Emphysematous pyelonephritis caused by C. glabrata / Pielonefrite enfisematosa por C. glabrata

Abstract Emphysematous pyelonephritis (EPN) is a rare acute necrotizing infection of the kidney and surrounding tissues, with gas in the renal parenchyma, collecting system or perirenal tissue. The bacterial etiology predominates; mainly Gram-negative bacilli; Candida spp. and C. albicans are rarely described. We describe a case of EPN caused by C. glabrata, sensitive to fluconazole in a young, hypertensive woman with undiagnosed diabetes mellitus (DM), with renal dysfunction upon admission; her abdominal CT scan found a volumetric increase in the left kidney, signs of gas collections and perirenal blurring. Despite the antimicrobial therapy instituted, due to clinical refractoriness, a double J catheter and subsequent total nephrectomy were indicated, with good postoperative evolution. Her uroculture showed C. glabrata sensitive to fluconazole, and the pathology study showed tubular atrophy and intense interstitial inflammatory infiltrate. Despite the serious, potentially fatal condition, we could control the infection and the patient recovered fully. Poor DM management is an important triggering factor, and it is of great relevance to identify the EPN through imaging exams due to the peculiarities of its clinical and potentially surgical management

Resumo A pielonefrite enfisematosa (PNE) é uma infecção aguda rara necrotizante do rim e dos tecidos adjacentes, com presença de gás no parênquima renal, sistema coletor ou tecido perirrenal. Predomina a etiologia bacteriana, principalmente bacilos Gram-negativos; Candida spp. e na maioria das vezes C. albicans são raramente descritas. Descreve-se um caso de PNE causada por C. glabrata sensível a fluconazol em mulher jovem, hipertensa e com diabetes mellitus (DM) não diagnosticada, com disfunção renal à admissão; tomografia computadorizada de abdome constatou aumento volumétrico do rim esquerdo, sinais de coleções gasosas e borramento perirrenal. Apesar da terapia antimicrobiana instituída, devido à refratariedade clínica, foi indicado cateter duplo J e posterior nefrectomia total, com boa evolução pós-operatória. A urocultura evidenciou C. glabrata sensível a fluconazol, e o anatomopatológico demonstrou atrofia tubular e intenso infiltrado inflamatório intersticial. Apesar da condição grave, potencialmente fatal, houve controle do foco infeccioso e plena recuperação da paciente. O mau manejo do DM é um importante fator desencadeante, e é de grande relevância identificar a PNE por meio de exames de imagem devido às peculiaridades de seu manejo clínico e potencialmente cirúrgico.

Emphysematous pyelonephritis caused by C. glabrata.

Emphysematous pyelonephritis (EPN) is a rare acute necrotizing infection of the kidney and surrounding tissues, with gas in the renal parenchyma, collecting system or perirenal tissue. The bacterial etiology predominates; mainly Gram-negative bacilli; Candida spp. and C. albicans are rarely described. We describe a case of EPN caused by C. glabrata, sensitive to fluconazole in a young, hypertensive woman with undiagnosed diabetes mellitus (DM), with renal dysfunction upon admission; her abdominal CT scan found a volumetric increase in the left kidney, signs of gas collections and perirenal blurring. Despite the antimicrobial therapy instituted, due to clinical refractoriness, a double J catheter and subsequent total nephrectomy were indicated, with good postoperative evolution. Her uroculture showed C. glabrata sensitive to fluconazole, and the pathology study showed tubular atrophy and intense interstitial inflammatory infiltrate. Despite the serious, potentially fatal condition, we could control the infection and the patient recovered fully. Poor DM management is an important triggering factor, and it is of great relevance to identify the EPN through imaging exams due to the peculiarities of its clinical and potentially surgical management.

Características de gestantes com sífilis em um hospital universitário do Paraná / Characteristics of pregnant women with syphilis at a University Hospital of Paraná

A sífilis em gestante constitui uma importante causa evitável de morbimortalidade neonatal. O objetivo do estudo foi estimar a magnitude e características de gestantes com sífilis atendidas em um hospital universitário da região oeste do Paraná. Foi realizado um estudo descritivo, conduzido com revisão de prontuários e fichas de notificação de gestantes diagnosticadas com sífilis, no período de 2010 - 2016. Os resultados referem-se a 121 casos, a taxa de detecção de sífilis em gestantes foi 5,96 casos por mil nascidos vivos. Mostrou-se mais frequente em mulheres com idade ≥ 20 anos e escolaridade ≤ 8 anos. O tratamento foi inadequado em 68,7% das gestantes e 14,9% dos recém-nascidos foram notificados com sífilis congênita. Recomenda-se melhorar a qualidade do pré-natal, dos registros de notificação e providenciar educação continuada para os profissionais de saúde. (AU)

Syphilis in pregnant woman is an important preventable cause of neonatal morbidity and mortality. The objective of this study was to estimate the magnitude and characteristics of pregnant women with syphilis treated at a university hospital in the western region of the state of Paraná. A descriptive study was carried out with a review of medical records and reports of pregnant women diagnosed with syphilis in the period between 2010-2016. The results refer to 121 cases; the rate of detection of syphilis in pregnant women was 5.96 cases per a thousand live births. It was more frequent in women aged ≥ 20 years and with level of education of ≤ 8 years. The treatment was inadequate in 68.7% of the pregnant women, and 14.9% of the newborns were notified with congenital syphilis. The improvement of prenatal care quality, notification reports, and continuing education of health professionals are recommended. (AU)