RESUMO
The objective of this study was to examine the epidemiology and the clinical manifestations of typhoid fever as well as the susceptibility and strain relatedness of Salmonella typhi isolates in Lebanon from 2006 to 2007. A total of 120 patients with typhoid fever were initially identified from various areas of the country based on positive culture results for S. typhi from blood, urine, stools, bone marrow and/or positive serology. Clinical, microbiological and molecular analysis was performed on cases with complete data available. These results indicated that drinking water was an unlikely mode of transmission of the infection. Despite increasing reports of antimicrobial resistance among S. typhi isolates, the vast majority of these isolates were susceptible to various antibiotic agents, including ampicillin, cephalosporins, quinolones, and trimethoprim/sulfamethoxazole. Molecular analysis of the isolates revealed a predominance of one single genotype with no variation in distribution across the geographical regions.
Assuntos
Salmonella typhi/isolamento & purificação , Febre Tifoide/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Farmacorresistência Bacteriana Múltipla , Humanos , Lactente , Líbano/epidemiologia , Pessoa de Meia-Idade , Tipagem Molecular , Febre Tifoide/microbiologia , Febre Tifoide/transmissão , Microbiologia da ÁguaRESUMO
OBJECTIVES: Previous studies from Lebanon have shown Gram-negative organisms to be the predominant agents in febrile neutropenic patients. The objective of this study was to evaluate the most current epidemiological trends among patients with neutropenic fever. METHODS: This prospective observational cohort study, the largest to date in the country, was conducted at the American University of Beirut Medical Center between January 2001 and December 2003, with the objective of describing the characteristics of patients with neutropenic fever and to assess temporal trends. RESULTS: We included 177 episodes of neutropenic fever. The most common underlying malignancy was lymphoma (42.4%). Gastrointestinal and abdominal infections were predominant (31.6%) and 23.7% of cases represented fever of unknown origin. Gram-negative organisms were responsible for 78.8% (26/33) of bloodstream infections compared to 33.3% (11/33) with Gram-positive organisms. The in-hospital mortality rate in this study (12.1%) was considerably lower than in previous years. CONCLUSIONS: Gram-negative organisms are persistently predominant in our center. In a developing country like Lebanon with limited resources, lower mortality rates commensurate with worldwide reports were successfully achieved in this high-risk patient population. Protocols and guidelines should be adapted to the characteristics of individual institutions to ensure delivery of appropriate care to febrile neutropenic patients.
Assuntos
Bacteriemia/epidemiologia , Febre/epidemiologia , Neutropenia/epidemiologia , Centros Médicos Acadêmicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Estudos de Coortes , Feminino , Febre/tratamento farmacológico , Febre/microbiologia , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/epidemiologia , Humanos , Líbano/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/microbiologia , Neutropenia/tratamento farmacológico , Neutropenia/microbiologia , Estudos ProspectivosRESUMO
Surgical site infections (SSIs) following spinal surgery are associated with significant morbidity and long-term complications. The epidemiology of these infections has not been previously studied in Lebanon. This nested case-control study was conducted between 2001 and 2003 at the American University of Beirut Medical Center. Cases were defined as patients who developed surgical site infection within 30 d of surgery. Controls were patients with no evidence of infection. There were 27 cases of surgical site infections among 997 surgeries with an incidence of 2.7%. Compared to controls, cases were older (mean age 59 vs 47 y, p=0.001), and were more likely to have diabetes (OR = 4.0; 95% CI 1.2-12.8) and foreign body implantation (OR = 3.4; 95% CI 1.3-9.3). Antibiotic prophylaxis was given for a range of 0-6 d in cases and 0-7 d in controls. Coagulase-negative staphylococci were the most commonly isolated organisms. Hospital stay was significantly longer in cases than controls. The rates of surgical site infections following spinal surgery at our center are comparable to worldwide rates. There is unjustified overuse of prophylactic antibiotics in our patients that has the potential of inducing emergence of antimicrobial resistance.
Assuntos
Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Líbano/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
Brucellosis is a multi-system disease that is endemic in many Mediterranean countries including Lebanon. However, human Brucella prostatic abscess was not reported in the English medical literature. We here describe the case of a young man who presented with fever and urinary symptoms, and who subsequently proved to have culture confirmed Brucella prostatic abscess. The culture of drained pus grew Brucella melitensis.
Assuntos
Abscesso/microbiologia , Brucella melitensis/isolamento & purificação , Brucelose/microbiologia , Doenças Prostáticas/microbiologia , Adulto , Humanos , MasculinoRESUMO
Neurosarcoidosis can have variable clinical manifestations. Intracerebral bleeding is very rare in the setting of neurosarcoidosis and has been reported only twice. In this report, we describe a patient with neurosarcoidosis who had intracerebral bleeding while on corticosteroid therapy, despite apparent clinical improvement.
Assuntos
Encefalopatias/complicações , Encefalopatias/tratamento farmacológico , Hemorragia Cerebral/etiologia , Glucocorticoides/uso terapêutico , Metilprednisolona/uso terapêutico , Prednisona/uso terapêutico , Sarcoidose/complicações , Sarcoidose/tratamento farmacológico , Adulto , Humanos , MasculinoRESUMO
We compared community-acquired urinary tract infection (UTI) with hospital-acquired UTI at the American University of Beirut Medical Center. Escherichia coli was the most frequently isolated organism. Hospital-acquired E. coli isolates were often multidrug resistant. These results can be used to improve empiric treatment of UTI.
Assuntos
Infecções Urinárias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Resistência Microbiana a Medicamentos , Escherichia coli/efeitos dos fármacos , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Líbano/epidemiologia , Masculino , Pessoa de Meia-Idade , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologiaRESUMO
Typhoid fever is endemic in Lebanon. Usual presentation includes fever, headache, abdominal pain and constipation or diarrhea. Extra-intestinal manifestations are not uncommon and involve variety of organ systems. Rhabdomyolysis is rare and has been reported in various Salmonella infections. We present a case of rhabdomyolysis and renal failure that was successfully treated with imipenem/cilastatin and hemodialysis.
Assuntos
Rabdomiólise/diagnóstico , Rabdomiólise/microbiologia , Febre Tifoide/diagnóstico , Injúria Renal Aguda/microbiologia , Adolescente , Feminino , Humanos , Salmonella typhiRESUMO
Antibiotic-induced skin eruption in the setting of infectious mononucleosis is a common and well-documented clinical scenario. The skin lesions are non-specific and the mechanisms causing them are unclear. Several reports have described this entity with different antibiotic classes, mainly penicillins. Only 1 case of azithromycin-induced skin eruption has previously been described in this setting. Herein, we report the second case.