RESUMO
Myroides sp., previously known as Flavobacterium odoratum, is a relatively unknown organism with unclear human pathogenicity. While Myroides sp. has been implicated in human infections, many reports have described the organism as a relatively avirulent opportunistic pathogen. We present an unusual case of rapidly fatal necrotizing fasciitis and septic shock due to Myroides odoratus. Our case demonstrates the pathogenicity of Myroides, and highlights potential risk factors for infection including underlying liver disease and open wounds. The recognition of Myroides is of particular importance given its resistance to multiple antibiotics. We review the literature on Myroides sp. skin and soft tissue infections, including necrotizing forms, and discuss the clinical presentation and management of this potentially emerging pathogen.
Assuntos
Antibacterianos/uso terapêutico , Fasciite Necrosante/tratamento farmacológico , Infecções por Flavobacteriaceae/tratamento farmacológico , Flavobacteriaceae/isolamento & purificação , Choque Séptico/tratamento farmacológico , Antibacterianos/farmacologia , California , Diagnóstico Diferencial , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/microbiologia , Evolução Fatal , Feminino , Flavobacteriaceae/efeitos dos fármacos , Infecções por Flavobacteriaceae/diagnóstico , Infecções por Flavobacteriaceae/microbiologia , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Choque Séptico/diagnóstico , Choque Séptico/microbiologiaRESUMO
Antidepressant treatment trials of irritable bowel syndrome (IBS) have suggested beneficial effects. Twenty-eight patients with the disorder (9 constipation-predominant, 19 diarrhea-predominant) completed a double-blind crossover study using desipramine, atropine, and placebo in random sequence. A four-week observation period preceded three six-week test periods. Bowel habits, abdominal distress, and affect were reported daily and in biweekly evaluations. Psychological assessments and rectosigmoid contractile studies were done in each period. Stool frequency, diarrhea, abdominal pain, depression, and slow contractions decreased significantly more in diarrhea-predominant patients during desipramine compared with placebo and atropine treatments. Diarrhea-prone patients' depression scores fell more in all periods than constipation-prone patients. Fifteen patients (13 diarrhea-predominant) improved globally during desipramine, five during placebo and six during atropine treatments. Desipramine may be helpful in treating IBS, perhaps through antidepressant and antimuscarinic effects.
