RESUMO
BACKGROUND: Clostridium difficile (C. difficile) is a gram-positive anaerobic bacillus capable of producing diarrhea or colitis in the hospitalized patient, particularly in those exposed to the use of antibiotics, and 6% to 38% mortality in patients with C. difficile-associated diarrhea (CDAD) has been described. AIMS: To determine the hospital death rate in patients presenting with CDAD. As a secondary aim, hospital stay and risk factors for unfavorable outcome were recorded. METHODS: A retrospective cohort study was carried out. The case records of hospitalized patients presenting with diarrhea and that tested positive for C. difficile through toxin A and B assays were reviewed. The number of non-surviving patients that presented with CDAD during hospitalization was recorded along with the principal factors associated with the worst outcome. RESULTS: Of the 66 patients enrolled in the study, 6 (9,1%) died during their hospitalization. The median age was lower in the group of surviving patients than in the group of non-surviving patients, with 51,5 years (range 36 to 66,75) and 81,5 years (range 69,5 to 83,25), respectively (p=0,002). Hospital stay was 32,50 days (range 8,25 to 64,25) in the group of non-surviving patients and was 6,5 days (range 4 to 15,75) (p=0,045) in the group with no deaths. CONCLUSIONS: The elevated mortality found in the hospitalized CDAD patients in the Intensive Care Unit makes the maintenance of strict surveillance in this population imperative so there can be opportune detection and treatment.
Assuntos
Clostridioides difficile , Diarreia/epidemiologia , Enterocolite Pseudomembranosa/epidemiologia , Adolescente , Adulto , Idoso , Estudos de Coortes , Diarreia/terapia , Enterocolite Pseudomembranosa/terapia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Intraperitoneal inoculation of axenically cultured Entamoeba histolytica trophozoites constitutes an easy to perform, highly reproducible procedure for inducing amebic liver abscesses in hamsters. Efficiency in abscess production (95% of infected animals after 1 week) was similar to data reported using direct intrahepatic or intraportal inoculation. The morphological sequence of infection shows that amebas in the peritoneal cavity initially produce a large exudate constituted mainly of acute inflammatory cells. These cells form a rim of polymorphonuclear leukocytes surrounding the amebas, which adhere to the trophozoite and can sometimes be observed polarized to one end of the parasite, suggesting capping of surface receptors. Early stages are also characterized by the production of distant inflammatory reactions in the hepatic portal spaces. At 6 h postintraperitoneal inoculation, larger foci of inflammatory reactions surrounding amebas are developed in the peritoneum, extending to and damaging the liver surface membranes as well as the serosa of other internal organs. Thereafter, tissue damage progresses deeper into the liver parenchyma, and a few days later, coalescing granulomas and large necrotic areas are observed in the liver tissue. Based on the present morphological time-sequence study, we suggest that inflammatory cells associated with E. histolytica trophozoites play an important role in commencing the damage of liver sheaths and producing the subsequent parenchymal lesions. The simplicity and reliability of this model are important factors to consider when large numbers of experimentally induced amebic liver abscesses are needed.
Assuntos
Entamoeba histolytica/fisiologia , Abscesso Hepático Amebiano/parasitologia , Fígado/parasitologia , Cavidade Peritoneal/parasitologia , Animais , Cricetinae , Entamoeba histolytica/patogenicidade , Entamoeba histolytica/ultraestrutura , Fígado/patologia , Fígado/ultraestrutura , Abscesso Hepático Amebiano/patologia , Masculino , Mesocricetus , Microscopia Eletrônica , Cavidade Peritoneal/patologia , VirulênciaAssuntos
Antígenos de Protozoários/análise , Entamoeba histolytica/patogenicidade , Inflamação/patologia , Fígado/parasitologia , Proteínas de Protozoários/análise , Animais , Cricetinae , Entamoeba histolytica/química , Entamoeba histolytica/imunologia , Interações Hospedeiro-Parasita , Imuno-Histoquímica , Fígado/citologia , Microscopia Imunoeletrônica , Fatores de TempoRESUMO
Rat livers inoculated intraportally with trophozoites of E. histolytica were studied by light and electron microscopy. At one hour post-inoculation, trophozoites were localized at the hepatic sinusoids without inflammatory reaction and only slight vascular congestion. From two hours post-inoculation, trophozoites were associated with small inflammatory foci distributed at random. At three to four hours, trophozoites showed signs of cellular damage. After eight hours, no parasites were seen and only some lymphoplasmocytic infiltration were detected. It is suggested that in the experimental hepatic amebic infection in the rat the acuta inflammatory reaction associated to trophozoites plays a role in the parasite rejection.