Artritis gonocócica y déficit de C2 / Gonococcal arthritis and C2 deficiency

La enfermedad gonocócica diseminada es una manifestación infrecuente de la afectación por Neisseria gonorrhoeae, que presenta una clínica variada y no bien definida, siendo la afectación articular un hallazgo característico. Presentamos el caso de una mujer de 64 años con enfermedad gonocócica diseminada de inicio agudo, que comenzó con deterioro generalizado y oligoartritis. Se realizó artrocentesis de carpo, obteniéndose un líquido sinovial de aspecto purulento, cuyo estudio microbiológico identificó Neisseira gonorrhoeae. En el estudio se objetivó un complemento hemolítico total (CH50) de cero, no detectándose la fracción C2 del complemento. Son muy pocos los casos descritos en la literatura de enfermedad gonocócica diseminada asociada a déficit de C2. Presentamos un nuevo caso y revisamos los previamente publicados

Disseminated gonococcal infection is a rare presentation of the sexually transmitted pathogen, Neisseria gonorrhoeae. Here, we report the case of a 64-year-old woman with disseminated gonococcal infection, which started with symptoms of oligoarthritis and malaise. Neisseria gonorrhoeae was identified in the carpal synovial fluid. The follow-up study revealed an absence of total hemolytic complement and complement C2 was not detected. Being relatively common, C2 deficiency has been associated with disseminated gonococcal infection in a few cases. We present a new case and discuss those previously published

Neumonías adquiridas en la comunidad por Staphylococcus aureus resistente a meticilina en lactantes / Methicillin-resistant Staphylococcus aureus community-acquired pneumonia in infants

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Gonococcal Arthritis and C2 Deficiency. / Artritis gonocócica y déficit de C2.

Disseminated gonococcal infection is a rare presentation of the sexually transmitted pathogen, Neisseria gonorrhoeae. Here, we report the case of a 64-year-old woman with disseminated gonococcal infection, which started with symptoms of oligoarthritis and malaise. Neisseria gonorrhoeae was identified in the carpal synovial fluid. The follow-up study revealed an absence of total hemolytic complement and complement C2 was not detected. Being relatively common, C2 deficiency has been associated with disseminated gonococcal infection in a few cases. We present a new case and discuss those previously published.

Clinical and microbiological profile of infectious keratitis in an area of Madrid, Spain / Perfil clínico y microbiológico de la queratitis infecciosa en un área de Madrid, España

INTRODUCTION: To study antibiotic susceptibility in bacterial keratitis (BK), its profile over 10 years and its influence on ophthalmological practice. METHODS: Retrospective review of BK with positive corneal scraping over a 10-year period. Risk factors for keratitis, visual acuity (VA), empirical topical treatment, corneal infection characteristics and outcomes were analyzed for BK due to Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Pseudomonas aeruginosa and Propionibacterium acnes. RESULTS: 389 positive corneal scrapings were collected. All Gram-positive bacteria were susceptible to vancomycin. P. aeruginosa demonstrated >90% sensitivity to the most-commonly-used topical antibiotics. Susceptibility to methicillin was 90.2% for S. aureus and 66.3% for S. epidermidis. The results of 215 patients were available. 1.9% required enucleation and 2.8% required surgical treatments. Final VA improved after treatment in keratitis due to S. aureus (p = 0.026) and S. epidermidis (p = 0.005). There was a correlation between S. aureus resistance to methicillin (p = 0.002) and levofloxacin (p = 0.043) and enucleation (20% and 10%, respectively) compared with a 0% rate of enucleation in S. aureus-susceptible keratitis. CONCLUSIONS: BK due to S. pneumoniae is very aggressive irrespective of antibiotic sensitivity. S. aureus was frequently isolated in patients with systemic diseases. It causes severe keratitis and remains moderately resistant to methicillin and levofloxacin. For this reason, keeping vancomycin in empirical regimens is believed to be necessary

INTRODUCCIÓN: Estudiar la susceptibilidad antibiótica en queratitis bacteriana (QB), el perfil temporal a lo largo de 10 años y su influencia en la clínica ocular. MÉTODOS: Revisión retrospectiva durante un periodo de 10 años de QB con raspado corneal positivo. Se analizaron los factores de riesgo de queratitis, la agudeza visual (AV), el tratamiento empírico tópico, las características de la infección corneal y el resultado clínico para QB por Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Pseudomonas aeruginosa y Propionibacterium acnes. RESULTADOS: Se recogieron 389 raspados corneales positivos. Todas las bacterias grampositivas fueron susceptibles a la vancomicina. P. aeruginosa presentó sensibilidad mayor del 90% a los antibióticos tópicos más comúnmente utilizados. La susceptibilidad a la meticilina fue del 90,2% para S. aureus y del 66,3% para S. epidermidis. Los resultados clínicos estaban disponibles para 215 pacientes. El 1,9% requirieron enucleación y el 2,8% tratamientos quirúrgicos. La AV final mejoró después del tratamiento en queratitis por S. aureus (p = 0,026) y por S. epidermidis (p = 0,005). Hubo correlación entre la resistencia de S. aureus a la meticilina (p = 0,002) y levofloxacino (p = 0,043) y enucleación (20 y 10%, respectivamente) en comparación con una tasa de enucleación del 0% en S. aureus susceptible. CONCLUSIONES: Las QB por S. pneumoniae son muy agresivas independientemente de la sensibilidad antibiótica. S. aureus se aisló con frecuencia en pacientes con enfermedades sistémicas, causa queratitis severa y permanece moderadamente resistente a la meticilina y a levofloxacino; debido a esto, consideramos necesario mantener la vancomicina en la pauta empírica

Clinical and microbiological profile of infectious keratitis in an area of Madrid, Spain.

INTRODUCTION: To study antibiotic susceptibility in bacterial keratitis (BK), its profile over 10 years and its influence on ophthalmological practice. METHODS: Retrospective review of BK with positive corneal scraping over a 10-year period. Risk factors for keratitis, visual acuity (VA), empirical topical treatment, corneal infection characteristics and outcomes were analyzed for BK due to Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Pseudomonas aeruginosa and Propionibacterium acnes. RESULTS: 389 positive corneal scrapings were collected. All Gram-positive bacteria were susceptible to vancomycin. P. aeruginosa demonstrated >90% sensitivity to the most-commonly-used topical antibiotics. Susceptibility to methicillin was 90.2% for S. aureus and 66.3% for S. epidermidis. The results of 215 patients were available. 1.9% required enucleation and 2.8% required surgical treatments. Final VA improved after treatment in keratitis due to S. aureus (p=0.026) and S. epidermidis (p=0.005). There was a correlation between S. aureus resistance to methicillin (p=0.002) and levofloxacin (p=0.043) and enucleation (20% and 10%, respectively) compared with a 0% rate of enucleation in S. aureus-susceptible keratitis. CONCLUSIONS: BK due to S. pneumoniae is very aggressive irrespective of antibiotic sensitivity. S. aureus was frequently isolated in patients with systemic diseases. It causes severe keratitis and remains moderately resistant to methicillin and levofloxacin. For this reason, keeping vancomycin in empirical regimens is believed to be necessary.

Evaluation of two real time PCR assays for the detection of bacterial DNA in amniotic fluid.

PURPOSE: The aim of this study was to evaluate two non-commercial Real-Time PCR assays for the detection of microorganisms in amniotic fluid followed by identification by pyrosequencing. METHODS: We collected 126 amniotic fluids from 2010 to 2015 for the evaluation of two Real-Time PCR assays for detection of bacterial DNA in amniotic fluid (16S Universal PCR and Ureaplasma spp. specific PCR). The method was developed in the Department of Microbiology of the University Hospital La Paz. RESULTS: Thirty-seven samples (29.3%) were positive by PCR/pyrosequencing and/or culture, 4 of them were mixed cultures with Ureaplasma urealyticum. The Universal 16S Real-Time PCR was compared with the standard culture (81.8% sensitivity, 97.4% specificity, 75% positive predictive value, 98% negative predictive value). The Ureaplasma spp. specific Real-Time PCR was compared with the Ureaplasma/Mycoplasma specific culture (92.3% sensitivity, 89.4% specificity, 50% positive predictive value, 99% negative predictive value) with statistically significant difference (p=0.005). CONCLUSIONS: Ureaplasma spp. PCR shows a rapid response time (5h from DNA extraction until pyrosequencing) when comparing with culture (48h). So, the response time of bacteriological diagnosis in suspected chorioamnionitis is reduced.

Escolar con fiebre, inflamación parotídea, otorrea y fístula retroauricular / Fever, parotid swelling, otorrhea and retroauricular fistula in a child

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Staphylococcus aureus Blepharitis Associated with Multiple Corneal Stromal Microabscess, Stromal Edema, and Uveitis.

We report a case of an immunocompetent woman with atypical marginal keratitis. She presented with recurrent episodes of multiples microabscess distributed in a triangular pattern associated with stromal oedema and anterior chamber uveitis, affecting both eyes, but not simultaneously. The episodes responded to steroid drops, corneal inflammation was coincidental with a worsening of her blepharitis in the affected eye and S. aureus was isolated from the lids.

Resistance to linezolid in a methicillin-susceptible Staphylococcus aureus clinical isolate without previous exposure to oxazolidinones.

A linezolid-resistant, methicillin-susceptible isolate of Staphylococcus aureus was obtained from an infected surgical wound in an ambulatory patient. The isolate belonged to ST125 and was susceptible to all the antibiotics tested except linezolid (MIC 8 µg/ml) and levofloxacin. Linezolid resistance could be ascribed to the presence of the mutation G2576T in 2 of the 23S rRNA alleles. The mutant alleles were stably maintained in the absence of antibiotic selection.

Survey of emm gene sequences from pharyngeal Streptococcus pyogenes isolates collected in Spain and their relationship with erythromycin susceptibility.

We conducted a nationwide survey of the variable 5' emm (M protein gene) sequences from 614 pharyngeal Streptococcus pyogenes isolates susceptible (299 isolates) and resistant (315 isolates) to erythromycin that were isolated in Spain from 1996 to 1999. Almost 98% of these isolates had emm sequences in agreement with previously recorded M antigen association. We only identified a new 5' emm sequence in 17 isolates. Nine different emm types accounted for 85% of the S. pyogenes isolates susceptible to erythromycin. By contrast, only 3 emm types accounted for 70% of the erythromycin-resistant isolates. Further characterization of these isolates by ribotyping and pulsed-field gel electrophoresis indicated that high frequency of erythromycin resistance in Spain is due to few clones.

Gonococia extragenital cutánea primaria / Primary cutaneous extragenital gonorrhea

La presentación cutánea primaria aislada, sin afectación genital, ni evidencia de bacteriemia previa o coexistente, es un hecho excepcional en las infecciones gonocócicas. Un varón blanco de 25 años presentó dolor e inflamación en la región periungueal del primer dedo de la mano izquierda, sin desencadenante aparente y sin evidencia de infección genital ni sistémica asociadas. Se indicó drenaje más tratamiento con cloxacilina oral, y el paciente mejoró en pocos días. El cultivo de la lesión cutánea mostró crecimiento de cepas de Neisseria gonorrhoeae (AU)