RESUMO
Introducción: Streptococcus agalactiae es un microorganismo causal infrecuente en el absceso epidural espinal (AEE) que generalmente afecta a pacientes con comorbilidades predisponentes y/o alguna potencial fuente de infección. Caso clínico: Presentamos el caso de un paciente de 53años, inmunocompetente y sin antecedentes médicos de interés, que desarrolló un cuadro de dolor lumbar, paraparesia y disfunción de esfínteres en el contexto de un síndrome febril sin foco conocido de una semana de evolución. La exploración neurológica mostró paraparesia flácida proximal, nivel sensitivo T10, esfínter anal atónico y reflejos osteotendinosos normales. La RM medular mostró un extenso AEE dorsal. Se realizó una laminectomía urgente con drenaje del absceso en menos de 24h y se inició antibioterapia empírica. El resultado del cultivo mostró Streptococcus agalactiae. Tras un estudio exhaustivo, no se encontró ninguna enfermedad predisponente ni fuente de la infección. Conclusiones: Describimos un caso infrecuente de AEE causado por Streptococcus agalactiae en un paciente sano sin factores predisponentes. Este caso subraya la importancia del diagnóstico precoz de esta entidad, dado que se puede asociar potencialmente con un mejor pronóstico
Background: Streptococcus agalactiae is an uncommon microorganism that causes spinal epidural abscess (SEA) and usually affects individuals with a predisposing condition or potential source of infection. Case description: We present the case of an immunocompetent 53-year-old patient with an unremarkable past medical history who developed progressive low extremity weakness, bowel and bladder dysfunction and genital sensory impairment. A neurological exam on admission revealed flaccid proximal paraparesis, T10 sensory level, atonic anal sphincter and normal myotatic reflexes. Urgent neuroimaging showed a large thoracic epidural spinal abscess. Laminectomy and abscess drainage were immediately performed and systemic antibiotic treatment was initiated. Abscess cultures revealed Streptococcus agalactiae. After an exhaustive workup no predisposing factors or local or systemic source for the infection were found. Conclusions: We report a singular case of spinal epidural abscess caused by Streptococcus agalactiae in a healthy patient with no predisposing factors. This case also highlights the importance of an early diagnosis and treatment to obtain a better neurological outcome
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Abscesso Epidural/complicações , Streptococcus agalactiae/isolamento & purificação , Imunocompetência , Laminectomia , Medula Espinal/diagnóstico por imagem , Abscesso Epidural/imunologia , Dor Lombar/etiologia , Paraparesia/complicações , Transtornos da Excreção/complicações , Biomarcadores Tumorais , Medula Espinal/patologiaRESUMO
Objective: To characterize a methicillin-resistant Staphylococcus aureus (MRSA) isolate responsible for an aggressive infection (peridural and psoas abscess secondary to haematogenous septic arthritis) in a poultry farmer. Methods: Molecular characterization was performed, including spa- and multilocus sequence typing of the isolate, assessment of its resistance phenotype and detection of tetracycline resistance and of virulence and immune evasion cluster (IEC) genes were performed. Results: The MRSA isolate was tetracycline- and fluorquinolone-resistant, and was ascribed to CC398, spa-t1451. The isolate harboured tet(M) (distinctive of livestock-associated (LA) MRSA-CC398 clade) and IEC-type B system (characteristic of the methicillin-susceptible human lineage, but typically absent in LA-MRSA-CC398 strains), and lacked toxin-coding genes lukF/lukS-PV, tsst-1, eta and etb. Conclusion: IEC re-acquisition by LA-MRSA-CC398-LA strains is an unusual finding, but could constitute an emerging public health problem. It would represent an evolutionary step towards LA-MRSA-CC398's adaptation to human hosts, and might enhance its invasiveness and ability to be transmitted to humans (AU)
Objetivo: Caracterizar un aislado de Staphylococcus aureus resistente a meticilina (SARM), causante de una infección muy agresiva (absceso epidural y de psoas secundarios a artritis séptica hematógena) en un granjero avícola. Métodos: El aislado fue caracterizado molecularmente (spa- y multilocus sequence typing), y se estudió su fenotipo de resistencia y la presencia de genes de resistencia a tetraciclina, de virulencia y del sistema immune evasion cluster (IEC). Resultados: El aislado de SARM, resistente a tetraciclina y fluoroquinolonas, fue tipado como spa-t1451-CC398, albergaba el gen tet(M) (distintivo de SARM-CC398 asociado al ganado [AG]) y el sistema IEC-tipo B (característico de S. aureus meticilin-sensible-CC398 adscrito al clado humano, pero no de SARM-CC398-AG), carecía de lukF/lukS-PV, tsst-1, eta, y etb. Conclusión: La readquisición del sistema IEC por aislados SARM-CC398-AG es excepcional, pero constituiría un problema emergente de salud pública. Representaría un paso evolutivo en la readaptación de SARM-CC398-AG al hombre, pudiendo incrementar su invasividad y transmisibilidad a humanos (AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Evasão da Resposta Imune/genética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Abscesso Epidural/diagnóstico , Abscesso Epidural/microbiologia , Abscesso do Psoas/diagnóstico , Abscesso do Psoas/microbiologia , Abscesso Epidural/genética , Abscesso Epidural/imunologia , Artrite Infecciosa/complicações , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/microbiologia , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Técnicas Microbiológicas/métodosRESUMO
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Assuntos
Humanos , Masculino , Abscesso Epidural/complicações , Abscesso Epidural/metabolismo , Nervo Óptico/anormalidades , Nervo Óptico/virologia , Aspergilose/virologia , Fármacos Anti-HIV/administração & dosagem , HIV/genética , Abscesso Epidural/imunologia , Abscesso Epidural/virologia , Nervo Óptico/metabolismo , Aspergilose/prevenção & controle , Fármacos Anti-HIV , HIV/crescimento & desenvolvimentoAssuntos
Antirreumáticos/efeitos adversos , Artrite Infecciosa/imunologia , Artrite Reumatoide/tratamento farmacológico , Abscesso Epidural/imunologia , Staphylococcus lugdunensis , Inibidores do Fator de Necrose Tumoral , Idoso , Antirreumáticos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Reumatoide/imunologia , Abscesso Epidural/diagnóstico , Humanos , Hospedeiro Imunocomprometido , Imageamento por Ressonância Magnética , MasculinoRESUMO
A case of staphylococcal epidural abscess associated with infliximab and methotrexate therapy in a patient with psoriatic arthropathy is presented. He presented atypically with chest pain, on a background of long standing history of neck pain, and rapid progression to complete paraplegia. Clinicians should be aware that invasive staphylococcal infections are associated with biologic and disease modifying antirheumatic drug therapy, and these may present atypically and be rapidly progressive. Initial empiric antimicrobial therapy including staphylococcal coverage should be considered in the appropriate clinical context in acutely ill patients who are on these agents, along with prompt surgical intervention where appropriate.