were done on the therapeutic and preventative agents. The aim of this study was to investigate the effects of infection and cholesterol rich diet combined with an antibiotic, anti-inflammatory agent and red wine on the pulmonary vascular system. METHODS: Fifty-nine rats were evaluated. Six groups were created: Control-Group I (n = 10); infection - Group II (n = 9), infection-cholesterol rich diet - Group III (n = 12), infection-cholesterol rich dietcefepime - Group IV (n = 11); infection-cholesterol rich diet-diclofenac potassium - Group V (n = 9); infection-cholesterol rich diet and red wine - Group VI (n = 8). Blood samples of rats were collected for cholesterol analysis every month. Sections of central pulmonary arteries were examined for thickness of the intima and medial wall by computerised image analysis. RESULTS: There was a statistically significant difference in serum cholesterol levels and in thickness of the intima between the groups (p = 0.000). The rest of the groups had more intimal thickening than Group I (p = 0.000). Group III had thicker intima than Groups IV and V (p = 0.009, p = 0.011 respectively). There was no significant difference between the groups in thickness of media (p = 0.432). CONCLUSION: Infection and cholesterol rich diet have a synergistic effect on atherosclerosis in pulmonary arteries. However, antibiotics and anti-inflammatory agents could be useful in prevention.

OBJETIVO: La infección puede conducir a inflamación, ateroesclerosis y eventos vasculares trombóticos. El efecto aterosclerótico de la hipercolesterolemia en el sistema vascular es bien conocido. Sin embargo, se hicieron estudios limitados sobre los agentes preventivos y terapéuticos. El objetivo de este estudio fue investigar los efectos de la infección y la dieta rica en colesterol, combinados con agentes antibióticos, anti-inflamatorios, y vino tinto, sobre el sistema vascular pulmonar. MÉTODOS: Cincuenta y nueve ratas fueron evaluadas. Se hicieron seis grupos: grupo-control I (n = 10), grupo-infección II (n = 9), grupo infección-dieta rica en colesterol III (n = 12), grupo-infección-dieta rica en colesterol-cefepima IV (n = 11), grupo-infección-dieta rica en colesterol-diclofenaco potásico V (n = 9), grupo-infección-dieta rica en -vino tinto VI (n = 8). Se tomaron muestras de sangre de ratas para analizar el colesterol cada mes. Se examinaron secciones de las arterias pulmonares centrales para determinar el grosor de la pared íntima y media mediante análisis computarizado de imágenes. RESULTADOS: Hubo una diferencia estadísticamente significativa en los niveles de colesterol en suero y el grosor de la íntima entre los grupos (p = 0.000). El resto de los grupos tenía más engrosamiento de la íntima que el grupo I (p = 0.000). El grupo III tenía una íntima más gruesa que los grupos IV y V (p = 0,009, p = 0.011 respectivamente). No hubo ninguna diferencia significativa entre los grupos en cuanto al espesor de la media (p = 0.432). CONCLUSIÓN: La infección y la dieta rica en colesterol tienen un efecto sinérgico sobre la aterosclerosis en las arterias pulmonares. Sin embargo, los antibióticos y los agentes antiinflamatorios podrían ser útiles para la prevención.

Atividade pró-trombótica da toxina ExoU de Pseudomonas aeruginosa detectada em modelos experimentais in vivo e in vitro / Prothrombotic activity of the Pseudomonas aeruginosa toxin ExoU detected in experimental models in vivo and in vitro

Pseudomonas aeruginosa é um importante agente de pneumonia, particularmente em pacientes submetidos à ventilação mecânica, que pode evoluir para sepse, com elevadas taxas de letalidade. Na sepse, o processo inflamatório sistêmico exacerbado favorece o desequilíbrio entre as vias de coagulação e fibrinólise e a instalação de um estado pró-coagulante, com o aparecimento de trombose microvascular, coagulação intravascular disseminada e falência de múltiplos órgãos. Conhecendo a potente atividade pró-inflamatória da toxina ExoU produzida por P. aeruginosa, decorrente de sua atividade fosfolipásica A2, o objetivo desta tese foi investigar seu potencial de indução de alterações hemostáticas relacionadas à patogênese da sepse. Utilizando modelo de sepse em camundongos inoculados, por via intratraqueal, com suspensões de P. aeruginosa produtora de ExoU (PA103) ou de cepa com deleção do gene exoU, não produtora da toxina, foi mostrado que ExoU determinou maior gravidade da infecção, maior taxa de letalidade, leucopenia, trombocitose, hiperpermeabilidade vascular e transudação plasmática, evidenciadas, respectivamente, pela maior concentração de proteínas nos lavados broncoalveolares (LBAs) e acúmulo do corante Azul de Evans, previamente inoculado nos animais, por via endovenosa, no parênquima renal. ExoU favoreceu, também, a ativação plaquetária, confirmada pela maior concentração de plaquetas expressando P-seletina em sua supefície, maior número de micropartículas derivadas de plaquetas e maior concentração plasmática de tromboxano A2. A histopatologia dos pulmões e rins dos animais infectados com PA103 confirmou a formação de microtrombos, que não foram detectados nos animais controles ou infectados com a cepa mutante. Nos pulmões, a produção de ExoU determinou intensa resposta inflamatória com maior concentração de leucócitos totais e polimorfonucleados, interleucina-6 e fator de necrose tumoral-alfa nos LBAs. A análise imunohistoquímica mostrou intensa deposição...

Pseudomonas aeruginosa is an important agent of pneumonia, mainly in patients undergoing mechanical ventilation, which can progress to sepsis with high mortality rates. In sepsis, the systemic inflammatory process favors exacerbated imbalance between the coagulation and fibrinolysis pathways and the installation of a procoagulant state, leading to microvascular thrombosis, disseminated intravascular coagulation and multiple organ failure. Knowing the powerful proinflammatory activity of the P. aeruginosa toxin ExoU, secondary to its phospholipase A2 activity, the goal of this study was to investigate the ExoU potential to induce hemostatic changes related to sepsis pathogenesis. By using a murine model of pneumosepsis, obtained by the intratracheal injection of suspensions of the ExoU-producing PA103 P. aeruginosa strain or of its isogenic mutant PA103 exoU, defective in the toxin synthesis, ExoU was shown to enhance the severity of the infection and to induce higher mice mortality rate as well as leukopenia, thrombocytosis, vascular hyperpermeability and plasma transudation, evidenced, respectively, by the higher protein concentration in the bronchoalveolar lavage fluids (BALF) and accumulation of Evans blue dye, previously intravenous infectioned, in mice renal parenchyma. ExoU also favored platelet activation, evidenced by the higher concentration of platelets expressing P-selectin on their surface, greater number of platelet-derived microparticles and increased plasma concentration of thromboxane A2. Histopathology of the lungs and kidneys of PA103 - infected animals confirmed the formation of microthrombi, which were not detected in controls or in animals infected with the bacterial mutant. In lungs, ExoU induced an intense inflammatory response with high concentrations of total and polymorphonuclear leukocytes, interleukin-6 and tumor necrosis factor-alfa in mice BALF. Immunohistochemical analysis showed intense fibrin deposition in the alveoli...

Fatal necrotizing fasciitis caused by pseudomonas aeruginosa in Infants

Two cases of Necrotizing fasciitis caused by Pseudomonas aeruginosa in infants are presented. One is female 4 days old; the other is an 8 months old male. Both infants died despite aggressive treatment and intensive resuscitation. Both infants exhibited dark and bluish discoloration of some region of their skin. Pseudomonas aeruginosa was recovered from the blood culture in both infants. The aim of this communication is to report the occurrence of rare cases of necrotizing fasciitis caused by Pseudomonas aeruginosa in infants

Queratitis por Pseudomonas aeruginosa asociada al uso de lentes de contacto de hidrogel de silicona de última generación: Reporte de un caso / Pseudomonas aeruginosa keratitis associated with the use of last generation contact lens made of silicone hydrogel: case report

We report the case of a female patient, 56-year-old housewife, for the first time user of last generation contact lenses: Lotrafilcon B, which presented a severe corneal ulcer by Pseudomonas aeruginosa in hev left eye and subsequently required keratoplasty. Initially she reported pain and arrived at the emergency department with red eye, corneal central ulcer of three days of evolution and hypopion. Initially she received topic mydriatic drugs and prednisolone at 1 percent. At the next day the ophthalmologycal exam showed hypopion at 5 percent and a central severe ulcer greater than 3 mm in diameter with sharp edges and mucopurulent secretion. The treatment was changed to moxifloxacin and natamycin. The microbiological analysis performed in two laboratories yielded Aspergillus sp. and Pseudomonas aeruginosa sensitive to ciprofloxacin, tobramycin, gentamicin and moxifloxacin. The presence of Aspergillus was interpreted as a pollution lens case and likely colonization of the cornea because of the patient good performance. After four months although improving she required corneal transplantation. Photographic documentation of the case under illumination with slit lamp is presented.

Se comunica el caso de una paciente mujer, de 56 años de edad, ama de casa, usuaria por primera vez de lentes de contacto de última generación: lotrafilcon B, que presentó una úlcera corneal grave por Pseudomonas aeruginosa en su ojo izquierdo y posteriormente requirió quera toplastía. Inicialmente reportó dolor y llegó a la unidad de urgencia con ojo rojo, úlcera corneal central de tres días de evolución e hipopión. El tratamiento farmacológico inicial fue con midriático y prednisolona al 1 por ciento. La valoración oftalmológica del día siguiente demostró hipopión al 5 por ciento y úlcera central grave mayor a 3 mm de diámetro con bordes definidos y secreción mucopurulenta. Se cambió tratamiento a moxifloxacina y natamicina. El análisis microbiológico en dos laboratorios, confirmó el aislado de Aspergillus sp y Pseudomonas aeruginosa; esta última sensible a ciprofloxacina, tobramicina, gentamicina y moxifloxacina. La presencia de Aspergillus se interpretó como contaminación del estuche y probable colonización de la cornea por la clínica y buena evolución. A los cuatro meses de evolución, aunque presentó mejoría, requirió trasplante corneal. Se incluye documentación fotográfica del caso bajo iluminación con lámpara de hendidura.

Incidence of metallo-beta-lactamase-producing Pseudomonas aeruginosa in diabetes and cancer patients.

Metallo-beta-lactamase (MBL)-producing Pseudomonas aeruginosa strains have been reported to be an important cause of nosocomial infections. There is not enough information from India regarding their prevalence in diabetic and cancer patients. The present study was undertaken over a period of one year from January to December 2006 to study the incidence of MBL P. aeruginosa and the clinical outcome in diabetes and cancer patients admitted to S.L. Raheja Hospital, Mumbai. Two hundred and thirty isolates of P. aeruginosa were obtained from different samples of patients. These isolates were subjected to susceptibility testing to anti-pseudomonal drugs as per CLSI guidelines. They were further screened for the production of MBL by disc potentiation testing using EDTA-impregnated imipenem and meropenem discs. Of the 230 isolates of P. aeruginosa, 60 (26%) isolates were found resistant to carbapenems (both imipenem and meropenem) and 33 (14.3%) were found to be MBL producers. Of the 33 MBL-producing isolates, 24 (72.7%) were diabetic patients, six (18.1%) were cancer patients and three (9%) patients had both diabetes and cancer. Five (15.1%) patients responded to the combination therapy of colistin, piperacillin with tazobactam and amikacin, while 28 (84.8%) patients responded to the combination therapy of amikacin, piperacillin with tazobactam and gatifloxacin. Thus, the rapid dissemination of MBL producers is worrisome and necessitates the implementation of not just surveillance studies but also proper and judicious selection of antibiotics, especially carbapenems.

Endoscopic biliary drainage in patients with amebic liver abscess and biliary communication.

BACKGROUND: Percutaneous drainage or surgery is required when amebic liver abscess (ALA) fails to respond to medical management. In some of these patients, non-response may be due to communication of ALA with the biliary tree. This report describes our experience with the use of endoscopic biliary draining in such patients. METHODS: Medical records of patients with ALA undergoing either needle aspiration or percutaneous pigtail drainage were retrieved; the indications for drainage were: abscess volume exceeding 250 mL, a thin rim of tissue (< 1 cm thick) around the abscess, systemic toxic features and failure to improve on medical treatment. Patients with abscess drain output >25 mL/day persisting for 2 weeks or presence of bile in the drain fluid underwent endoscopic biliary drainage. RESULTS: A total of 115 patients with ALA underwent percutaneous treatment. None of the 25 patients with needle aspiration needed any further treatment. Of the 90 who underwent catheter drainage, the catheter could be removed within one week in 77 patients; the remaining 13 patients (median age 42 years, range 24-65; all men) had an abscess-biliary communication. In them, the median catheter output was 88 mL/day (range 45-347) and 54 mL/day (28-177) at 2 days and 2 weeks after catheter placement. The drain fluid contained bile in all 13 patients and in addition contained pus in 10 patients. Eleven patients had a solitary abscess and two had multiple abscesses. Cholangiogram showed biliary communication in all 13 patients. All patients were treated with placement of 10F biliary endoprosthesis or 10F nasobiliary drain. Pigtail catheter was removed within 1 week in 11 of 13 patients. CONCLUSION: In patients with amebic liver abscess communicating with the biliary tree, biliary stenting may hasten clinical recovery and allow early removal of liver abscess catheter drain.

Ecthyma gangrenosum: a rare cutaneous manifestation caused by pseudomonas aeruginosa without bacteraemia in a leukaemic patient--a case report.

Ecthyma gangrenosum is a rare and invasive cutaneous infection caused by Pseudomonas aeruginosa in the majority of cases, typically affecting immunocompromised patients, particularly those with neutropenia. We report a rare case of ecthyma gangrenosum in the absence of bacteraemia presenting as a solitary necrotic ulcer in a female patient with acute lymphoblastic leukaemia. A culture from the ecthyma lesion revealed the presence of Pesudomonas aeruginosa, but the results of repeated blood cultures were negative. The patient responded well to amikacin to which the isolate was susceptible in vitro. Considering high rate of mortality, early diagnosis and prompt effective treatment is mandatory.

Pseudomonas sepsis with Noma: an association?

We report here a 2.5-year-old male child with community-acquired Pseudomonal sepsis showing the characteristic lesions of ecthyma gangrenosum. The child had development of gangrenous changes of the nose and face - the 'cancrum oris' or 'Noma'. We highlight the possible association of Pseudomonas sepsis and Noma, with malnutrition playing a central role in causing both the diseases.

Atrofia mucosa/translocação bacteriana na sepse experimental em ratos Wistar / Mucosal atrophy/bacterial translocation in experimental sepsis in Wistar rats

OBJETIVO: Avalizar a relação entre lesão mucosa e translocação bacteriana. MÉTODO: Utilizou-se 50 ratos distribuídos em 5 grupos: 1.Controle: injeção de inóculo padrão de Pseudomonas aeruginosa, 2.Dreno: injeção do inóculo padrão e drenagem da cavidade abdominal, após 6 horas, 3.Lavado: injeção do inóculo padrão e lavagem da cavidade abdominal, após 6 horas, 4.Lavado + dreno: injeção do inóculo padrão e após 6 horas, drenagem e lavagem da cavidade, 5.Normal: avaliação histológica da parede intestinal normal. Após o óbito, realizou-se hemocultura e cultura peritoneal. Realizou-se medida da espessura total da parede do jejuno e da camada mucosa em vilosidades seccionadas de forma longitudinal. RESULTADOS: Na hemocultura, houve crescimento de Pseudomonas aeruginosa e Escherichia coli em 90 por cento e 52,5 por cento dos animais. Na cultura peritoneal, houve crescimento de P. aeruginosa, E. coli e Klebsiella sp em 87,5 por cento, 85 por cento e 5 por cento dos animais. Quanto a altura da camada mucosa e da parede intestinal, não houve alteração estatisticamente significativa entre os 5 grupos. CONCLUSAO: A sepse aguda não causou alteração na camada mucosa do intestino delgado e a translocação ocorrida não pode ser considerada como decorrente de uma lesão da mucosa intestinal.

Prevalence of pathogens in cystic fibrosis patients in Bahia, Brazil

INTRODUCTION: Recurrent respiratory infections account for most of the morbidity and mortality of cystic fibrosis patients. MATERIALS AND METHODS: The objective was to determine the prevalence of pathogens isolated from lower respiratory tract secretions in cystic fibrosis patients. In this descriptive observational study, data from 69 patients was collected from medical records. RESULTS: The microorganisms that were identified included 36.2 percent P. aeruginosa, 28.9 percent S. Aureus, 4.3 percent K. pneumoniae, 1.5 percent H. influenzae, 1.5 percent E. coli, 1.5 percent S. maltoophilia, and in 27.5 percent the flora was normal. The prevalence of P. aeruginosa was 83 percent in patients under two years of age, demonstrating early colonization. CONCLUSION: P. aeruginosa and S. aureus were the most prevalent pathogens; there was also early infection/colonization by P. aeruginosa. This information will contribute to improved therapeutic measures for patients of the Bahia Cystic Fibrosis Reference Center

Pseudomonas aeruginosa as a Potential Cause of Antibiotic-Associated Diarrhea

Although Pseudomonas aeruginosa is not generally considered as a cause of antibiotic-associated diarrhea, several cases of diarrhea caused by P. aeruginosa have been reported. We experienced seven cases of nosocomial diarrhea presumably caused by P. aeruginosa, which was the predominant organism isolated from stool cultures. Clostridium difficile toxin was also positive in one patient. No other potential or recognized enteropathogens were identified from stools. All patients had underlying diseases and had been receiving antibiotics before the diarrheal onset. All of the seven P. aeruginosa isolates were resistant to previously given antibiotics. Diarrhea stopped three days after withdrawal of probable offending antibiotics without specific treatment in two patients. The other five patients having continuous diarrhea despite withdrawal of probable offending antibiotics, were successfully treated with antipseudomonal agents. The median duration of diarrhea after the initiation of treatment was 6.3 days. These data suggest that P. aeruginosa can be a potential cause of antibiotic-associated diarrhea. Further investigations are warranted to evaluate the possible etiologic role of P. aeruginosa in antibiotic-associated diarrhea.

A case of glomerulonephritis in association with pyogenic liver abscess

Glomerulonephritis associated with visceral abscess is being increasingly recognized. The association of glomerulonephritis with visceral suppuration in the absence of endocarditis was first described by Whitworth and associates. Abscesses were most frequently located in the respiratory tract but have been reported at numerous other sites, including appendix, uterus, aorto-femoral bypass graft and cutaneous wound. This report documents the apparently rare occurrence of glomerulonephritis with acute renal failure in association with pyogenic liver abscess. The need for awareness of glomerulonephritis as a cause of acute renal failure in pyogenic liver abscess is highlighted.