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BACKGROUND The retropharyngeal abscess is a rare presentation of head and neck tuberculosis. The pathogenesis of the abscess formation in the retropharyngeal space in the adult is controversial. CASE REPORT We report a case of large retropharyngeal abscesses in a 46-year-old man with disseminated tuberculosis. The patient had severe progressive dysphagia, weight loss, and a slowly enlarging bilateral cervical mass during a period of three months. His posterior pharynx wall was bulging and red, and both tonsils were enlarged and congested. The neck had an abscess of 5 cm in diameter that was firm, tender, and warm along the left sternocleidomastoid muscle. Palpable bilateral lymphadenitis was detected in the submandibular, cervical, axillary, and inguinal regions. A computed tomographic (CT) scan of the neck revealed large bilobulated retropharyngeal abscesses. A liver ultrasound showed multiple hypoechoic lesions. A Ziehl-Neelsen smear for acid-fast bacilli was positive from different abscess samples, and mycobacterial cultures subsequently yielded Mycobacterium tuberculosis. Antituberculous therapy was begun and the retropharyngeal abscesses were aspirated by external incision with complete drainage and relief of symptoms. CONCLUSIONS Large retropharyngeal abscess is a rare entity in which Mycobacterium tuberculosis etiology should be considered, especially in endemic countries, and the diagnosis may be difficult because symptoms and signs are influenced by abscess size and time of onset, or if the etiology is not suspected.
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The present study estimates the prevalence of some enteropathogens in infants and preschoolers with acute diarrhea. From 2006 to 2007, 5459 consecutive stool samples were evaluated. Cryptosporidium parvum was the parasite identified with the higher frequency (5.1%), followed by Giardia lamblia (1.2%). Campylobacter jejuni was isolated in 858 cases (15.7%) and was the most frequent enteropathogen overall. The rates of C parvum, Shigella, and Salmonella were higher in the summer. Rotavirus had the expected winter peak and it was the third enteropathogen because of its frequency. Overall frequency of stool-reducing substances was 15.6% and was associated with a rotavirus-positive test.
Assuntos
Infecções Bacterianas/epidemiologia , Diarreia/parasitologia , Enteropatias Parasitárias/epidemiologia , Estações do Ano , Doença Aguda , Criança , Pré-Escolar , Estudos Transversais , Diarreia/epidemiologia , Diarreia Infantil/epidemiologia , Diarreia Infantil/parasitologia , Fezes/microbiologia , Fezes/parasitologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , México/epidemiologia , PrevalênciaRESUMO
OBJECTIVE: To identify serotypes and susceptibility of S. pneumoniae strains from 48 children with invasive infections and 50 carriers. MATERIAL AND METHODS: Typing was performed by the Quellung reaction and susceptibility by Kirby-Bauer and Etest according to CLSI standards. RESULTS: Of 31 meningeal strains, serotypes 19F, 3, 6B, 14 and 23F were predominant. Resistance to penicillin and STX was 16 and 58%, respectively; of 17 invasive non-meningeal strains, serotypes 19F and 3 were predominant and resistance to penicillin and SXT was 0 and 82%, respectively; of carrier strains, serotypes 6A, 6B, 19F and 23F were predominant. CONCLUSIONS: A 10-valent conjugate vaccine could offer a better coverage for meningeal strains.
Assuntos
Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/efeitos dos fármacos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , México , Testes de Sensibilidade Microbiana , Sorotipagem , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
Objective. To identify serotypes and susceptibility of S. pneumoniae strains from 48 children with invasive infections and 50 carriers. Material and Methods. Typing was performed by the Quellung reaction and susceptibility by Kirby-Bauer and Etest according to CLSI standards. Results. Of 31 meningeal strains, serotypes 19F, 3, 6B, 14 and 23F were predominant. Resistance to penicillin and STX was 16 and 58 percent, respectively; of 17 invasive non-meningeal strains, serotypes 19F and 3 were predominant and resistance to penicillin and SXT was 0 and 82 percent, respectively; of carrier strains, serotypes 6A, 6B, 19F and 23F were predominant. Conclusions. A 10-valent conjugate vaccine could offer a better coverage for meningeal strains.
Objetivo. Identificar serotipos y susceptibilidad en cepas aisladas de 48 niños con infecciones invasivas y de 50 portadores. Material y métodos. Serotipificación mediante reacción de Quellung y susceptibilidad mediante Kirby-Bauer y E-test. Resultados. De 31 cepas meníngeas, predominaron serotipos 19F, 3, 6B, 14 y 23F y la resistencia a penicilina (P) y trimetoprim-sulfametoxazol (SXT) fue de 16 y 58 por ciento. En 17 cepas invasivas no meníngeas, predominaron serotipos 19F y 3 y la resistencia a P y SXT fue de 0 y 82 por ciento, en cada caso. En portadores predominaron serotipos 6A, 6B, 19F y 23F. Conclusiones. La resistencia es similar a otros informes. La vacuna conjugada 10-valente podría ofrecer mejor cobertura para serotipos asociados a meningitis.
Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/efeitos dos fármacos , Estudos Transversais , México , Testes de Sensibilidade Microbiana , Sorotipagem , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
AIM: To determine the genotypes in Mexican hepatitis B virus (HBV) isolates and characterize their precore and core promoter mutations. METHODS: Forty-nine HBV isolates of Mexico obtained from sera of 15 hepatitis patients, 6 hemodialysis patients, 20 men seeking HIV testing, and 8 AIDS patients were analyzed. HBV isolates were amplified by PCR, and genotyped by line probe assay (INNO-LiPA HBV Genotyping; INNOGENETICS N V, Ghent, Belgium). HBV genotype confirmation was performed by DNA sequencing part of the sAg region. Precore and core promoter mutation characterization was performed by line probe assay (INNO-LiPA HBV PreCore; INNOGENETICS N V, Ghent, Belgium). RESULTS: Overall, HBV genotype H was found in 37 (75.5%) out of the 49 isolates studied. HBV genotypes G, A, and D were found in 5 (10.2%), 4 (8.2%), and 3 (6.1%) isolates, respectively. HBV genotype H was predominant in isolates from hemodialysis patients (100%), hepatitis patients (80%), and men seeking HIV testing (75%), and accounted for half of infections in AIDS patients (50%). Six (12.2%) out of the 49 HBV isolates showed both wild type and mutant populations at precore codon 28. These mixed wild type and precore mutant populations were observed in one HBV genotype A isolate and in all HBV genotype G isolates. A dual variant core promoter mutation was observed in 1 (2%) of the isolates, which was genotype H. CONCLUSION: HBV genotype H is highly predominant in HBV isolates of Mexico followed by genotypes G, A and D. A low frequency of precore and core promoter mutations is observed in HBV Mexican isolates.
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DNA Viral/genética , Vírus da Hepatite B/genética , Hepatite B/epidemiologia , Hepatite B/genética , Genótipo , Hepatite B/etnologia , Vírus da Hepatite B/classificação , Humanos , Masculino , México/epidemiologia , Mutação/genética , Prevalência , Proteínas do Core Viral/genéticaRESUMO
BACKGROUND: Drug resistance of hepatitis B virus (HBV) is an increasing clinical problem. Resistance to lamivudine in HBV isolates in Mexico has been poorly explored. OBJECTIVES: To characterize the mutation patterns associated with genotypic resistance to lamivudine and their prevalence among HBV isolates in Mexico. MATERIAL AND METHODS: Thirty-nine Mexican HBV isolates were analysed by PCR and line probe assay for detection of genetic variants in the polymerase open reading frame domains B and C (INNO-LiPA HBV DR; INNOGENETICS N. V., Ghent, Belgium). This assay detects wild-type and mutations at codons 180, 204 and 207 of the HBV polymerase gene, and at codon positions 171, 172, 195, 196, 198 and 199 of the HBV surface antigen (HBsAg). HBV isolates were obtained from HBsAg-positive serum samples of 15 chronic hepatitis patients, two haemodialysis patients with chronic HBV carriage, 20 men found positive for HBsAg when seeking HIV testing and two AIDS patients with chronic HBV infection. None of the participants had received antiviral therapy. RESULTS: Overall, HBV wild-type was found in 37 (94.9%) out of the 39 isolates studied. Two (5.1%) out of the 39 isolates showed mixed wild-type and mutant populations. These mutations occurred in isolates from one hepatitis patient and one haemodialysis patient. The isolate from the hepatitis patient showed a double mutation at codon positions 180 (L180M) and 204 (M204V), thus a 2.6% prevalence of genotypic resistance to lamivudine was found. The isolate from the haemodialysis patient showed a single mutation at codon position 180 (L180M). The two HBV mutant isolates were further analysed for genotype and both isolates were genotype H. CONCLUSIONS: HBV genotypic resistance to lamivudine exists in Mexican isolates. The results highlight the importance of testing for HBV resistance before treatment and have implications for a more rational use of drugs.
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Farmacorresistência Viral/genética , Vírus da Hepatite B/efeitos dos fármacos , Hepatite B/virologia , Lamivudina/farmacologia , Inibidores da Transcriptase Reversa/farmacologia , Códon/genética , DNA Viral/biossíntese , DNA Viral/genética , Amplificação de Genes , Genótipo , Hepatite B/epidemiologia , Antígenos de Superfície da Hepatite B/imunologia , Humanos , México/epidemiologiaRESUMO
BACKGROUND: Persistent diarrhea (PD) of infancy has incurred high morbidity and lethality. However, decrease in its prevalence, morbidity, and lethality appeared to occur progressively throughout the last decade of the twentieth century. Our objective in this study was to compare prevalence, lethality, and morbidity of infants and children with PD managed in a pediatric referral hospital. METHODS: We conducted a comparative cross-sectional study. A total of 546 patients with PD managed during three different periods (1988-1991, 1993-1994, and 1997-1999) were described and analyzed. Prevalence x 100 admissions, prevalence rates of nutritional status, sepsis, pneumatosis intestinalis, carbohydrate and protein intolerance, and lethality were calculated. We used Student t and chi2 tests (alpha = 0.05). RESULTS: Mean age on admission was 13.8 +/- 24.3 months; 296 (54.2%) patients were males. Prevalence of admissions for PD decreased gradually from 31.7 to 13.8%; rates of lethality and mortality remained unchanged. Malnutrition had high prevalence throughout the three periods evaluated. Rate of carbohydrate intolerance diminished but protein intolerance increased; proportion of pneumatosis intestinalis and bowel perforation did not change. Isolation of Salmonella spp. and small bowel bacterial overgrowth decreased significantly from the 1988-1991 series when compared with later series. CONCLUSIONS: Although these observations were made at a pediatric referral hospital, they may suggest that prevalence of PD is diminishing. However, its lethality and mortality rates remain unchanged. Malnutrition persists as a relevant associated factor. Decrease of carbohydrate intolerance and increase in protein intolerance rates resemble rates of children with PD of developed countries. These observations may reflect an epidemiologic transition of PD in Mexico.
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Diarreia Infantil/epidemiologia , Diarreia Infantil/mortalidade , Animais , Pré-Escolar , Estudos Transversais , Diarreia Infantil/microbiologia , Carboidratos da Dieta/metabolismo , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , Desnutrição , México/epidemiologia , Estudos RetrospectivosRESUMO
OBJECTIVE: To analyze the results of a stool work-up protocol in a series of infants and preschoolers with acute diarrhea. MATERIAL AND METHODS: A cross-sectional descriptive study was conducted between April 1999 and March 2000, among 288 children seen at a pediatric office in Guadalajara, Mexico. The mean age (+/-/SD) was 23.1 +/- 13.9 months; 43% were females. Data were collected on demographic and clinical characteristics. The stool work-up consisted of fresh smear and methylene blue and Kinyoun smears, as well as determination of pH and reducing substances. Stool culture was performed in samples with > or = 3 leukocytes/microscopic field and rotavirus antigen detection only in selected cases. Data were analyzed using descriptive statistics, chi 2, odds ratios, and 95% confidence intervals. RESULTS: Enterophatogens (%) identified were: rotavirus 47.1, Campylobacter jejuni 27.4, Salmonella spp. 5.1, Shigella spp. 4.3, Cryptosporidium parvum 2.8, Giardia lamblia 2.4, Blastocystis hominis 1.4, Entamoeba histolytica 0.7. An OR of 5.7 was obtained for isolation of enteroinvasive bacteria in the presence of fecal leukocytes. Lactose intolerance was detected in 19.1%. The frequencies of rotavirus antigen identification and lactose intolerance were significantly higher in infants; the OR for lactose intolerance in infants with rotavirus was 21. Mucus and blood in the stools were associated to enteroinvasive bacteria and Cryptosporidium parvum. CONCLUSIONS: The current stool work-up protocol allowed the identification of enteropathogenic parasites, rotavirus and lactose intolerance in a short period of time. Leukocytes in stools were associated to the isolation of enteroinvasive bacteria. The frequency of agents associated to diarrheal disease was similar to that from other national studies. This stool work-up protocol could be useful as a tool to limit the unnecessary prescription of drugs and to follow universal recommendations for dietary management of these patients. The English version of this paper is available at: http://www.insp.mx/salud/index.html.
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Diarreia/diagnóstico , Fezes/química , Doença Aguda , Animais , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/epidemiologia , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Diarreia/epidemiologia , Diarreia/microbiologia , Diarreia/parasitologia , Diarreia/terapia , Diarreia/virologia , Fezes/microbiologia , Fezes/parasitologia , Fezes/virologia , Feminino , Hidratação , Humanos , Lactente , Enteropatias Parasitárias/diagnóstico , Enteropatias Parasitárias/epidemiologia , Intolerância à Lactose/diagnóstico , Intolerância à Lactose/epidemiologia , Contagem de Leucócitos , Masculino , México/epidemiologia , Infecções por Protozoários/diagnóstico , Infecções por Protozoários/epidemiologia , Infecções por Rotavirus/diagnóstico , Infecções por Rotavirus/epidemiologiaRESUMO
OBJECTIVE: To analyze the results of a stool work-up protocol in a series of infants and preschoolers with acute diarrhea. MATERIAL AND METHODS: A cross-sectional descriptive study was conducted between April 1999 and March 2000, among 288 children seen at a pediatric office in Guadalajara, Mexico. The mean age (+/-/SD) was 23.1 +/- 13.9 months; 43 were females. Data were collected on demographic and clinical characteristics. The stool work-up consisted of fresh smear and methylene blue and Kinyoun smears, as well as determination of pH and reducing substances. Stool culture was performed in samples with > or = 3 leukocytes/microscopic field and rotavirus antigen detection only in selected cases. Data were analyzed using descriptive statistics, chi 2, odds ratios, and 95 confidence intervals. RESULTS: Enterophatogens () identified were: rotavirus 47.1, Campylobacter jejuni 27.4, Salmonella spp. 5.1, Shigella spp. 4.3, Cryptosporidium parvum 2.8, Giardia lamblia 2.4, Blastocystis hominis 1.4, Entamoeba histolytica 0.7. An OR of 5.7 was obtained for isolation of enteroinvasive bacteria in the presence of fecal leukocytes. Lactose intolerance was detected in 19.1. The frequencies of rotavirus antigen identification and lactose intolerance were significantly higher in infants; the OR for lactose intolerance in infants with rotavirus was 21. Mucus and blood in the stools were associated to enteroinvasive bacteria and Cryptosporidium parvum. CONCLUSIONS: The current stool work-up protocol allowed the identification of enteropathogenic parasites, rotavirus and lactose intolerance in a short period of time. Leukocytes in stools were associated to the isolation of enteroinvasive bacteria. The frequency of agents associated to diarrheal disease was similar to that from other national studies. This stool work-up protocol could be useful as a tool to limit the unnecessary prescription of drugs and to follow universal recommendations for dietary management of these patients.
Assuntos
Humanos , Animais , Masculino , Feminino , Lactente , Pré-Escolar , Diarreia , Fezes , Estudos Transversais , Estudos de Coortes , Diarreia , Fezes , México , Contagem de Leucócitos , Doença Aguda , Enteropatias Parasitárias/diagnóstico , Enteropatias Parasitárias/epidemiologia , Hidratação , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/epidemiologia , Infecções por Protozoários/diagnóstico , Infecções por Protozoários/epidemiologia , Infecções por Rotavirus/diagnóstico , Infecções por Rotavirus/epidemiologia , Intolerância à Lactose/diagnóstico , Intolerância à Lactose/epidemiologiaRESUMO
Background. Bacteriuria = 10 to fifth CFU/ml is evidence of urinary tract infection in the absence of associated signs or symptoms. The presence of pyuria with asymptomatic bacteriuria established the response of elderly women against microorganisms capable of causing invasiveness or tissue injury of the urinary tract. Methods. The association between bacteriuria and pyuria was determined in 178 elderly, ambulatory women without symptoms of urinary tract infection in seven nursing homes. Urine culture results were subsequently analyzed in conjunction with absolute leukocyte count in urine. In this cross-sectional study, asymptomatic bacteriuria in elderly women was classified with and without pyuria. Results. The prevalence of asymptomatic bacteriuria was found in 44 (24.7 percent) elderly women. The presence of pyuria had a sensitivity of 63.6 percent for bacteriuria and a specificity of 91 percent. The positive predictive value for the presence of pyuria predicting those with bacteriuria was 70 percent, and the negative predictive value for the absence of pyuria predicting those without bacteriuria was 88.4 percent. Escherichia coli was the most common organism isolated in 81.8 percent of the women. Conclusions. bacteriuria = 10 to fifth CFU/ml associated with pyuria was detected in 77 percent of elderly women with asymptomatic urinary tract infections bacteriuria of < 10 to fifth CFU/ml with pyuria proves less sensitive as an indicator of urinary tract infection. Elderly women with pyuria but without bacteriuria should be studied for other causes of urinary tractinflammation