RESUMO
Because of its infrequent and protean presentation and the lack of clinical data, the management of acute infections with the foodborne trematode Fasciola hepatica is challenging. We report four serologically confirmed cases that illustrate our experience with this parasitic infection in Chile. All patients were adults presenting with upper abdominal pain. Other symptoms included fever, nausea/vomiting, and cutaneous manifestations. In all cases, marked eosinophilia was present. All patients lived in an urban environment, and three reported the consumption of raw watercress. Computed tomography (CT) scans showed hypodense hepatic lesions, whereas ultrasonography findings were unremarkable. One patient suffered portal vein thrombosis, which might be a rare complication of acute fascioliasis. All patients were successfully treated with triclabendazole. Our case series demonstrates that patients with acute fascioliasis typically present with a combination of upper abdominal pain, marked eosinophilia, and hypodense hepatic lesions on CT imaging. Diagnosis should be confirmed by serological investigation. A history of recent consumption of raw watercress is an important finding, but in some patients the source of infection remains obscure.
Assuntos
Benzimidazóis/uso terapêutico , Fasciola hepatica/patogenicidade , Fasciolíase , Animais , Anti-Helmínticos/uso terapêutico , Benzimidazóis/administração & dosagem , Benzimidazóis/farmacologia , Chile , Diagnóstico por Imagem , Fasciola hepatica/efeitos dos fármacos , Fasciolíase/diagnóstico , Fasciolíase/diagnóstico por imagem , Fasciolíase/tratamento farmacológico , Fasciolíase/patologia , Feminino , Doenças Transmitidas por Alimentos/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Triclabendazol , Adulto JovemRESUMO
Oral ulcers are a frequent problem in transplant medicine. It is important to consider infectious etiologies, exacerbated by the immunosuppressive treatment, but other etiologies are also possible, like adverse drug reactions. Mycophenolate mofetil (MMF) is an immunosuppressive medication that has been used in combination with calcineurin inhibitors and steroids. Reports of renal transplant patients with oral ulcers related to MMF have appeared lately and herein we have described 2 cases in liver transplant patients. Their oral ulcers resolved quickly after suspension of the medication. Our 2 cases in liver transplant patients represented a unique setting for this type of complication.
Assuntos
Imunossupressores/efeitos adversos , Transplante de Fígado/imunologia , Ácido Micofenólico/análogos & derivados , Úlceras Orais/induzido quimicamente , Adulto , Antibacterianos/uso terapêutico , Ciclosporina/uso terapêutico , Feminino , Humanos , Resistência a Meticilina , Pessoa de Meia-Idade , Ácido Micofenólico/efeitos adversos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus , Resultado do TratamentoRESUMO
BACKGROUND: Spondylodiscitis is a rare but prolonged inflammation of two adjacent vertebral bodies and the disk in between. AIM: To report the clinical features of a series of patients with spondylodiscitis. MATERIAL AND METHODS: A retrospective analysis of medical records of patients with spondylitis, identified between 1989 and 2002. RESULTS: A total of 25 cases were identified, 15 female, aged 49.8 years as a mean. Their mean evolution before admission was 4.3 months. Main complaints were back or radicular pain. Mild anemia was present in most patients. Mean erythrocyte sedimentation rate and C reactive protein values were 66 mm/h and 60 mg/L, respectively. Forty four percent of patients had neurological complications. Vertebral computed tomography and scintigraphic studies were done in 72 per cent of patients, but magnetic resonance imaging was done only in 4 (16 per cent). In 18 patients, a tissue sample for pathological and microbiological analysis, was obtained by imaging guiding or surgically. Tuberculosis, diagnosed on pathology, was the leading cause of spondylitis in nine cases (36 per cent), followed by Staphylococcus aureus infection in five (20 per cent). Other agents found were E coli and group D Streptococcus (one each). Age, symptoms, evolution time and different laboratory parameters did not differ between patients with tuberculosis and patients with other causes. A microbiological cause was not established in 36 per cent of cases. Most patients evolved satisfactorily and recovered from neurological complications (88 per cent). One patient with tuberculosis did not improve after prolonged treatment and 2 patients infected with S aureus died (8 per cent). CONCLUSIONS: Spondylodiscitis is associated to a diversity of microbial agents and in most cases has a favorable prognosis.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Discite/microbiologia , Vértebras Lombares/microbiologia , Discite/diagnóstico , Discite/terapia , Estudos Retrospectivos , Imageamento por Ressonância Magnética , Infecções Estafilocócicas/complicações , Sedimentação Sanguínea , Seguimentos , Tomografia Computadorizada por Raios X , Tuberculose da Coluna Vertebral/complicaçõesRESUMO
Since 1994 an extensive epidemic of infections with Salmonella enteritidis (S. enteritidis) has affected Chile. In order to understand the diversity of infective sources, the possible origin of the epidemic, and the epidemiological relationships between clinical, food, and poultry isolates, we carried out phage typing of three groups of samples: 1) 310 S. enteritidis clinical samples collected between 1975 and 1996, 2) 47 food isolates obtained during S. enteritidis outbreaks, and 3) 27 strains isolated in surveillance studies of poultry-raising establishments. With the clinical samples, a total of 13 phage types were identified, 2 isolates could not be typed, and 1 was considered atypical. The phage types that were identified most frequently were 1 (56.8%) and 4 (31.3%), trailed by type 8 (4.8%) and type 28 (1.9%). Over time and in different regions of the country there were major changes in the distribution of the phage types. In the first years of collection the only phage types registered were 8 and 28, which disappeared around 1980 and then began reappearing sporadically in 1996. With the gradual S. enteritidis expansion that started in 1988, in the central and southern areas of the country phage type 4 began to appear; that type had not been found before in Chile. In 1991 in the northern area of the country phage type 1 began to predominate; it was another type that had not been reported before in Chile. In the food isolates the only phage types identified were 1 and 4, which were also the most common in the poultry isolates. Phage typing of S. enteritidis has proved to be useful in guiding the epidemiological analysis of the infections caused by this pathogen.
Assuntos
Tipagem de Bacteriófagos , Microbiologia de Alimentos , Aves Domésticas/microbiologia , Infecções por Salmonella/microbiologia , Salmonella enteritidis/classificação , Animais , Chile , HumanosRESUMO
BACKGROUND: The virulence of Streptococcus pyogenes is determined by a variety of structural molecules, toxins and complex enzymes. Pyrogenic exotoxins cause fever, erythematous reactions, cytotoxic and immunological effects. AIM: To assess the frequency of speA, SpeB and SpeC genes in Chilean Streptococcus pyogenes strains and their association with the invasiveness of infections. MATERIAL AND METHODS: The genes for pyrogenic exotoxins SpeA, SpeB and SpeC were determined by polymerase chain reactions in 114 strains of group A Streptococcus pyogenes isolated from Chilean patients with invasive or non invasive infections. RESULTS: The gene for SpeA was present in 30.7% of isolates, the gene for SpeB was present in 69.3% and the gen for SpeC in 44.7% of isolates. The gene for SpeA was present in 20 of 33 invasive infections and in 15 of 81 non invasive infections (p < 0.0001). On the contrary, the gene for SpeC was present in 11 of 33 invasive infections and in 41 of 81 non invasive infections (p < 0.05). The frequency of speB was similar in invasive and non invasive infections. CONCLUSIONS: There is a clear relationship between the presence of SpeA genes and the severity of infections caused by Streptococcus pyogenes.
Assuntos
Proteínas de Bactérias/genética , Cisteína Endopeptidases/genética , Exotoxinas/genética , Genes Bacterianos/genética , Proteínas de Membrana/genética , Pirogênios/genética , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes/genética , Genótipo , Humanos , Reação em Cadeia da Polimerase , Streptococcus pyogenes/isolamento & purificação , Streptococcus pyogenes/patogenicidade , Virulência/genéticaRESUMO
BACKGROUND: Salmonella enteritidis (SE) is a frequent cause of diarrhea, and is transmitted mainly by SE contaminated eggs or poultry meat. The frequency of SE contaminated eggs or chicken meat and the risk for acquiring this pathogen is unknown in Chile. AIM: To measure SE contamination in eggs poultry meat and entrails offered in retail markets in the Metropolitan Area during two consecutive years (1998-1999). MATERIAL AND METHODS: Samples were placed in sterile bags and transported to the laboratory before 4 hours at 4 degrees C. Microbiologic detection was done using a standard procedure and an immunodetection assay. RESULTS: SE was found in one of 1081 egg samples (0.09%). The contaminated sample was offered in a supermarket under their own commercial name. Six percent of 1154 poultry meat samples were contaminated by SE and 2.3% by other Salmonella serotypes. Entrails had even higher rates with 10.2% of 370 samples harboring SE and 2.7% other serotypes. Total Salmonella sp. isolates and SE isolates declined during 1999. Nine SE phagotypes were identified, predominating types 4 and 7. CONCLUSIONS: Eggs and other avian products are contaminated by different SE phagotypes and other Salmonella serotypes, implicating a risk for the consumers (Rev Méd Chile 2000; 128: 1075-83).
Assuntos
Ovos/microbiologia , Microbiologia de Alimentos , Produtos Avícolas/microbiologia , Salmonella enteritidis/isolamento & purificação , Animais , Galinhas , Chile , Humanos , Saúde da População UrbanaRESUMO
To determine clonal relationship among Chilean enterohemorrhagic Escherichia coli (EHEC) strains from different sources (clinical infections, animal reservoirs, and food), 54 EHEC isolates (44 of E. coli O157, 5 of E. coli O111, and 5 of E. coli O26) were characterized for virulence genes by colony blot hybridization and by pulsed-field gel electrophoresis (PFGE). By colony blotting, 12 different genotypes were identified among the 44 E. coli O157 isolates analyzed, of which the genetic profile stx1+ stx2+ hly+ eae+ was the most prevalent. All human O157 strains that were associated with sporadic cases of hemolytic-uremic syndrome (HUS) carried both the stx1 and stx2 toxin-encoding genes and were eaeA positive. Only 9 of 13 isolates from human controls were stx1+ stx2+, and 8 carried the eaeA gene. Comparison of profiles obtained by PFGE of XbaI-digested genomic DNA showed a great diversity among the E. coli O157 isolates, with 37 different profiles among 39 isolates analyzed. Cluster analysis of PFGE profiles showed a wide distribution of clinical isolates obtained from HUS cases and asymptomatic individuals and a clonal relationship among O157 isolates obtained from HUS cases and pigs. Analysis of virulence genes showed that a correlation exists among strains with the genotype stx1+ stx2+ eae+ and pathogenic potential. A larger difference in the PFGE restriction patterns was observed among the EHEC strains of serogroups O26 and O111. These results indicate that several different EHEC clones circulate in Chile and suggest that pigs are an important animal reservoir for human infections by EHEC. Guidelines have been proposed for better practices in the slaughter of animals in Chile.
Assuntos
Escherichia coli O157/classificação , Escherichia coli O157/genética , Microbiologia de Alimentos , Síndrome Hemolítico-Urêmica/microbiologia , Animais , Chile , Reservatórios de Doenças , Escherichia coli O157/isolamento & purificação , Genes Bacterianos , Variação Genética , Humanos , Filogenia , Valores de Referência , SorotipagemRESUMO
Group A Streptococcal infections have increased in severity and frequency worldwide. We report a female patient that was admitted by Group A Streptococcal lethal toxic shock syndrome due to pharyngitis as the primary focus and without cutaneous involvement. Streptococcus pyogenes was isolated from blood cultures and case definition fulfilled standard recommendations. Epidemiological studies among family members showed, that two children (aged 5 and 12 years) harbored the same strain in their pharynxes as confirmed by arbitrarily primed PCR (AP-PCR) using primers ERIC and Pn-1. Control strains were included in the analysis. None of three health care workers involved in intubation and laryngoscopic procedures with the patient carried S pyogenes. AP-PCR appears to be a useful and rapid procedure to demonstrate clonal relatedness among S pyogenes strains.
Assuntos
Choque Séptico/microbiologia , Infecções Estreptocócicas/complicações , Streptococcus pyogenes/genética , Adulto , Feminino , Humanos , Reação em Cadeia da Polimerase , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes/isolamento & purificação , Streptococcus pyogenes/patogenicidadeRESUMO
BACKGROUND: Salmonella enteritidis infections have increased worldwide in the last years. Isolation of this pathogen was remarkably rare in Chile until 1994, when the still ongoing outbreak emerged. AIM: To assess the main epidemiological characteristics of the Salmonella enteritidis epidemic in Chile. MATERIALS AND METHODS: Cases of clinical infections by Salmonella enteritidis were recorded from bacteriological and demographic notifications obtained at The National Reference Laboratory for Enterobacteria. Infection rates were calculated using the total Chilean population and the population of the different Health Services along the country. RESULTS: Until 1993, 13.67 Salmonella enteritidis strains per year were received at the Reference Laboratory. The figures increased to 478 and 432 in 1994 and 1995, respectively. National rates were 3.41 and 3.04 notifications/100,000 inhabitants in 1994 and 1995 respectively. Northern regions were the most affected and 90% of observed cases during 1994 came from Arica and Antofagasta. At the present time, 20% of cases are observed in Santiago, located in the mid-portion of the country. The outbreak has mainly affected children and young adults (70% of cases). Strains have been isolated from stool cultures, suggesting gastrointestinal infections as the main clinical presentation. More than 98% of strains are susceptible to chloramphenicol, ampicillin, tetracycline, sulfa-trimetroprim, cefotaxime or ciprofloxacin. CONCLUSIONS: The obtained data clearly indicate the existence of an epidemic outbreak of Salmonella enteritidis infections, with a geographic progression from North to South.
Assuntos
Infecções por Salmonella/epidemiologia , Salmonella enteritidis/isolamento & purificação , Chile/epidemiologia , Surtos de Doenças , Humanos , PrevalênciaRESUMO
BACKGROUND: Pseudomonas aeruginosa and Acinetobacter baumanii are two important nosocomial agents that require permanent testing of their antimicrobial susceptibility. AIM: To use E-test to determine minimal inhibitory concentrations, estimate bacterial diversity and presumably identify B-lactamases of strains of Pseudomonas aeruginosa and Acinetobacter baumanii isolated from nosocomial infections. MATERIALS AND METHODS: Sixty eight strains of Pseudomonas aeruginosa and Acinetobacter baumanii isolated in a teaching hospital were analyzed with E-test strips to determine their minimal inhibitory concentrations for different antimicrobials. RESULTS: More than 75% of Acinetobacter baumanii were resistant to Piperacillin, Cefpirome, Cefepime, Gentamicin or Amikacin, 40% of strains were resistant to Ceftazidime, 27 and 53% of isolates had a decreased susceptibility to Meropenem and Piperacillin-tazobactam respectively. Twenty eight to 54% of Pseudomonas aeruginosa strains were resistant to Cefepime, Cefpirome, Ciprofloxacin and Gentamicin. Eighteen and 10% of strains were resistant to Meropenem and Imipenem respectively. Less than 10% of strains were resistant to Amikacin, Azireonam, Piperacillin-tazobactam or Ceftazidime. Most of beta-lactam resistance of Pseudomonas aeruginosa was associated to decreased susceptibility or resistance to Cefpirome, Cefepime or to Meropenem-Imipenem and did not match clearly with known beta-lactamase profiles. CONCLUSIONS: The knowledge of susceptibility of these bacteria responsible for nosocomial infections, will help to plan the appropriate use of antimicrobials.