RESUMO
Infective endocarditis is a serious condition, which is associated with high mortality in elderly patients. Gemella haemolysans (GH) is a microorganism from the Streptococcus family, rarely involved in infective endocarditis. Here, we present a case of Gemella haemolysans endocarditis in an 86-year-old patient, successfully treated by antibiotics and surgery following a pre-treatment comprehensive geriatric assessment (CGA). This case is discussed in the context of a review of all published cases of Gemella haemolysans endocarditis. We illustrate the benefit of a systematic pre-treatment comprehensive geriatric assessment in elderly patients with infective endocarditis.
Assuntos
Endocardite Bacteriana/tratamento farmacológico , Avaliação Geriátrica/métodos , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Feminino , França , Gemella/efeitos dos fármacos , Gemella/patogenicidade , Implante de Prótese de Valva Cardíaca/métodos , HumanosAssuntos
Artrite Infecciosa/microbiologia , Gemella/isolamento & purificação , Infecções por Bactérias Gram-Positivas/microbiologia , Articulação do Joelho/microbiologia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/tratamento farmacológico , Feminino , Gemella/efeitos dos fármacos , Gemella/patogenicidade , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Articulação do Joelho/efeitos dos fármacos , Resultado do TratamentoRESUMO
Gemella haemolysans has long been considered a commensal in the human upper respiratory tract. Commensals are natural inhabitants on or within another organism, deriving benefit without harming or benefiting the host. Opportunistic infection of the CNS by the species is exceedingly rare. In the present case, a 16-year-old boy was admitted with a ventriculoperitoneal shunt infection, which was confirmed to be due to G. haemolysans. Following antibiotic treatment, removal of the old shunt, and delayed insertion of a new shunt, the patient made a full neurological recovery. To the authors' knowledge, this is the eighth case of CNS infection with G. haemolysans. Although prosthesis-related infections have been reported in other systems, this is the first case of CNS infection by the bacterium associated with an implant. Previous reported cases of CNS infection by G. haemolysans are reviewed. Due to the variable Gram staining property of the organism, the difficulty in diagnosing G. haemolysans infection is emphasized.
Assuntos
Antibacterianos/uso terapêutico , Infecções do Sistema Nervoso Central/tratamento farmacológico , Gemella/isolamento & purificação , Gentamicinas/uso terapêutico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Penicilina G/uso terapêutico , Infecções Relacionadas à Prótese/tratamento farmacológico , Derivação Ventriculoperitoneal/efeitos adversos , Adolescente , Antibacterianos/administração & dosagem , Causalidade , Ceftazidima/uso terapêutico , Infecções do Sistema Nervoso Central/microbiologia , Síndrome de Dandy-Walker/cirurgia , Gemella/efeitos dos fármacos , Gentamicinas/administração & dosagem , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Infusões Intravenosas , Injeções Espinhais , Masculino , Testes de Sensibilidade Microbiana , Penicilina G/administração & dosagem , Infecções Relacionadas à Prótese/microbiologia , Resultado do Tratamento , Vancomicina/uso terapêuticoRESUMO
OBJECTIVE: The aim of this study was to evaluate in vitro the antimicrobial efficacy of a modified 3-mix paste and to compare it with an iodoform paste (Ultrapex) against anaerobic microorganisms isolated from root canals of infected or necrotic primary teeth. STUDY DESIGN: An in vitro experimental assay was performed over isolated and identified anaerobic microorganisms of 21 samples, in order to compare the antimicrobial ability of both root canal filling materials, using a disc-diffusion method. RESULTS: A total of 21 microbial samples (15 polymicrobial and 6 monomicrobial) were obtained, from which 19 different strains were identified. Modified 3-mix paste showed an excellent antimicrobial effect against most of both kinds of microbial samples, although some of them exhibited resistance; on the other hand, Ultrapex showed only minimal antimicrobial ability (null or low categories). Clostridium ramosum exhibited the most resistance to both materials. CONCLUSION: The bactericidal effect of the modified 3-mix paste was superior to Ultrapex, with a statistically significant difference, against anaerobic microorganisms isolated from infected root canals of primary teeth.