ABSTRACT
Objectives: To describe the clinical features, history and association with intestinal disease in central nervous system (CNS) S. bovis infections. Methods: Four cases of S. bovis CNS infections from our institution are presented. Additionally a systematic literature review of articles published between 1975 and 2021 in PubMed/MEDLINE was conducted. Results: 52 studies with 65 cases were found; five were excluded because of incomplete data. In total 64 cases were analyzed including our four cases: 55 with meningitis and 9 with intracranial focal infections. Both infections were frequently associated with underlying conditions (70.3%) such as immunosuppression (32.8%) or cancer (10.9%). In 23 cases a biotype was identified, with biotype II being the most frequent (69.6%) and S. pasteurianus the most common within this subgroup. Intestinal diseases were found in 60.9% of cases, most commonly neoplasms (41.0%) and Strongyloides infestation (30.8%). Overall mortality was 17.1%, with a higher rate in focal infection (44.4% vs 12.7%; p=0.001). Conclusions: CNS infections due to S. bovis are infrequent and the most common clinical form is meningitis. Compared with focal infections, meningitis had a more acute course, was less associated with endocarditis and had a lower mortality. Immunosuppression and intestinal disease were frequent in both infections.(AU)
Introducción: Streptococcus bovis, una causa bien conocida de endocarditis asociada a cáncer colorrectal, es también una causa poco frecuente de infecciones del sistema nervioso central (SNC), incluyendo meningitis, abscesos cerebrales o empiema subdural. El objetivo de este estudio es describir las características clínicas, los antecedentes médicos y la asociación con la enfermedad intestinal en las infecciones por S. bovis en el SNC. Métodos: Describimos 4 infecciones por S. bovis en el SNC en nuestra Unidad y, a continuación, presentamos una revisión bibliográfica de los artículos publicados entre 1975-2021 en PubMed/MEDLINE. Resultados: Se encontraron 52 estudios con 65 casos; 5 se excluyeron por datos incompletos. En total se analizaron 64 casos incluyendo nuestros 4: 55 con meningitis y 9 con infecciones focales intracraneales. Ambas infecciones se asociaron con frecuencia a condiciones subyacentes (70,3%) como la inmunosupresión (32,8%) o el cáncer (10,9%). En 23 casos se identificó un biotipo, siendo el más frecuente el biotipo ii (69,6%), y dentro de ellos, S. pasteurianus. En el 60,9% de los casos se detectaron enfermedades intestinales, siendo las más frecuentes las neoplasias (41,0%) y la infestación por Strongyloides (30,8%). La mortalidad global fue del 17,1%, con una tasa mayor en la infección focal (44,4 frente a 12,7%; p=0,001). Conclusiones: Las infecciones del SNC debidas a S. bovis son poco frecuentes y la forma clínica más común es la meningitis. En comparación con las infecciones focales, la meningitis tiene un curso más agudo, está menos asociada a la endocarditis y tiene una menor mortalidad. La inmunosupresión y la enfermedad intestinal fueron frecuentes en ambas infecciones.(AU)
Subject(s)
Humans , Male , Female , Adult , Central Nervous System Infections/diagnosis , Meningitis/drug therapy , Brain Abscess , Streptococcus bovis , Endocarditis/diagnosis , Microbiology , Microbiological Techniques , Meningitis/diagnosis , Gastrointestinal Diseases/complicationsABSTRACT
OBJECTIVES: To describe the clinical features, history and association with intestinal disease in central nervous system (CNS) S. bovis infections. METHODS: Four cases of S. bovis CNS infections from our institution are presented. Additionally a systematic literature review of articles published between 1975 and 2021 in PubMed/MEDLINE was conducted. RESULTS: 52 studies with 65 cases were found; five were excluded because of incomplete data. In total 64 cases were analyzed including our four cases: 55 with meningitis and 9 with intracranial focal infections. Both infections were frequently associated with underlying conditions (70.3%) such as immunosuppression (32.8%) or cancer (10.9%). In 23 cases a biotype was identified, with biotype II being the most frequent (69.6%) and S. pasteurianus the most common within this subgroup. Intestinal diseases were found in 60.9% of cases, most commonly neoplasms (41.0%) and Strongyloides infestation (30.8%). Overall mortality was 17.1%, with a higher rate in focal infection (44.4% vs 12.7%; p=0.001). CONCLUSIONS: CNS infections due to S. bovis are infrequent and the most common clinical form is meningitis. Compared with focal infections, meningitis had a more acute course, was less associated with endocarditis and had a lower mortality. Immunosuppression and intestinal disease were frequent in both infections.
Subject(s)
Central Nervous System Infections , Streptococcal Infections , Streptococcus bovis , Adult , Humans , Central Nervous System , Central Nervous System Infections/microbiology , Central Nervous System Infections/pathology , Focal Infection/microbiology , Focal Infection/pathology , Intestinal Diseases/microbiology , Intestinal Diseases/pathology , Meningitis/microbiology , Meningitis/pathology , Streptococcal Infections/complications , Streptococcal Infections/epidemiology , Streptococcus bovis/physiologyABSTRACT
Objetivo Revisar el protocolo de solicitud de sangre oculta en heces (SOH) en pacientes sintomáticos como prueba de derivación a colonoscopia, utilizando un punto de corte de 15μg Hb/g heces en 3 muestras consecutivas y comparar su utilidad con las recomendaciones actuales de un punto de corte de 10μg Hb/g heces en una muestra. Material y métodos Estudio observacional retrospectivo centrado en las peticiones de la prueba de SOH en pacientes sintomáticos en Atención Primaria. Las muestras fueron analizadas en el servicio de laboratorio durante el año 2017. En el análisis de datos se incluyeron 715 pacientes con la prueba de SOH positiva y 925 pacientes con resultado negativo. Se realizó un análisis descriptivo de los resultados de SOH, motivo de solicitud y colonoscopia, junto con el estudio de la utilidad diagnóstica de la prueba SOH para los puntos de corte de 10 y 15μg Hb/g heces en la misma población. Resultados La tasa de positividad de la prueba fue del 22,8% y la tasa de detección de cáncer colorrectal fue del 11%. El número de muestras no modifica la precisión diagnóstica. El valor predictivo negativo es superior con el punto de corte de 10μg Hb/g heces. Conclusione La selección correcta de pacientes y del punto de corte óptimo aumentan la tasa de detección de cáncer colorrectal. El cambio de protocolo de 10μg Hb/g heces y la recogida de una muestra para pacientes sintomáticos desde Atención Primaria mejoran la utilidad de la prueba SOH (AU)
Aim To review referral protocol in symptomatic patients from primary care of using 15μgHb/g faeces threshold with three consecutive samples in faecal occult blood (FOB) test. To compare test utility using current recommendations of 10μgHb/g faeces threshold and one sample. Material and methods A retrospective observational study was designed, including FOB samples of symptomatic patients from primary care. Samples were analyzed at the biochemistry laboratory in 2017. Seven hundred and fifteen patients tested positive and 925 patients negative. Exclusion criteria were secondary care request and patients under the age of 18. Descriptive analysis was performed of FOB results and clinical data about request and colonoscopy. FOB test's diagnostic utility was studied for different threshold (10 and 15μgHb/g faeces) in the same population. Results FOB positivity rate was 22.8% and cancer detection rate was 11%. However, the number of samples does not modify diagnostic precision. Negative predictive value is higher with 10μgHb/g faeces threshold. Conclusions Correct patient selection and optimal threshold increase cancer detection rate. The protocol with 10μgHb/g faeces threshold and one sample collection for symptomatic patients from primary care improves the FOB test's purpose (AU)
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Early Detection of Cancer/methods , Colorectal Neoplasms/diagnosis , Occult Blood , 50230 , Primary Health Care , Sensitivity and Specificity , Retrospective StudiesABSTRACT
AIM: To review referral protocol in symptomatic patients from primary care of using 15µgHb/g faeces threshold with three consecutive samples in faecal occult blood (FOB) test. To compare test utility using current recommendations of 10µgHb/g faeces threshold and one sample. MATERIAL AND METHODS: A retrospective observational study was designed, including FOB samples of symptomatic patients from primary care. Samples were analyzed at the biochemistry laboratory in 2017. Seven hundred and fifteen patients tested positive and 925 patients negative. Exclusion criteria were secondary care request and patients under the age of 18. Descriptive analysis was performed of FOB results and clinical data about request and colonoscopy. FOB test's diagnostic utility was studied for different threshold (10 and 15µgHb/g faeces) in the same population. RESULTS: FOB positivity rate was 22.8% and cancer detection rate was 11%. However, the number of samples does not modify diagnostic precision. Negative predictive value is higher with 10µgHb/g faeces threshold. CONCLUSIONS: Correct patient selection and optimal threshold increase cancer detection rate. The protocol with 10µgHb/g faeces threshold and one sample collection for symptomatic patients from primary care improves the FOB test's purpose.
Subject(s)
Colorectal Neoplasms , Occult Blood , Humans , Retrospective Studies , Early Detection of Cancer/methods , Colorectal Neoplasms/diagnosis , Primary Health Care , Delivery of Health CareABSTRACT
Resumen La Enfermedad de Behçet (EB), es una entidad poco común, idiopática, de naturaleza crónica y recurrente con afectación multisistémica. Entre ellos, el tracto gastrointestinal ha suscitado especial interés, al asociarse a mayor morbimortalidad y dado sus presentaciones heterogéneas puede simular otras enfermedades gastrointestinales y ser un gran reto diagnóstico para el gastroenterólogo. Por lo tanto, presentamos una revisión narrativa donde se pretenderá describir las manifestaciones gastrointestinales de la EB y sus diagnósticos diferenciales.
Abstract Behçet's Disease (BD) is a rare, idiopathic, chronic and relapsing entity; characterized by multisystem involvement. The gastrointestinal tract has aroused special interest, as it is associated with higher morbidity and mortality and given its heterogeneous presentations, being able to simulate other gastrointestinal pathologies, becoming a great diagnostic challenge for gastroenterologists. Therefore, we present a narrative review, where we intend to describe the possible gastrointestinal manifestations of BD and its differentials.
ABSTRACT
INTRODUCTION AND AIMS: The primary aim was to explore the epidemiologic trend of pediatric inflammatory bowel disease in Latin America, and the secondary aims were to obtain an overview of the diagnostic/therapeutic focus of the members of the LASPGHAN and examine the relation of case frequency to year, during the study period. MATERIALS AND METHODS: Latin American pediatric gastroenterologists participated in an online survey, conducted through the SurveyMonkey platform, that investigated the yearly frequency of new inflammatory bowel disease patients within the time frame of 2005-2016, their disease variety, the gastrointestinal segments affected, and the diagnostic and treatment methods utilized. The correlation of new case frequency with each study year was evaluated. RESULTS: A total of 607 patients were studied. The diagnoses were ulcerative colitis in 475 (78.3%) cases, Crohn's disease in 104 (17.1%), and inflammatory bowel disease D unclassified in 28 (4.6%). The trend in ulcerative colitis was a lineal increase in the frequency of new cases related to each study year, with a significant correlation coefficient. Pancolitis was found in 67.6% of the patients. The diagnostic methods included clinical data, endoscopy, and biopsies in more than 99% of the cases, and imaging studies were indicated selectively. Drug regimens were limited to 5-aminosalicylic acid derivatives, azathioprine, 6-mercaptopurine, infliximab, and adalimumab. CONCLUSIONS: Pediatric inflammatory bowel disease in Latin America appears to have increased during the years included in the study period, with a predominance of moderate or severe ulcerative colitis. That lineal trend suggests the predictive likelihood of a gradual increase in the coming years, with possible epidemiologic and clinical implications.
Subject(s)
Colitis, Ulcerative , Crohn Disease , Gastroenterology , Inflammatory Bowel Diseases , Child , Colitis, Ulcerative/diagnosis , Humans , Inflammatory Bowel Diseases/diagnosis , Latin America/epidemiologyABSTRACT
INTRODUCTION AND OBJECTIVES: The primary aim was to explore the epidemiologic trend of pediatric inflammatory bowel disease in Latin America, and the secondary aims were to obtain an overview of the diagnostic/therapeutic focus of the members of the LASPGHAN and examine the relation of case frequency to year, during the study period. MATERIALS AND METHODS: Latin American pediatric gastroenterologists participated in an online survey, conducted through the SurveyMonkey platform, that investigated the yearly frequency of new inflammatory bowel disease patients within the time frame of 2005 to 2016, their disease variety, the gastrointestinal segments affected, and the diagnostic and treatment methods utilized. The correlation of new case frequency with each study year was evaluated. RESULTS: A total of 607 patients were studied. The diagnoses were ulcerative colitis in 475 (78.3%) cases, Crohn's disease in 104 (17.1%), and inflammatory bowel disease D unclassified in 28 (4.6%). The trend in ulcerative colitis was a lineal increase in the frequency of new cases related to each study year, with a significant correlation coefficient. Pancolitis was found in 67.6% of the patients. The diagnostic methods included clinical data, endoscopy, and biopsies in more than 99% of the cases, and imaging studies were indicated selectively. Drug regimens were limited to 5-aminosalicylic acid derivatives, azathioprine, 6-mercaptopurine, infliximab, and adalimumab. CONCLUSIONS: Pediatric inflammatory bowel disease in Latin America appears to have increased during the years included in the study period, with a predominance of moderate or severe ulcerative colitis. That lineal trend suggests the predictive likelihood of a gradual increase in the coming years, with possible epidemiologic and clinical implications.
ABSTRACT
Faecal immunochemical tests for haemoglobin (FIT), as an adjunct to clinical information, assist in the triage of patients presenting in primary care with lower abdominal symptoms. Controversy remains regarding whether and which qualitative and quantitative FIT can be used, which groups of patients would benefit most from FIT, whether FIT should be done in primary and/or secondary care, and how FIT should be incorporated into diagnostic pathways. Controversy also exists as to the optimum cut-off used for referral for colonoscopy. A single sample of faeces may be sufficient. Reporting of results requires consideration. FIT provide a good rule in test for colorectal cancer and a good rule out test for significant bowel disease, but robust safety-netting is required for patients with negative results and ongoing symptoms. Risk scoring models have been developed, but their value is unclear as yet. Further evaluation of these topics is required to inform good practice.
Subject(s)
Adenoma/blood , Adenoma/diagnosis , Colorectal Neoplasms/blood , Colorectal Neoplasms/diagnosis , Feces/chemistry , Hemoglobins/analysis , Inflammatory Bowel Diseases/blood , Inflammatory Bowel Diseases/diagnosis , Hematologic Tests/methods , Humans , Immunochemistry , Practice Guidelines as TopicABSTRACT
La cirugía por puerto único con técnica de guante (glove port) es un abordaje adecuado al momento económico y tecnológico que vivimos. Entre las intervenciones susceptibles de su aplicación está la realización de colostomías. Describimos la técnica quirúrgica y resultados de los pacientes a los que se realizó colostomía por puerto único con técnica de guante, a lo largo de los años 2011 y 2012, en dos hospitales de Asturias, España. Realizamos seis colostomías sigmoideas. Cuatro pacientes presentaban enfermedad tumoral, otro caso fue por una fascitis necrosante perineal, y el sexto un paciente con enfermedad de Crohn y fístulas perianales complejas. La edad media de los pacientes, cuatro hombres y dos mujeres, fue de 54 años (rango 42-67 años). El tiempo medio de intervención fue de 42 minutos (rango 30-65 minutos). No hubo complicaciones durante la cirugía ni en el postoperatorio. En nuestro medio, el gasto en material se redujo a la mitad con respecto a otros dispositivos convencionales de puerto único. La técnica de guante representa el abordaje por puerto único más económico y mínimamente invasivo para la realización de estomas, siendo en nuestra experiencia una técnica sencilla, segura y fácilmente reproducible.(AU)
The single port surgery with glove technique is a novel process, suitable to the present day economic and technological moment .Colostomies are surgical interventions suitable to its application. We describe the surgical method and outcome of patients who underwent colostomy by single port glove technique within the years 2011 and 2012, in two hospitals in Asturias, Spain. We carried out six sigmoid colostomies. Four patients had tumoral pathology, another a perineal necrotizing fasciitis, and the sixth, a patient with Crohns disease and complex peri-anal fistulas. The average age of the patients, four men and two women, was 54 years (range 42-67 years). The average intervention time was 42 minutes (range 30-65 minutes). There were no complications during the surgery or in the postoperative period. In our facilities material expenditure was reduced to half as regards other conventional single port devices. The glove technique represents the most economic and least invasive approach for the surgical procedure of stomas, in our experience considered a simple, safe and easily reproducible technique.(AU)
ABSTRACT
La cirugía por puerto único con técnica de guante (glove port) es un abordaje adecuado al momento económico y tecnológico que vivimos. Entre las intervenciones susceptibles de su aplicación está la realización de colostomías. Describimos la técnica quirúrgica y resultados de los pacientes a los que se realizó colostomía por puerto único con técnica de guante, a lo largo de los años 2011 y 2012, en dos hospitales de Asturias, España. Realizamos seis colostomías sigmoideas. Cuatro pacientes presentaban enfermedad tumoral, otro caso fue por una fascitis necrosante perineal, y el sexto un paciente con enfermedad de Crohn y fístulas perianales complejas. La edad media de los pacientes, cuatro hombres y dos mujeres, fue de 54 años (rango 42-67 años). El tiempo medio de intervención fue de 42 minutos (rango 30-65 minutos). No hubo complicaciones durante la cirugía ni en el postoperatorio. En nuestro medio, el gasto en material se redujo a la mitad con respecto a otros dispositivos convencionales de puerto único. La técnica de guante representa el abordaje por puerto único más económico y mínimamente invasivo para la realización de estomas, siendo en nuestra experiencia una técnica sencilla, segura y fácilmente reproducible.
The single port surgery with glove technique is a novel process, suitable to the present day economic and technological moment .Colostomies are surgical interventions suitable to its application. We describe the surgical method and outcome of patients who underwent colostomy by single port glove technique within the years 2011 and 2012, in two hospitals in Asturias, Spain. We carried out six sigmoid colostomies. Four patients had tumoral pathology, another a perineal necrotizing fasciitis, and the sixth, a patient with Crohn's disease and complex peri-anal fistulas. The average age of the patients, four men and two women, was 54 years (range 42-67 years). The average intervention time was 42 minutes (range 30-65 minutes). There were no complications during the surgery or in the postoperative period. In our facilities material expenditure was reduced to half as regards other conventional single port devices. The glove technique represents the most economic and least invasive approach for the surgical procedure of stomas, in our experience considered a simple, safe and easily reproducible technique.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Colon, Sigmoid/surgery , Colostomy/methods , Gloves, Surgical , Laparoscopy/methods , Colostomy/economics , Laparoscopy/economics , Operative Time , Spain , Surgical Stomas/economics , Treatment OutcomeABSTRACT
The plasma kallikrein-kinin system (KKS) participates in the pathogenesis of inflammatory reactions involved in cellular injury, coagulation, fibrinolysis, kinin formation, complement activation, cytokine secretion and release of proteases. It has been shown that KKS activation in the systemic inflammatory response syndrome results in decrease of its component plasma proteins. Similar changes have been documented in diabetes, sepsis, children with vasculitis, allograft rejection, disseminated intravascular coagulation, patients with recurrent pregnancy losses, hereditary angioedema, adult respiratory distress syndrome and coronary artery disease. Direct involvement of the KKS in the pathogenesis of experimental acute arthritis and acute and chronic enterocolitis has been documented by previous studies from our laboratory using experimental animal models. It has been found that in HK deficient Lewis rats, experimental IBD was much less severe. We showed a genetic difference in kininogen structure between resistant Buffalo and susceptible Lewis rats, which results in accelerated cleavage of HK and it is responsible for the susceptibility to the inflammatory process in the Lewis rats. It has been demostrated that therapy with a specific plasma kallikrein inhibitor (P8720) modulated the experimental enterocolitis, arthritis and systemic inflammation. Furthermore, it has been shown that a bradykinin 2 receptor (B2R) antagonist attenuates the inflammatory changes in the same animal model. We have showed that a monoclonal antibody targeting HK decreases angiogénesis and arrests tumor growth in a syngeneic animal model. In summary, these results indicate that the plasma KKS plays a central role in the pathogenesis of chronic intestinal inflammation, arthritis and angiogenesis.
Se ha demostrado la participación del sistema plasmático de kalikreína-kininas (KKS) en el proceso inflamatorio, el cual incluye reacciones de daño celular, coagulación y fibrinólisis, formación de kininas, activación del complemento, secreción de citoquinas y liberación de proteasas. El KKS se encuentra activado en el síndrome de respuesta inflamatoria sistémica con una disminución en la concentración plasmática de las proteínas que lo constituyen. También se ha demostrado una activación similar en la diabetes, choque séptico, vasculitis en infantes, enfermedad injerto-huésped, coagulación intravascular diseminada, pacientes con abortos de repetición, angioedema hereditario, el síndrome de estrés respiratorio del adulto y enfermedad coronaria arterial. Mediante el uso de modelos animales experimentales, nuestro laboratorio ha demostrado una participación directa del KKS en la patogénesis de la artritis experimental aguda y la enterocolitis aguda y crónica. Se ha demostrado que en la rata tipo Lewis, cuando es deficiente de kininógeno de alto peso molecular (HK), la enfermedad inflamatoria intestinal es menos severa comparada con la presentada en ratas con niveles normales de HK como la Buffalo. Nosotros mostramos una diferencia entre el gene que codifica la molécula del kininógeno de la rata tipo Buffalo (resistentes) y Lewis (susceptibles), que resulta en un incremento de la actividad proteolítica de kalikreína sobre su substrato HK, lo cual predispone a las ratas Lewis al desarrollo de la enfermedad inflamatoria crónica. Se ha demostrado una disminución en las manifestaciones inflamatorias sistémicas de la enterocolitis y artritis experimental mediante el uso de un inhibidor específico de la kalikreína (P8720). Además, el antagonista del receptor 2 de la bradikinina (BR2) atenuó los cambios inflamatorios en el mismo modelo animal. Asimismo, se ha demostrado que las ratas Lewis deficientes de kininógeno desarrollaron inflamación intestinal sistémica menos severa. Mediante el uso del anticuerpo monoclonal C11C1 contra HK se logró una disminución de la angiogenesis y, consecuentemente, el crecimiento tumoral. En conclusión, los resultados demuestran que el sistema plasmático de KKS desempeña un papel preponderante en la patogénesis de la artritis reumatoide, la enfermedad intestinal crónica y en el proceso angiogénico.
Subject(s)
Animals , Rats , Kallikrein-Kinin System/physiology , Kininogen, High-Molecular-Weight/physiology , Neovascularization, Physiologic/physiology , Amino Acid Sequence , Antibodies, Monoclonal/immunology , Arthritis, Reactive/physiopathology , Boron Compounds/therapeutic use , Cell Adhesion/physiology , Fibrinolysis/physiology , Genetic Predisposition to Disease , Inflammation/physiopathology , Inflammatory Bowel Diseases/genetics , Inflammatory Bowel Diseases/physiopathology , Kininogen, High-Molecular-Weight/biosynthesis , Kininogen, High-Molecular-Weight/chemistry , Kininogen, High-Molecular-Weight/deficiency , Kininogen, High-Molecular-Weight/genetics , Kininogen, High-Molecular-Weight/therapeutic use , Models, Molecular , Molecular Sequence Data , Oligopeptides/therapeutic use , Peptidoglycan/toxicity , Polysaccharides, Bacterial/toxicity , Rats, Inbred BUF , Rats, Inbred Lew , Structure-Activity RelationshipABSTRACT
La colitis ulcerosa es una inflamación crónica no granulomatosa, que afecta fundamentalmente al colon. Se caracteriza por inflamación y ulceraciones de la mucosa intestinal. La etiopatogenia es compleja y multifactorial. Los síntomas gastrointestinales dependen de la situación, magnitud y severidad de la inflamación. El diagnóstico se basa en la sospecha clínica apoyada por estudios de laboratorio y de gabinete y el tratamiento depende de la severidad del cuadro. Presentamos a un niño que curso con un cuadro de colitis ulcerosa fulminante y que evoluciono favorablemente con el tratamiento instaurado.
Ulcerative colitis is a chronic non granulomatous inflammation that affects mainly the colon. It is characterized by inflammation and ulceration of the intestinal mucosa. The etiology and pathogenesis is complex and due to several factors. Gastrointestinal symptoms depend on the location, size and severity of the inflammation. Diagnosis is based upon clinical examination supported by laboratory studies. Treatment depends on the severity of the case. We present the history of a child that showed a very severe case of ulcerative colitis who responded favorably to prescribed treatment.
