Assuntos
Encefalite Transmitida por Carrapatos/patologia , Meningoencefalite/patologia , Adulto , Animais , Anticorpos Antivirais/sangue , Especificidade de Anticorpos , Arbovírus/imunologia , Diagnóstico Diferencial , Eletromiografia , Encefalite Transmitida por Carrapatos/líquido cefalorraquidiano , Encefalite Transmitida por Carrapatos/diagnóstico , França , Humanos , Imunoglobulina G/sangue , Itália , Imageamento por Ressonância Magnética , Masculino , Meningoencefalite/líquido cefalorraquidiano , Meningoencefalite/diagnóstico , Poliomielite/diagnóstico , Romênia/etnologia , Espanha , ViagemRESUMO
Thoracic infections due to Trichomonas species often go unrecognised as they are seldom described in the literature. We describe a case that, to our knowledge, is the first reported case of empyema caused by this organism. A 59 year old man with metastatic adenocarcinoma of the lung developed a right pyopneumothorax following treatment with corticosteroids and radiotherapy. The pleural fluid was purulent and fetid, and contained large numbers of Trichomonas tenax amongst a mixed bacterial flora. Pleural drainage and antibiotic therapy with metronidazole, ciprofloxacin and gentalline were instituted immediately, but the patient died 4 days later. Trichomonas tenax is part of the normal oral floral and may on occasions colonize the airways. It can thus become involved during aspiration pneumonia or cause pleural infection following the rupture of a pulmonary abscess. Such infection tends to be associated with concurrent respiratory pathology or with immunodepression. The significance Trichomonas tenax when found in the airways is unclear and their pathogenic role is discussed.
Assuntos
Pneumopatias Parasitárias/diagnóstico , Infecções Oportunistas/diagnóstico , Doenças Pleurais/parasitologia , Tricomoníase/diagnóstico , Trichomonas/isolamento & purificação , Animais , Evolução Fatal , Humanos , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Doenças Pleurais/microbiologiaAssuntos
Infecções por HIV/etiologia , Hepatite C/etiologia , Reação Transfusional , Humanos , TailândiaAssuntos
Artrite Infecciosa/microbiologia , Kingella kingae/isolamento & purificação , Infecções por Neisseriaceae/complicações , Administração Oral , Adulto , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/patologia , Feminino , Humanos , Injeções Intravenosas , Kingella kingae/patogenicidade , Articulação do Joelho/microbiologia , Articulação do Joelho/patologia , Infecções por Neisseriaceae/tratamento farmacológico , Infecções por Neisseriaceae/patologia , Penicilina G/administração & dosagem , Penicilina G/uso terapêutico , Resultado do Tratamento , Virginiamicina/administração & dosagem , Virginiamicina/uso terapêuticoRESUMO
Between April and October 1997, 21 children of 4 days to 13 years old were admitted to the Pedatric Unit of Aulnay Sous Bois's Hospital for viral meningitidis. The number of white blood cells in the cerebrospinal fluid (CSF) was between 1 and 612 cells/mm3, with, on an average, 56% of segmented cells, 34% lymphocytes and 34% monocytes. Proteins and glucose of CSF were standard. One CSF was normal. Viral meningitidis was confirmed by viral culture of CSF onto MRC5. Enterovirus were identified by direct immunofluorescence (Monoclonal Mouse Anti-Enterovirus, Dako). Serotyping (Enterovirus antisera, Eurobio, Trousses 4) identified an echovirus 30 in all cases. A highly conserved 154 bp sequence at the 5'non-coding region was studied by reverse transcription-polymerase chain reaction (RT-PCR) followed by single-strand conformation polymorphism (SSCP) (GenPhor, Pharmacia) analysis. Two dominant SSCP patterns were observed: the first contained 4/21 strains and the other 10/21 strains. The SSCP patterns of the 7 other strains were different. These results show that 2 echovirus 30 dominant clones were responsible of viral meningitidis admitted to the Pediatric Unit of Aulnay Sous Bois's hospital, between april and october 1997. The PCR-SSCP of the 5'non-coding region of echovirus 30 is a convenient, simple, reproducible epidemiologic method and it's easily applicable in a general hospital.
Assuntos
Surtos de Doenças , Infecções por Echovirus/epidemiologia , Enterovirus Humano B/isolamento & purificação , Meningite Viral/epidemiologia , Polimorfismo Conformacional de Fita Simples , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Adolescente , Sequência de Bases , Criança , Pré-Escolar , Sequência Conservada , Infecções por Echovirus/diagnóstico , Enterovirus/isolamento & purificação , Enterovirus Humano B/classificação , Enterovirus Humano B/genética , Feminino , Técnica Direta de Fluorescência para Anticorpo , França/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Meningite Viral/diagnóstico , SorotipagemRESUMO
SETTING: Department of Seine-Saint-Denis, France. OBJECTIVE: To compare the presentation and outcome of Mycobacterium kansasii infections according to human immunodeficiency virus (HIV) status. DESIGN: Retrospective analysis of all the medical charts of adults meeting the diagnostic criteria of the American Thoracic Society for M. kansasii infection between 1991 and 1995. RESULTS: Between 1991 and 1995, 35 cases (23 HIV-[6%] and 12 HIV+ [34%]) were found, giving an annual incidence of 0.5/100000. The following particularities were common to both groups: 1) frequency and prominence of respiratory and general symptoms, 2) rarity of clinically apparent extra-thoracic involvement, 3) bacteriological confirmation mostly obtained with respiratory tract specimens, 4) favourable bacteriological outcome, and 5) low mortality attributable to the mycobacterial infection. The most striking differences concerned chest radiography: HIV- patients had apical cavitated and nodular lesions, while HIV+ patients exhibited a variety of other patterns, including alveolar infiltrates, miliary lesions and/or thoracic lymphadenopathy. CONCLUSION: Apart from pulmonary radiographic differences, presentation and short-term outcome of M. kansasii infections were similar in HIV+ and HIV-patients.
Assuntos
Infecções por HIV/complicações , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium kansasii , Adulto , Idoso , Feminino , França , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/diagnóstico por imagem , Radiografia , Estudos RetrospectivosAssuntos
Diagnóstico por Computador/instrumentação , Eosinofilia/sangue , Eosinofilia/diagnóstico , Eosinófilos , Testes Hematológicos/instrumentação , Contagem de Leucócitos/métodos , Protocolos Clínicos , Eosinofilia/etiologia , Humanos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Forty-three percent of the tuberculosis cases reported in France are from the Ile de France region. The incidence of tuberculosis in this region is 33 cases per 100,000 inhabitants, twice the national average. A restriction fragment length polymorphism (RFLP) analysis was performed with clinical isolates of Mycobacterium tuberculosis isolated during 1995 in 10 hospitals in Paris and surrounding areas to detect tuberculosis transmission and define the factors associated with clustering in this population. The molecular markers used were the insertion sequence IS6110 and the direct repeat (DR) sequence. Social, demographic, and clinical data were collected from the patients' medical files. Ten patients with isolates with a single copy of IS6110 were excluded from further analysis. Twenty-four patients with false-positive cultures due to laboratory contamination (based on RFLP analysis with IS6110 and examination of patient data) were also excluded. The study was then conducted with 272 strains isolated from 272 patients. Further fingerprinting was performed by using the DR element with strains with patterns by RFLP analysis with IS6110 that differed by one band only and strains with identical patterns by RFLP analysis with IS6110 and with low numbers of copies of IS6110. The combined use of both markers identified unique patterns for 177 strains and clustered 95 (35.7%) strains in 26 groups, each containing isolates from 2 to 12 patients. The clustering was strongly associated with homelessness and the male sex. It was not associated with age, birth in a foreign country, human immunodeficiency virus positivity, or residence in hostels or prison. Isolates from homeless people were often included in large clusters, and homeless people could be the source of tuberculosis transmission for more than 50% of the clustered patients. These results suggest that homeless people play a key role in the spread of M. tuberculosis in the community and that poor socioeconomic conditions are the main risk factors associated with active tuberculosis transmission.
Assuntos
DNA Bacteriano/análise , Mycobacterium tuberculosis/genética , Tuberculose/epidemiologia , Tuberculose/transmissão , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/transmissão , Fatores Etários , Sondas de DNA , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Erros de Diagnóstico , Emigração e Imigração , Reações Falso-Positivas , Feminino , Soropositividade para HIV , Pessoas Mal Alojadas , Hospitais , Humanos , Incidência , Masculino , Epidemiologia Molecular , Mutagênese Insercional , Mycobacterium tuberculosis/isolamento & purificação , Paris/epidemiologia , Polimorfismo de Fragmento de Restrição , Prisões , Sequências Repetitivas de Ácido Nucleico , Fatores Sexuais , Classe Social , Tuberculose/diagnósticoRESUMO
UNLABELLED: We report 7 cases of antibiotic-associated and hemorrhagic colitis due to Klebsiella oxytoca. The diagnosis was performed by sigmoidoscopy with bacteriological biopsy culture. PATIENTS AND METHODS: Nine patients, aged 25-83 years, were hospitalized from February 1993 to October 1995 with hemorrhagic acute diarrhea following antibiotic treatment: amoxicillin (n = 3). amoxicillin-clavulanic acid (n = 4), cephalosporine (n = 2). All patients have had two stool samples cultures including Clostridium difficile toxin detection. Sigmoidoscopy with collection of biopsy specimens for bacteriological cultures was performed routinely. RESULTS: Endoscopic findings established the diagnosis of colitis in all cases: rectitis (n = 1), diffuse left colitis (n = 4), segmental left colitis (n = 4). The lesions were erythematous and purpuric (n = 5) or ulcerative (n = 4). Stool culture was normal in all cases but Klebsiella oxytoca was isolated in 7 cases (78%). CONCLUSIONS: Sigmoidoscopy and bioptic microbiology ensured the diagnosis of antibiotic-associated hemorrhagic colitis due to Klebsiella oxytoca.
Assuntos
Colite Ulcerativa/microbiologia , Colo/microbiologia , Infecções por Klebsiella/diagnóstico , Sigmoidoscopia , Adulto , Idoso , Antibacterianos/efeitos adversos , Técnicas Bacteriológicas , Biópsia por Agulha , Colite Ulcerativa/induzido quimicamente , Colo/patologia , Diarreia/induzido quimicamente , Diarreia/microbiologia , Estudos de Avaliação como Assunto , Fezes/microbiologia , Fezes/parasitologia , Feminino , Humanos , Infecções por Klebsiella/complicações , Masculino , Pessoa de Meia-IdadeAssuntos
Infecções por Citomegalovirus/complicações , Hemorragia Gastrointestinal/virologia , Proctite/virologia , Adulto , Infecções por Citomegalovirus/imunologia , Hemorragia Gastrointestinal/imunologia , Humanos , Imunocompetência , Masculino , Proctite/imunologia , Úlcera/imunologia , Úlcera/virologiaRESUMO
The aim of this study was to analyse the interest of proctosigmoidoscopy and biopsies microbiology in antibiotic-associated acute diarrhea in adults. Between February 1993 and October 1995, we have studied prospectively 24 patients with antibiotic-associated acute diarrhea. Ages ranged from 17 to 83 years. They had taken antibiotics: amoxicillin (n = 8) amoxicillin-clavulanic acid (n = 11), cephalosporinia (n = 3), cotrimoxazole (n = 1), macrolide (n = 1). For each patient, 2 stool cultures with Cytotoxin assay for Clostridium difficile and 3 fecal samples for parasitic enteropathogens were collected. Proctosigmoidoscopy with biopsies microbiology was carried out in all patients. Stool culture was always negative but colonic biopsies cultures were positive with Klebsiella oxytoca in 7 patients. Cytotoxin assay of C. difficile was positive in 11 patients. Proctosigmoidoscopy permitted also diagnosis of 2 pseudomembranous colitis without cytotoxin assay of C. difficile. Proctosigmoidoscopy permitted diagnosis of 83% of antibiotic-associated acute diarrhea. Complementary to Cytotoxin assay of C. difficile, it should be necessary in antibiotic-associated acute diarrhea in adults.
Assuntos
Antibacterianos/efeitos adversos , Colo/microbiologia , Diarreia/diagnóstico , Diarreia/etiologia , Sigmoidoscopia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Clostridioides difficile , Colo/parasitologia , Colo/patologia , Diarreia/microbiologia , Diarreia/parasitologia , Enterocolite Pseudomembranosa/diagnóstico , Enterocolite Pseudomembranosa/microbiologia , Feminino , Humanos , Klebsiella , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
The goal of this study was to evaluate the contribution of sigmoidoscopy with bioptic microbiology to the etiologic diagnosis of acute diarrhea in adults. Patients and methods. Sixty-five patients with acute diarrhea were included prospectively from February 1993 to November 1994. Ages ranged from 17 to 83 years. In each patient, two stool samples were cultured and three examined for parasites. Clostridium difficile toxin was looked for in the 18 patients who had taken antimicrobials before onset of the diarrhea. Sigmoidoscopy with collection of biopsy specimens for bacteriologic cultures was performed routinely. Results. A pathogenic organism was identified in 35 patients (54%). Eighteen patients (28%) had positive stool cultures. Clostridium difficile toxin was detected in six patients. Colonic biopsy cultures were positive in 26 patients (40%). Endoscopic findings established the diagnosis of pseudomembranous colitis with negative tests for C. difficile toxin in two patients, diverticulitis in one, ischemic colitis in two, and cryptogenic colitis in seven. Conclusions. Sigmoidoscopy ensured the diagnosis in over 72% of cases of acute diarrhea. This investigation complements stool cultures and should be done routinely in adults with severe acute diarrhea.
Assuntos
Colo/microbiologia , Colo/patologia , Diarreia/diagnóstico , Sigmoidoscopia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Toxinas Bacterianas/isolamento & purificação , Biópsia , Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/diagnóstico , Colite/complicações , Colite/diagnóstico , Colite/patologia , Colite Isquêmica/complicações , Colite Isquêmica/diagnóstico , Colite Isquêmica/patologia , Diarreia/etiologia , Diarreia/microbiologia , Diarreia/patologia , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/diagnóstico , Doença Diverticular do Colo/patologia , Enterocolite Pseudomembranosa/complicações , Enterocolite Pseudomembranosa/diagnóstico , Enterocolite Pseudomembranosa/patologia , Fezes/microbiologia , Fezes/parasitologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Two antiseptic solutions (iodine polyvidone and chlorhexidine) were compared-in a prospective non-randomized study including 294 parturient women. This study aimed to assess their efficacy against infections through epidural catheters. All catheters were subsequently cultivated. Cultures were significantly positive in 3% of cases after iodine polyvidone and 1% after chlorhexidine decontamination (not significant). No clinical or biological infections were detected. Notwithstanding some apparently unavoidable but moderate contaminations, prevention of infections post epidural analgesia depends principally on a complete adherence to asepsia rules.
Assuntos
Anestesia Epidural , Anti-Infecciosos Locais/uso terapêutico , Infecções Bacterianas/prevenção & controle , Clorexidina/uso terapêutico , Povidona-Iodo/uso terapêutico , Adulto , Cateterismo , Espaço Epidural , Feminino , Humanos , Gravidez , Estudos ProspectivosRESUMO
We report a retrospective study of 12 caucasian men infected with HIV who had developed Mycobacterium kansasii infection (Mk). All patients had a low blood lymphocyte CD4 count (1-130, mean 15/mm3) and ten met the diagnostic criteria for AIDS. The 12 patients had pulmonary symptoms (dyspnea, cough) and fever. On chest X-ray, nodular, interstitial or diffuse parenchymal infiltrates, mediastinal and hilar adenopathies were observed. Two patients had pleural effusion, but none had cavitary lung disease. Mk was isolated by culture of sputum (n = 7), blood (n = 3), bronchial biopsy (n = 2) or bone marrow (n = 1). No patient had clinical extra-pulmonary disease. Survival after diagnosis was in average 7 months. Potential for therapeutic response is reviewed and documented.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS , Infecções por Mycobacterium não Tuberculosas/etiologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Adulto , Antituberculosos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/mortalidade , Estudos Retrospectivos , Fatores de TempoRESUMO
From February to September 1993, we have established the serotype of group B Streptococcus (GBS) taken from diverse microbiological samples, in particular from gastric liquids. The method utilized was a technic of coagglutination (Dako Group B Streptococcus Serotyping Test, France) allowing the search for serotypes Ia, Ib, II, III, IV and V. All in all, 169 samples have been tested: 117 vaginal samples, 17 diverse samples, 26 gastric samples, 3 placentas and 7 ammmiotic liquids. Serotypes are spread as follow: III (41), II (33), Ia (26) et V (23).... Usually, serotype III was the most frequently found and the most virulent, particularly in infections in neonates.