ABSTRACT
Three patients with eosinophilic meningitis (EoM) were investigated in two hospitals in Porto Alegre, Southern Brazil. These patients had a common exposure after the ingestion of raw mollusks in a religious ritual. Two of them had an uncommon presentation with intense lower distal extremities pain and small fiber neuropathy as defined by an electroneuromyography (ENMG) study. All three patients were positive for Angiostrongylus cantonensis serology and recovered after antihelminthic and anti-inflammatory treatment. Increased awareness of A. cantonensis infection is important to avoid new infections and to improved recognition and handling of cerebral angiostrongyliasis.
Subject(s)
Angiostrongylus cantonensis/isolation & purification , Disease Outbreaks , Eosinophilia/epidemiology , Meningitis/epidemiology , Strongylida Infections/epidemiology , Adult , Animals , Brazil/epidemiology , Eosinophilia/parasitology , Female , Humans , Male , Meningitis/parasitology , Strongylida Infections/parasitologyABSTRACT
Introdução: Contaminação é complicação freqüente associada ao uso de cateter venoso central. A presença de biofilme, recalcitrante ao tratamentoconvencional, perpetua esta infecção. Na rotina atual, emprega-se heparina para preencher a luz do cateter, porém heparina não protege contra infecção,uma vez que não tem ação antibiótica. Uma alternativa à heparina é o emprego de edetato dissódico e minociclina (M-EDTA), um potente quelante decálcio, magnésio e ferro que destrói a membrana celular bacteriana e fúngica, além de desestruturar o biofilme, permitindo a ação local em altaconcentração de antibiótico associado. Objetivos: Verificar a eficiência de uma solução contendo M-EDTA como selo em cateter de Hemodiálise emcomparação com Heparina. Metodologia: Coletaram-se 160 hemoculturas seriadas, prospectivas, de 15 cateteres de pacientes renais crônicos antes dedialisar. Após a diálise, aplicou-se heparina nos cateteres do grupo A (oito cateteres) e M-EDTA nos do grupo B (sete cateteres). Na análise estatística, foi usado o Teste de Comparação entre Proporções Independentes, sendo considerado significativo um p< 0,05. Resultados: No grupo A, oito hemoculturas foram positivas, com incidência de 9,52 % após 248 dias de observação. No grupo B, uma hemocultura foi positiva, com 1,31% de contaminação (p<0,05) após 203 dias de observação. Foram identificados Staphylococcus aureus (quatro amostras), Klebsiella pneumoniae (três amostras) e Streptococcus pneumoniae (uma amostra) no grupo A e uma amostra de Klebsiella pneumoniae no grupo B. Conclusão: A solução de M-EDTA, comparada com heparina, previne e trata infecção em cateter de hemodiálise, sendo alternativa promissora para reduzir a preocupante prevalência de sepse em pacienterenal crônico usuário de cateter
Background: Contamination is a frequent complication associated with the use of central venous catheters. The presence of biofilm, resistant to conventional treatment, perpetuates such infections. Currently heparin is employed to fill the catheter lumens, though it does not protect from infection since it has no antibiotic action. One alternative to heparin is the use of minocycline and edetic acid (M-EDTA), a potent calcium, magnesium and iron chelating agent that destroys bacterial and fungal cell membrane and disrupts biofilm, thus allowing the associated antibiotic to exert its action locally at a high concentration. Objective: To compare the efficiency of a solution of M-EDTA as a lock in hemodialysis catheters with that of heparin. Methods: One hundred and sixty serial, prospective hemocultures were drawn from 15 catheters of chronic renal patients before dialysis. After dialysis, heparin was instilled in the catheters of group A (8 catheters) and M-EDTA in those of group B (7 catheters).The statistical analysis was performed using the comparative test between independent proportions. A p-value of < 0.05 was considered significant. Results: Among the catheters in group A, 8 hemocultures were positive, with an incidence of 9.52% after 248 days of follow-up. In group B, 1 hemoculture was positive, representing 1.31% of contamination (p<0.05) after 203 days of follow-up. The bacteria identified were Staphylococcus aureus (4 samples), Klebsiella pneumoniae (3 samples) and Streptococcus pneumoniae (1 sample) in group A and 1 sample with Klebsiella pneumoniae in group B. Conclusions: The M-EDTA solution, compared to heparin, prevents and treats infections in hemodialysis catheters, representing a promising alternative for decreasing the alarming prevalence of sepsis among chronic renal patients using catheters
