RESUMO
BACKGROUND: Infective endocarditis (IE) in intravenous drug users has been increasing in incidence. The major pathogen used to be methicillin-susceptible Staphylococcus aureus, but resistant isolates have also been increasing. This study aimed to investigate the clinical characteristics of IE in intravenous drug users and to evaluate the molecular patterns of methicillin-resistant S. aureus (MRSA) that cause IE in these drug users. METHODS: A total of 37 episodes of IE in intravenous drug users hospitalized from 1980 to 2006 at a 1,250-bed teaching hospital in Southern Taiwan were evaluated retrospectively. The genetic relatedness of S. aureus strains was assessed using pulsed-field gel electrophoresis. Polymerase chain reaction was used to detect Panton-Valentine leukocidin (PVL) and staphylococcal gamma-hemolysin (Hlg), and to determine the staphylococcal chromosomal cassette carrying the mecA methicillin-resistant gene (SCCmec) type. RESULTS: The patients had a mean +/- standard deviation age of 31.5 +/- 9.25 years, with a male predominance of 76%. Hepatitis C was present in all patients. Methicillin-susceptible S. aureus accounted for 76% of infections, and the most common clinical symptoms were fever (97%) and embolic phenomenon (68%). There were 4 MRSA isolates, 3 of which were SCCmec type III. PVL and Hlg genes were found in 2 and 3 MRSA isolates, respectively. Eighty percent similarity was found among the MRSA isolates by pulsed-field gel electrophoresis. CONCLUSION: Our results suggest that coinfection with hepatitis C was common in intravenous drug users with IE, and that molecular patterns of MRSA isolates had high similarity. SCCmec type III, which is usually hospital-acquired, could have caused the community-associated MRSA endocarditis in our patients.
Assuntos
Endocardite Bacteriana/epidemiologia , Staphylococcus aureus Resistente à Meticilina/genética , Infecções Estafilocócicas/epidemiologia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Proteínas de Bactérias/genética , Toxinas Bacterianas/genética , Exotoxinas/genética , Feminino , Proteínas Hemolisinas/genética , Humanos , Leucocidinas/genética , Masculino , Epidemiologia Molecular , Proteínas de Ligação às Penicilinas , Estudos RetrospectivosRESUMO
BACKGROUND AND PURPOSE: This study describes a Salmonella outbreak in a 9-member family in Southern Taiwan, and emphasizes the risk of Salmonella infection in extreme age. METHODS: Salmonella infection was identified by blood culture, stool swab, and Widal test. A questionnaire was designed for the family to ascertain the underlying disease, symptoms, and history of untreated water and food exposure. RESULTS: Of 9 members in the family, 4 had symptoms of fever, abdominal pain, and watery diarrhea. There was a relationship between Salmonella infection and age, and associated symptoms included fever, nausea, diarrhea, abdominal pain, and weakness. CONCLUSIONS: Salmonella infection tends to occur more frequently in very young or very old people, especially elderly patients with chronic pre-existing comorbidities. Therefore, age is a significant risk factor for this symptomatic disease.
Assuntos
Surtos de Doenças , Infecções por Salmonella/epidemiologia , Salmonella enteritidis , Adulto , Fatores Etários , Pré-Escolar , Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Infecções por Salmonella/microbiologia , Taiwan/epidemiologiaRESUMO
Reports of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) isolates carrying Panton-Valentine leukocidin (PVL) gene that causes infective endocarditis in injection drug users (IDUs) with human immunodeficiency virus (HIV) infection are rare in the English language literature. We present a case of CA-MRSA infective endocarditis with bilateral septic lung emboli in a previously healthy 45-year-old IDU. This case suggests that PVL gene-positive CA-MRSA should be considered as a potential pathogen in IDUs with infective endocarditis.
Assuntos
Toxinas Bacterianas/genética , Infecções Comunitárias Adquiridas/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/etiologia , Exotoxinas/genética , Infecções por HIV , Leucocidinas/genética , Infecções Estafilocócicas/complicações , Staphylococcus aureus/genética , Abuso de Substâncias por Via Intravenosa , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Endocardite Bacteriana/microbiologia , Humanos , Masculino , Meticilina/uso terapêutico , Resistência a Meticilina , Pessoa de Meia-Idade , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/patogenicidadeRESUMO
Acquired generalized lipodystrophy (AGL) is a rare disorder of adipose tissue characterized by loss of fat from large regions of the body, occurring after birth. Its etiology remains unknown. Most AGL patients have had fasting and/or postprandial hyperinsulinemia, diabetes mellitus, hypertriglyceridemia, and fatty liver. We describe the case of a 30-year-old woman with a progressively unsteady gait and a generalized loss of body fat beginning at the age of 7. Cerebellar degeneration was revealed by imaging study, and the patient was eventually bedridden at the age of 15, due to progressive ataxia. She developed diabetes at the age of 25 without the presence of any evidence of ketoacidosis. The glutamic acid decarboxylase antibody was negative, C-peptide level 3.6 ng/ml, HbA1c 13%, triglyceride 412 mg/dl, total cholesterol 196 mg/dl, high-density lipoprotein-cholesterol 28 mg/dl, adiponectin 0.76 microg/ml, and resistin was 22.8 ng/ml at the initial state of diabetes. AGL accompanied by type 2 diabetes and cerebellar degeneration was diagnosed on the basis of the clinical features and metabolic derangements.
