RESUMO
BACKGROUND: Isolates of nonanthrax Bacillus species in clinical samples are frequently considered as contaminants. However, there were case reports describing Bacillus sepsis among infants, associated with high mortality and morbidity. METHODS: We performed a retrospective review of the clinical and epidemiological features of Bacillus bacteremia at our neonatal intensive care unit from January 2002 to December 2009. RESULTS: Bacillus bacteremia was considered to be clinically significant in 11 infants. The median gestational age was 30 weeks. All had either central catheters or peripherally inserted arterial lines in situ. The mean neutrophil and lymphocyte counts were 6.73 × 10(9)/L (0.78 to 12.56 × 10(9)/L) and 2.75 × 10(9)/L (0.82 to 6.15 × 10(9)/L), respectively. All 11 infants received intravenous vancomycin, with an average duration of 12.4 days. In general, the earlier the catheter was removed, the quicker the clearance of bacteremia was achieved. All infants survived and were discharged from the hospital. CONCLUSIONS: The growth of Bacillus species in blood cultures cannot simply be regarded as a contaminant. Hematologic parameters are frequently unremarkable at the disease onset. Increased vigilance, early diagnosis, and effective therapy in conjunction with prompt catheter removal are the keys to successful management of Bacillus bacteremia.
Assuntos
Bacillus/isolamento & purificação , Bacteriemia/epidemiologia , Patógenos Transmitidos pelo Sangue/isolamento & purificação , Infecção Hospitalar/microbiologia , Unidades de Terapia Intensiva Neonatal , Antibacterianos/uso terapêutico , Bacillus/efeitos dos fármacos , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Cateteres de Demora/efeitos adversos , Estudos de Coortes , Infecção Hospitalar/epidemiologia , Remoção de Dispositivo , Feminino , Mortalidade Hospitalar/tendências , Humanos , Incidência , Recém-Nascido , Masculino , Prognóstico , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida , Centros de Atenção Terciária , Fatores de Tempo , Resultado do TratamentoRESUMO
SUMMARY: Zygomycetes are widely distributed in the environment as inhabitants of soil and decaying matter. On rare occasions, these organisms can cause invasive infections in immunocompromised hosts. As zygomycetes are resistant to most conventional antifungal agents, its infection is often fatal. We report 2 cases of unusual intra-abdominal Rhizopus microsporus infection in children with acute leukemia as a result of an unprecedented outbreak due to oral intake of contaminated allopurinol tablets and ready-to-eat food items. Among the 2 patients, one of them survived after aggressive combined surgical, antifungal (AmBisome, Caspofungin, and Posaconazole) and iron chelation therapy.
