Infección de puertos laparoscópicos por Micobacterias Atípicas / Laparoscopic Post-sites Infections by Atypical Mycobacteria

Introducción. Las Micobacterias Atípicas habitan normalmente aguas, suelos y ambientes quirúrgicos pudiendo infectar a personas con inmunidad comprometida o no comprometida afectando a prácticamente cualquier órgano. La especie Mycobactrium Abscessus Complex se describe frecuentemente como agente infeccioso de heridas quirúrgicas en puertos de cirugía laparoscópica siendo su tratamiento complejo y difícil. Materiales y Métodos. Estudio descriptivo de características clínicas, etiológicas y terapéuticas de pacientes con infección de los puertos quirúrgicos laparoscópicos causados por Micobacterias atípicas en cirugías consecutivas. Resultados. Once pacientes operados consecutivamente en el mismo medio y condiciones quirúrgicas desarrollaron infección de los puertos laparoscópicos. La incorrecta desinfección de instrumentos laparoscópicos fue la causa. Todos estos casos se registraron en un lapso de 43 días. El seguimiento fue de entre 10 a 14 meses. Las formas de presentación clínica fueron; fístulas, nódulos y seudotumores, en ese orden. Seis pacientes presentaron síntomas sistémicos como fiebre y sudoración nocturna. Se aislaron Micobacterias de crecimiento rápido caracterizados como M. Abscessus, M. Bolletii, M. Massiliense, especies del Complejo M. Abscessus. Los antibióticos utilizados fueron Claritromicina y Ciprofloxacino guiados por sensibilidad. Conclusiones. Los protocolos de desinfección deben ser estrictos. El tratamiento debe ser precoz y agresivo.

Introduction. Atypical Mycobacteria contaminates water, soil and surgical sets letting them to cause infections in people independent of their immunological status. Mycobacterium Abscessus Complex species frequently cause laparoscopic port sites infections turning about natural outcome in complex and hard to treat issues. Materials and Methods. Consecutive cases of patients affected with laparoscopic port sites infections by Atypical Mycobacterias are described. Etiological, clinical and therapeutic features are exposed. Results. Eleven patients acquired laparoscopic port site infections, all of them were consecutively operated at the same surgical background. Wrong proceedings in disinfection of laparoscopic devices were the causes. All of the surgeries were performed in a 43 days gap. Ten to fourteen months follow up is recorded. Fistulae was the most frequent lesion followed by nodules and pseudo tumors. Systemic symptoms like fever and nocturnal sweating were present in six patients. Rapid growing Mycobacterias were isolated by culture and labeled as M. Abscessus, M. Bolletii and M. Massiliense. Sensibility for antibiotics was tested and it commands therapeutic. Claritromicyn and Ciprofloxacyn were the most used antibiotics. Conclusions. Disinfection procedures there must be carefully controlled. Early and aggressive treatment have to be the rule.

Identificación de micobacterias en medio sólido mediante microscopía de fase invertida y tinción Ziehl-Neelsen / Mycobacteria identification in solid culture by inverted phase microscopy and ziehl-neelsen stain

RESUMEN Con el objetivo de identificar diferencias morfológicas en colonias de diferentes especies de micobacterias mediante microscopía de fase invertida, se sembraron en medio sólido 7H11, nueve especies de micobacterias patógenas de alta prevalencia y se observaron hasta por 21 días. Adicionalmente se realizaron coloraciones Ziehl-Neelsen (ZN) para cada una de ellas. No se identificó variaciones morfológicas entre las especies cultivadas, sin embargo, se observó que todas fueron capaces de formar cordones en su etapa temprana de crecimiento, siendo corroborado por coloración ZN en Mycobacterium tuberculosis. Asimismo, se determinó ciertas características microbiológicas como tiempo mínimo y la temperatura de crecimiento, y características bacilares basadas en la tinción ZN para cada especie estudiada. Estos hallazgos son importantes para la identificación del agente etiológico y podrían servir de base para estudios posteriores sobre la identificación de las biomoléculas involucradas en la agregación celular de cada micobacteria.

ABSTRACT With the aim of identifying morphological differences in colonies of different species of mycobacteria by means of inverted phase microscopy, nine species of high-prevalence pathogenic mycobacteria were seeded in 7H11 solid medium and were observed for up to 21 days. Additionally, Ziehl-Neelsen (ZN) stains were carried out for each one of them. No morphological variations were identified among the species grown on solid medium; however, it was identified that all are able to form cords in solid medium in an early stage of growth, being corroborated by the Ziehl-Neelsen stain in Mycobacterium tuberculosis. so techniques based on detecting M. tuberculosis depending on the identification of the cords should be taken with caution so as not to generate a bad diagnosis, so microbiological characteristics could also be established as a minimum time to detect growth, temperature of growth and bacillary characteristics based on the Ziehl-Neelsen stain for each species studied.

[Infectious and neoplasic complications after kidney transplantation]. / Complications infectieuses et néoplasiques après transplantation rénale.

Infections and malignancies are the expected complications of immunosuppressive therapy, which non-specifically impairs cellular and humoral immune responses in renal transplant recipients. Infections were usually frequent and severe during the early post-transplant period (first year). Recent diagnostic methods (molecular biology) and availability of new antivirals, antifungal and antibiotic drugs made rapid diagnosis and systematic preventive strategies much easier and this resulted in a significant reduction of infections and infectious death in this population. However, new infectious agents like BK polyomavirus, hepatitis E virus, parvovirus (as well as Chigunkunya, West Nile and others in particular areas) were recently recognized as responsible of aggressive infections in the immunocompromised host. Malignancies are also common after transplantation, due to the intensity and duration of immunosuppression. Skin cancers and lymphoproliferative disorders are the most common and are undoubtedly caused by viral infections, but incidence of non-skin cancers is also increased. After reduction of immunosuppression, treatment is similar to non-transplant patients: Results are usually poor and cancer is now the third cause of death in transplant recipients. Due to their anti-proliferative and anti-tumoral properties, incidence of de novo cancer significantly decreased in patients receiving mTor inhibitors as maintenance immunosuppression; furthermore, in patients already diagnosed with Kaposi sarcoma or recurrent skin cancers, introduction of mTor was associated with stabilisation and/or regression of malignant lesions.

Comparación del sistema BacT/ALERT® 3D con los métodos de cultivo Lowenstein-Jensen y Ogawa-Kudoh para el aislamiento de micobacterias / Comparison of BacT/ALERT 3D® system with the culture methods of Lowenstein-Jensen and Ogawa-Kudoh, for the isolation of mycobacteria

La tuberculosis es una enfermedad causada por bacterias pertenecientes al Complejo Mycobacterium tuberculosis. El diagnóstico se dificulta por su sintomatología inespecífica y los métodos bacteriológicos que ofrecen resultados tardíos. El objetivo del presente estudio fue comparar el desempeño del sistema automatizado BacT/ALERT® 3D con los métodos convencionales de cultivo en medio Lowenstein-Jensen (L-J) y Ogawa-Kudoh (O-K) para el aislamiento de micobacterias. Se procesaron 266 muestras provenientes de pacientes con sospecha de tuberculosis entre mayo y octubre de 2013. Se aislaron 63 bacilos acido-resistentes: 46 M. tuberculosis y 17 micobacterias no tuberculosas (MNT). Al comparar los tres métodos, se observó que todos presentaron desempeño similar en el aislamiento de M. tuberculosis. Las tasas de recuperación obtenidas no mostraron diferencia estadísticamente significativa (p>0,05) sin embargo, con BacT/ALERT® 3D se aislaron mayor número de MNT, con diferencia significativa respecto al L-J (p<0,05). El tiempo de detección promedio de M. tuberculosis fue de 11 días por BacT/ALERT® 3D, 20 días en L-J y 23 días en O-K. La contaminación cruzada, fue de 0,38%. Se concluyó que BacT/ALERT® 3D es una excelente herramienta para el aislamiento de M. tuberculosis, mejora la recuperación de las MNT y reduce significativamente el tiempo de diagnóstico, lo que permitiría un tratamiento oportuno, con mayor probabilidad de sobrevida del paciente.

Tuberculosis is a disease caused by species of the Mycobacterium tuberculosis complex. The diagnosis is difficult due to nonspecific symptoms and late results of bacteriological culture methods. The aim of this study was to compare the efficiency of the BacT/ALERT® 3D automated system with conventional methods of culture on Lowenstein-Jensen (L-J) and Ogawa-Kudoh (O-K). A total of 266 specimens from patients with clinical suspected tuberculosis were studied from May to October 2013. We recovered, 63 acid fast bacilli isolates: 46 identified as M. tuberculosis and 17 as nontuberculous mycobacteria (NTM). The three methods had a similar performance for isolation of M. tuberculosis; recovery rates obtained showed no statistically significant difference (p> 0.05). However, with the BacT/ALERT® 3D system, a larger number of MNT were isolated, with significant statistic difference for L-J (p <0.05). The average detection time for M. tuberculosis was 11 days with the BacT/ALERT® 3D system, with significant statistic difference for LJ (20.4 days) and O-K (23.2 days). Additionally, cross-contamination was determined as 0.38%. The study results showed that the BacT/ALERT® 3D system is an excellent tool for isolation of M. tuberculosis and it improves the recovery of NTM. Also, the time of diagnosis is significantly reduced, leading to earlier treatment that could improve patient recovery.