Uso de adenosin deaminasa como indicador para seleccionar líquidos pleurales para cultivo y/o técnicas moleculares para detección de micobacterias / Use of adenosine deaminase as a marker for selecting pleural fluids for culture and/or molecular techniques for detection of mycobacteria

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Histopathological clues in the diagnosis of fungal infection by Scedosporium in a case of endophthalmitis starting as conjunctivitis.

Cutaneous fungal infections can result in disastrous episodes if improperly diagnosed and treated, especially in immunosuppressed patients. Although dermatopathologists are highly familiar with some filamentous fungi - such as Aspergillus and Zygomycetes - they are not so aware of other less common species. We report a case of ocular infection by Scedosporium apiospermum that started as conjunctivitis and resulted in Phthisis bulbi and subsequent exeresis of the left eye. We describe some of the main morphological features of the fungus as well as the important morphological clues for the differential diagnosis with some similar species, such as Aspergillus, Scopulariopsis, Fusarium, Paecilomyces and Zygomycetes.

Infecciones oculares por Purpureocillium lilacinum: presentación de un caso y revisión de la literatura / Eye infections caused by Purpureocillium lilacinum: A case report and literature review

Antecedentes: Las infecciones oculares por Purpureocillium lilacinum (previamente denominado Paecilomyces lilacinus) constituyen un porcentaje importante de los casos registrados de infecciones por este hongo, considerado como patógeno emergente. Objetivos: Presentar un caso clínico de micosis ocular en una paciente de 70 años de edad con doble trasplante de córnea en el ojo derecho, que presentó una mala evolución a pesar del tratamiento antifúngico y quirúrgico. Métodos: Se realizó cultivo del anillo corneal, así como del resto de la córnea eviscerada en medios micológicos habituales, y se identificó por métodos moleculares el hongo aislado. Resultados: Se aislaron colonias de un hongo filamentoso que por su morfología macroscópica y aspecto microscópico se identificó como P. lilacinum, identificación que se confirmó por métodos moleculares en el laboratorio de referencia. Conclusiones: Las infecciones oculares por P. lilacinum son procesos poco frecuentes pero graves que precisan de rápidas medidas diagnósticas y terapéuticas si se pretende la mayor recuperación de la funcionalidad visual (AU)

Background: Purpureocillium lilacinum eye infections (previously called Paecilomyces lilacinus) make up a significant percentage of the recorded cases of infection by this fungus, and is considered as an emerging pathogen. Aims: To report a case of ocular mycosis in a patient aged 70, with a double corneal transplantation in the right eye, and exhibiting a poor response to antifungal and surgical treatment. Methods: Corneal ring and ocular tissues obtained by surgical procedures were cultured in common mycological media. Molecular identification of the isolated fungus was obtained. Results: Colonies of a filamentous fungus were obtained, and according to the macroscopic and microscopic morphology it was identified as P. lilacinum. The identification was confirmed by molecular methods in a reference laboratory. Conclusions: Eye infections due to P. lilacinum are rare but serious diseases that requires rapid diagnostic and therapeutic measures to enable visual function to recover (AU)

[Eye infections caused by Purpureocillium lilacinum: A case report and literature review]. / Infecciones oculares por Purpureocillium lilacinum: presentación de un caso y revisión de la literatura.

BACKGROUND: Purpureocillium lilacinum eye infections (previously called Paecilomyces lilacinus) make up a significant percentage of the recorded cases of infection by this fungus, and is considered as an emerging pathogen. AIMS: To report a case of ocular mycosis in a patient aged 70, with a double corneal transplantation in the right eye, and exhibiting a poor response to antifungal and surgical treatment. METHODS: Corneal ring and ocular tissues obtained by surgical procedures were cultured in common mycological media. Molecular identification of the isolated fungus was obtained. RESULTS: Colonies of a filamentous fungus were obtained, and according to the macroscopic and microscopic morphology it was identified as P. lilacinum. The identification was confirmed by molecular methods in a reference laboratory. CONCLUSIONS: Eye infections due to P. lilacinum are rare but serious diseases that requires rapid diagnostic and therapeutic measures to enable visual function to recover.

[Evolution of Escherichia coli antibiotic resistances in urine samples from the community]. / Evolución de la resistencia a antibióticos de Escherichia coli en muestras de orina procedentes de la comunidad.

OBJECTIVES: The objectives of this work are two: first, to evaluate the resistance of Escherichia coli to several antibiotics and their trends over a six-year period in strands isolated in urine samples from patients receiving health-care in general practitioner offices in our environment; and second, to evaluate if empirical treatment regimens commonly accepted in our country would be applicable in our environment depending on the results of this study. METHODS: We analyzed the urine cultures positive for Escherichia coli obtained from samples collected at the 10 primary health care centers of the health-care area of El Bierzo and Laciana (Leon, Spain) between the years 2002 and 2007. In vitro resistances of these germs to several common use antibiotics were determined: fosfomycin, nitrofurantoin, tobramycin, cefuroxime, cefixime, amoxicillin-clavulanic acid, cotrimoxazole, ciprofloxacin, norfloxacin, and ampicillin. The existence of statistically significant (p < 0.05) differences in sensitivity comparing the years 2002 and 2007, including all antimicrobials except cefixime, was analyzed by the chi-square test. For cefixime we compared the results between 2002 and 2005. RESULTS: An increase of the resistance of Escherichia coli isolated in urine to all antimicrobials under study has occurred, except for nitrofurantoin, being the differences statistically significant in most cases. Nevertheless, resistances to fosfomycin and nitrofurantoin have remained below 6% throughout the study period. Resistances to tobramycin and cefuroxime were slightly over 10% and cefixime below 3.4%, although in the last one we only have data until 2005. Resistances to amoxicillin-clavulanic acid, initially low, have progressively increase reaching 20.6% in 2007. The same has happened for cotrimoxazole, ciprofloxacin, norfloxacin and ampicillin, passing 32% in 2007 in the first three cases and 62% in the last one. CONCLUSIONS: Variations in bacterial resistance patterns for Escherichia coli obliges to have an updated knowledge of them to adapt general empirical treatment uses to each specific health-care area.

Evolución de la resistencia a antibióticos de Escherichia Coli en muestras de orina procedentes de la Comunidad / Evolution of Escherichia coli antibiotic resistances in urine samples from the community

Objetivo: Los objetivos de este trabajo son dos: primero, evaluar la resistencia a varios antibióticos y las tendencias de la misma en un periodo de seis años en cepas de Escherichia coli aisladas en muestras de orina de pacientes atendidos en Atención Primaria en nuestro medio y, segundo, valorar si las pautas de tratamiento empírico comúnmente aceptadas en nuestro país serían aplicables en nuestro entorno en función de los resultados del estudio. Métodos: Se analizaron los urocultivos positivos para Escherichia coli obtenidos de muestras enviadas desde los diez centros de Atención Primaria del Área Sanitaria de El Bierzo y Laciana (León) entre los años 2002 y 2007. Se determinó la resistencia in vitro de este germen a diversos antibióticos de uso frecuente: fosfomicina, nitrofurantoína, tobramicina, cefuroxima, cefixima, amoxicilina-clavulánico, cotrimoxazol, ciprofloxacino, norfloxacino y ampicilina. Se analizó mediante Chi cuadrado la existencia de diferencias estadísticamente significativas (p < 0,05) de sensibilidad, comparando los años 2002 y 2007 para todos los antimicrobianos excepto para cefixima. En este último caso se compararon los resultados obtenidos en 2002 y 2005. Resultados: Se ha producido un aumento de la resistencia de los aislamientos urinarios de Escherichia coli a todos los antimicrobianos estudiados, menos para la nitrofurantoína, que fue estadísticamente significativo en la mayoría de los casos. Aún así, la resistencia frente a fosfomicina y nitrofurantoína se ha mantenido por debajo del 6% a lo largo del periodo de estudio. Para tobramicina y cefuroxima apenas ha superado el 10% y para cefixima se encuentra por debajo del 3,4%, aunque en este último caso sólo se dispone de datos hasta 2005 en nuestro estudio. La resistencia frente a amoxicilina-clavulánico, inicialmente baja, ha ido aumentando progresivamente hasta alcanzar el 20,6% en 2007. Lo mismo ocurre para cotrimoxazol, ciprofloxacino, norfloxacino y ampicilina, hasta superar el 32% en 2007 en el caso de los tres primeros y el 62% en el último. Conclusiones: La variación en los patrones de resistencia bacteriana de Escherichia coli obliga a disponer de un conocimiento actualizado de los mismos para adaptar las pautas generales de tratamiento empírico a cada área de salud concreta (AU)

Objectives: The objectives of this work are two: first, to evaluate the resistance of Escherichia coli to several antibiotics and their trends over a six-year period in strands isolated in urine samples from patients receiving health-care in general practitioner offices in our environment; and second, to evaluate if empirical treatment regimens commonly accepted in our country would be applicable in our environment depending on the results of this study. Methods: We analyzed the urine cultures positive for Escherichia coli obtained from samples collected at the 10 primary health care centers of the health-care area of El Bierzo and Laciana (Leon, Spain) between the years 2002 and 2007. In vitro resistances of these germs to several common use antibiotics were determined: fosfomycin, nitrofurantoin, tobramycin, cefuroxime, cefixime, amoxicillin-clavulanic acid, cotrimoxazole, ciprofloxacin, norfloxacin, and ampicillin. The existence of statistically significant (p < 0.05j differences in sensitivity, comparing the years 2002 and 2007, including all antimicrobials except cefixime, was analyzed by the chi-square test. For cefixime we compared the results between 2002 and 2005. Results: An increase of the resistance of Escherichia coli isolated in urine to all antimicrobials under study has occurred, except for nitrofurantoin, being the differences statistically significant in most cases. Nevertheless, resistances to fosfomycin and nitrofurantoin have remained below 6% throughout the study period. Resistances to tobramycin and cefuroxime were slightly over 10% and cefixime below 3.4%, although in the last one we only have data until 2005. Resistances to amoxicillin-clavulanic acid, initially low, have progressively increase reaching 20.6% in 2007. The same has happened for cotrimoxazole, ciprofloxacin, norfloxacin and ampicillin, passing 32% in 2007 in the first three cases and 62% in the last one. Conclusions: Variations in bacterial resistance patterns for Escherichia coli obliges to have an updated knowledge of them to adapt general empirical treatment uses to each specific health-care area (AU)