ABSTRACT
A 66-year-old man with a history of renal transplant on chronic immunosuppression presented to his primary care physician with a swollen right index finger. On examination, mild swelling was present. Conservative management failed and initial plain films were negative. Corticosteroid injection was performed by orthopaedics, but symptoms recurred several months later and an MRI showed flexor digitorum tenosynovitis and abscesses of the superficialis and profundus tendons. A flexor tenolysis was performed with cultures positive for Mycobacterium szulgai, a rare, non-tuberculous mycobacterial infection. Treatment was initiated with moxifloxacin, ethambutol and azithromycin daily for nearly 4 months. Repeat MRI 3 months after completion of antibiotics showed near resolution of the tenosynovitis.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Antitubercular Agents/therapeutic use , Mycobacterium Infections, Nontuberculous/diagnosis , Nontuberculous Mycobacteria/isolation & purification , Tenosynovitis/pathology , Tenosynovitis/therapy , Aged , Animals , Fingers/diagnostic imaging , Fingers/pathology , Hand Injuries/complications , Humans , Immunocompromised Host , Magnetic Resonance Imaging , Male , Mycobacterium Infections, Nontuberculous/etiology , Ostreidae/pathogenicity , Tenosynovitis/diagnostic imagingABSTRACT
Se describe la investigación de un brote de gastroenteritis por norovirus asociado al consumo de ostras.Se encuestaron 346 expuestos (266 afectados). Solamente se enviaron 14 muestras de heces de pacientes al Centro Nacional de Microbiología. Se mandaron ostras recogidas en el lugar de producción al Centro Nacional de Alimentación. Las ostras cumplían los parámetros microbiológicos de calidad aplicables antes de la comercialización, que no incluyen investigación de virus. El análisis epidemiológico asoció la aparición de la enfermedad al consumo de ostras (odds ratio [OR] = 60,4; intervalo de confianza del 95%[IC95%]: 26,2-139,3) y de navajas (OR = 3,13; IC95%: 1,4-6,9). Los análisis microbiológicos identificaron norovirus en los afectados, pero no en las ostras que habían estado sometidas a un tiempo mayor de depuración que las consumidas. Es necesario un control riguroso de los alimentos de especial riesgo para la transmisión de norovirus y disponer de recursos de laboratorio para investigar brotes alimentarios pornorovirus (AU)
We describe investigation into an outbreak of norovirus gastroenteritis associated with oyster consumption.A survey was conducted in 346 exposed persons, 266 of whom were cases. Only 14 feces samples from patients were sent to the National Microbiology Laboratory. Oysters collected at the production sitewere sent to the National Food Center. The oysters met the microbiological quality standard required before sale, which did not include virus investigation. Epidemiological analysis showed an association between gastroenteritis and consumption of oysters (OR = 60.4; 95% CI: 26.2-139.3) and razor shells(OR = 3.13; 95% CI: 1.4-6.9). Microbiological analysis confirmed norovirus in affected individuals but not in the oysters that had been tested after a longer purification period than those consumed. Food with aspecial risk of norovirus transmission should be strictly monitored. Investigators should dispose of the necessary laboratory resources to study food-borne norovirus outbreaks (AU)
