RESUMO
La diabetes mellitus es una enfermedad metabólica que se caracteriza por tener un aumento en los niveles de glucemia, causando un estado inflamatorio sistémico que puede afectar la cicatrización de las lesiones periapicales presentes en la periodontitis apical, una enfermedad inflamatoria crónica causada por una infección endodóntica cuyo desarrollo está regulado por la respuesta inmunitaria del huésped. La diabetes podría interactuar con la periodontitis apical al desencadenar la modulación inmunitaria, pudiendo afectar la respuesta clínica de las lesiones periapicales e interferir con la cicatrización después del tratamiento endodóntico. El objetivo de esta revisión de la literatura es analizar la evidencia respecto a la relación entre la diabetes mellitus y la presencia y severidad de la periodontitis apical de origen endodóntico. Se recopilaron artículos de las bases de datos PubMed, Scopus y Web of Science entre los años 2016 y 2021. Se eligieron 31 artículos pertinentes para el estudio. En el 41,6% de los estudios se encontró una mayor presencia de periodontitis apical en pacientes con diabetes asociada a una lesión apical más compleja y comprometida. Un 25% de los estudios encontró que los pacientes diabéticos mal controlados presentan mayor presencia de periodontitis apical. Un 25% de los estudios encontró que niveles altos de HbA1c se asocian a la presencia de periodontitis apical. Se encontró una relación entre la diabetes y la periodontitis apical, por lo que la diabetes debe ser considerada como un factor preoperatorio importante en el desarrollo y severidad de la periodontitis apical, sin embargo, se deben realizar estudios experimentales más estandarizados para poder determinar con mayor exactitud esta relación, además de poder indagar la bidireccionalidad entre ambos.(AU)
Diabetes mellitus is a metabolic disease that is characterized by an increase in blood glucose levels, causing a systemic inflammatory state that can affect the healing of periapical lesions present in apical periodontitis, a chronic inflammatory disease caused by an endodontic infection whose development is regulated by the host's immune response. Diabetes could interact with apical periodontitis by triggering immune modulation, being able to affect the clinical outcome of periapical lesions and interfering with healing after endodontic treatment. The objective of this literature review is to analyze the evidence regarding the relationship between diabetes mellitus and the presence and severity of apical periodontitis of endodontic origin. Articles were collected from the PubMed, Scopus and Web of Science databases between the years 2016 and 2021. 31 relevant articles were included for this study. In 41.6% of the studies a greater presence of apical periodontitis was found in patients with diabetes associated with a more complex and compromised apical lesion. 25% of the studies reported that poorly controlled diabetic patients had a greater presence of apical periodontitis. 25% of the studies reported high levels of HbA1c in association with apical periodontitis. A relationship was found between diabetes and apical periodontitis, which means diabetes should be considered as an important preoperative factor in the development and severity of apical periodontitis; however, more standardized experimental studies should be carried out to determine this relationship more accurately, in addition to being able to investigate a bidirectionality between the two.(AU)
RESUMO
Introduction: The aim of this study was to describe a very rare case of endogenous bacterial endophthalmitis caused by Klebsiella pneumoniae in both eyes with a difference in the onset of symptoms of 14 months in an immunocompetent patient. Case Presentation: A 66-year-old immunocompetent man presented with asynchronous bilateral endogenous endophthalmitis produced by the K. pneumoniae bacterium at the starting point of a liver abscess after cholecystectomy surgery, causing endophthalmitis 1 year and 2 months apart between an eye and another. The first was diffuse anteroposterior endophthalmitis in the left eye that ended in visual loss and phthisis bulbi due to delayed initial diagnosis and established treatment, and the second was focal endophthalmitis in the right eye that preserved the organ and resulted in a vision of 20/20 due to early suspected diagnosis and rapid instituted treatment. Conclusion: To our knowledge, this is the first published case of a long asynchronous bilateral endogenous bacterial endophthalmitis caused by K. pneumoniae with a prolonged difference of 14 months in the onset of symptoms between one eye and another. This case is a vision-threatening ophthalmologic emergency that can be associated with life-threatening systemic morbidities. The early diagnosis of infection represents a challenge for clinicians, ophthalmologists, and microbiologists.
RESUMO
OBJECTIVES: To use three-dimensional anorectal ultrasonography (3D-US) to evaluate the outcome of ligation of the intersphincteric fistula tract (LIFT) in patients with crypto-glandular transsphincteric fistula and describing the patterns of healing, failure, and recurrence rate. METHODS: After classifying the fistula and determining the length of the sphincter muscle to be transected, the patients were submitted to LIFT. The accuracy of pre- and postoperative 3D-US with 360° endoprobe (16 MHz) with automatic scanning and clinical findings was evaluated against surgical findings. Three outcomes were considered: healing, failure (persistent anal fistula through the original external opening or intersphincteric), and recurrence (reappearance of the anal fistula). RESULTS: Sixty-three patients of both sexes were evaluated. The 3D-US assessment revealed primary healing in 50 (79.3%) patients, although in 6 (9.5%) cases healing was delayed and the cavity was without communication with the anal canal. The procedure failed in 9 (15.9%) and fistula recurred in 4 (6.3%), all of whom underwent a second surgery based on a new 3D-US, resulting in a 92.3% (12/13) healing rate on 3D-US. CONCLUSIONS: A 3D-US was found to be useful in the preoperative assessment of fistulas by quantifying the percentage of muscle to be transected, and in the postoperative assessment by identifying healing, types of failure, and recurrence. The 3D-US was accurate and consistent with surgical findings.
RESUMO
OBJECTIVE: To compare the short and long-term benefits (the length of hospital stay, surgical complications, and early clinical improvement) of adding early ultrasound-guided drainage to broad-spectrum antibiotic treatment. METHODOLOGY: Patients undergoing tubo-ovarian abscess treatment between January 2017 and June 2022 in a tertiary hospital were retrospectively evaluated. Of the patients studied, 50 subjects were treated with antibiotics alone and 63 underwent guided drainage. Twenty-one individuals underwent early drainage within 72 hours of admission, and 42 underwent guided drainage after this period. RESULTS: There was no statistical difference in the length of hospital stay between the groups simultaneously, averaging 6.4 days for the controls, 5.1 days for the early drainage group, and 9.6 days for the late drainage group (p = 0.290). In the multiple linear regression with the length of hospital stay outcome and adjusting for potential confounding factors, there was an average reduction of 2.9 days in the hospital stay (p = 0.04) for the early drainage group (< 72 hours) compared to the controls. Early clinical improvement and an expected drop in CRP were more frequent in patients who underwent drainage. Length of hospital stay increases with abscess diameter: 0.4 [(95% CI 0.1 - 0.7) (p = 0.05)] days per centimeter, regardless of other variables. CONCLUSIONS: Ultrasound-guided drainage of tubo-ovarian abscesses associated with antibiotic therapy is an effective treatment, with few complications, and may lead to clinical improvement especially when performed early.
Assuntos
Abscesso , Antibacterianos , Drenagem , Tempo de Internação , Doenças Ovarianas , Humanos , Feminino , Estudos Retrospectivos , Drenagem/métodos , Adulto , Estudos Transversais , Abscesso/terapia , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Doenças Ovarianas/terapia , Doenças Ovarianas/diagnóstico por imagem , Doenças Ovarianas/tratamento farmacológico , Doenças Ovarianas/cirurgia , Pessoa de Meia-Idade , Tratamento Conservador/métodos , Doenças das Tubas Uterinas/terapia , Doenças das Tubas Uterinas/diagnóstico por imagem , Doenças das Tubas Uterinas/cirurgia , Ultrassonografia de Intervenção/métodos , Resultado do Tratamento , UltrassonografiaRESUMO
Resumen El absceso cerebral es un proceso supurativo focal producido en la mayoría de los casos por agentes bacte rianos. Aggregatibacter aphrophilus es una bacteria gram negativa perteneciente al grupo HACEK, causante de endocarditis infecciosa, abscesos hepáticos, entre otras. Los abscesos cerebrales secundarios a este germen son infrecuentes y en la mayoría de los casos asociados a contactos con animales domésticos, pobre higiene dental o procedimientos odontológicos. El tratamiento consiste en drenaje del absceso (mayores de 2.5 cm) combinado con terapia antibiótica, idealmente betalactámicos. Se presenta el caso de un paciente varón de 64 años sin antecedentes de relevancia quien ingresó al servicio de emergencias por cuadro de cefalea, hemianopsias de una semana de evolución y posteriormente crisis tónico clónicas, en quien posteriormente en estudios imageno lógicos y cultivo de lesión cerebral se arribó al diagnóstico de absceso cerebral por A. aphrophilus. Este informe tiene como objetivo ilustrar al lector sobre la rareza de esta infección, debido a que A. aphrophilus forma parte normal de la flora orofaríngea y del tracto respiratorio, en los que rara vez ocasiona bacteriemias invasivas.
Abstract Brain abscess is a focal suppurative process pro duced in most cases by bacterial agents. Aggregati bacter aphrophilus is a gram-negative bacteria belong ing to the HACEK group, which causes infective endo carditis, liver abscesses, among others. Brain abscesses secondary to this germ are rare and, in most cases, it is associated with contact with pets, poor dental hygiene or dental procedures. Treatment consists of drainage of the abscess (greater than 2.5 cm) combined with antibiotic therapy, ideally beta-lactams. The case of a 64-year-old male patient with no relevant history is here presented. He was admitted to the emergency service due to headache, hemianopsia of a week's duration and later tonic-clonic seizures, in whom imaging studies and culture of a brain lesion subse quently revealed a brain abscess due to A. aphrophilus. This case aims to illustrate about the rarity of this infection, because A. aphrophilus is a normal part of the oropharyngeal flora and respiratory tract, in which it rarely causes invasive bacteremia.
RESUMO
El absceso cerebral es una infección localizada, una colección de material purulento en el parénquima cerebral, que puede surgir como complicación de otra infección o por traumatismo o cirugía. La infección por Nocardia spp. es poco común en pacientes inmunocompetentes, considerándose un agente oportunista. Se describe el caso de un paciente de 51 años, previamente sano, que consultó por cuadro insidioso de meses de evolución de cefalea holocraneana, además de convulsiones tónico-clónicas generalizadas, con picos febriles persistentes, en quien se diagnosticaron abscesos múltiples en el sistema nervioso central a un germen infrecuente.
Brain abscess is a localized infection, a collection of purulent material in the brain parenchyma, which can arise as a complication of another infection or from trauma or surgery. Infection by Nocardia spp. is uncommon in patients without immunocompromised, being considered an opportunistic agent. We present a case of a 51-year-old patient, previously healthy, who consulted for an insidious picture of holocranial headache of months of evolution, in addition to generalized tonic-clonic seizures, with persistent feverish peaks, in whom multiple abscesses were diagnosed in the central nervous system to an infrequent germ, such as Nocardia spp.
RESUMO
Objetivo: Evaluar la cicatrización por segunda intención en las heridas quirúrgicas obstétricas y ginecológicas complicadas con absceso de pared abdominal. Métodos: Estudio de tipo prospectivo, descriptivo, analítico y observacional, se estudiaron 38 pacientes con absceso de pared abdominal posterior a cesárea o cirugía ginecológica en quienes se implementó la cicatrización por segunda intención de la herida. Los datos obtenidos se expresaron como valores absolutos, en porcentajes y como media + desviación estándar. Se aplicó ANOVA para analizar los factores que influyeron en el tiempo de cierre de la herida, considerando un valor de p < 0,05 como estadísticamente significativo. Resultados: En cuanto a las características generales promedio se encontró edad 29,66 ± 10,65 años, peso 72,18 ± 14,21 kg, talla 1,62 ± 0,05 metros, e índice de masa corporal 27,62 ± 4,58 Kg/m2. Para los factores de riesgo, cirugías abdominales previas 44,74 %, infección urinaria 21,05 %, flujo vaginal 28,95 %, ruptura prematura de membranas 18,42 %, hipertensión arterial 39,47 %, diabetes 5,26 %, obesidad 31,58 % y tabaquismo 10,53 %. El germen más frecuente fue Staphylococcus aureus (35,14 %). El 52,63 % ameritó cambio de antibiótico. Se utilizaron apósitos en 55,26 %. El cierre de la herida tardó en promedio 31,30 ± 8,40 días. Las pacientes estuvieron 12,61 ± 5,78 días en hospitalización. Conclusiones: Se obtuvieron buenos resultados estéticos y funcionales, la utilización de apósitos no acelera el tiempo de cicatrización de las heridas(AU)
Objective: Objective: To evaluate healing by secondary intention in obstetric and gynecological surgical wounds complicated by abdominal wall abscess. Methods: A prospective, descriptive, analytical, and observational study was conducted in 38 patients with abdominal wall abscess after cesarean section or gynecological surgery in whom healing by second intention of the wound was implemented. The data obtained were expressed as absolute values, in percentages and as mean + standard deviation. ANOVA was applied to analyze the factors that influenced wound closure time, considering a p-value < 0.05 as statistically significant. Results: Regarding the average general characteristics, age was 29.66 ± 10.65 years, weight 72.18 ± 14.21 kg, height 1.62 ± 0.05 meters, and body mass index 27.62 ± 4.58 Kg/m2. For risk factors, previous abdominal surgeries 44.74%, urinary tract infection 21.05%, vaginal discharge 28.95%, premature rupture of membranes 18.42%, hypertension 39.47%, diabetes 5.26%, obesity 31.58% and smoking 10.53%. The most frequent germ was Staphylococcus aureus (35.14%). A total of 52.63% required a change of antibiotic. Dressings were used in 55.26 %. It took an average of 31.30 ± 8.40 days to close the wound. Patients spent 12.61 ± 5.78 days in hospitalization. Conclusions: Good aesthetic and functional results were obtained; the use of dressings does not accelerate the wound healing time(AU)
Assuntos
Humanos , Feminino , Gravidez , Adulto , Pessoa de Meia-Idade , Cicatrização , Parede Abdominal , Abscesso , Ferida Cirúrgica , CesáreaRESUMO
Objective: The aim of this study is to evaluate the etiological profile and antimicrobial resistance in breast abscess cultures from patients from the community, treated at a public hospital located in Porto Alegre, Brazil. Methods: This is an retrospective cross-sectional study that evaluated the medical records of patients with bacterial isolates in breast abscess secretion cultures and their antibiograms, from January 2010 to August 2022. Results: Based on 129 positive cultures from women from the community diagnosed with breast abscesses and treated at Fêmina Hospital, 99 (76.7%) of the patients had positive cultures for Staphylococcus sp, 91 (92%) of which were cases of Staphylococcus aureus. Regarding the resistance profile of S. aureus, 32% of the strains were resistant to clindamycin, 26% to oxacillin and 5% to trimethoprim-sulfamethoxazole. The antimicrobials vancomycin, linezolid and tigecycline did not show resistance for S. aureus. Conclusion: Staphylococcus aureus was the most common pathogen found in the breast abscess isolates during the study period. Oxacillin remains a good option for hospitalized patients. The use of sulfamethoxazole plus trimethoprim should be considered as a good option for use at home, due to its low bacterial resistance, effectiveness and low cost.
Assuntos
Abscesso , Antibacterianos , Humanos , Feminino , Estudos Transversais , Estudos Retrospectivos , Abscesso/microbiologia , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Pessoa de Meia-Idade , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Brasil , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Testes de Sensibilidade Microbiana , Farmacorresistência Bacteriana , Doenças Mamárias/microbiologia , Doenças Mamárias/tratamento farmacológico , Adulto Jovem , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , AdolescenteRESUMO
Hypervirulent K. pneumoniae infection has been raising worldwide and is one of the major causes of community-acquired pyogenic liver abscess. We described a case report of pyogenic liver abscess caused by an atypical hypervirulent (non-hypermucoviscous) K. pneumoniae K1 ST23 in a diabetic Asian patient who resided in Mexico. The susceptibility to antimicrobials, pathogenicity, molecular and genomic analysis were determined. A man from Guangdong (China) with a recent diagnosis of diabetes mellitus was admitted to the hospital, and he denied traveling in the last 3 months. A computed tomography revealed a right lobe liver abscess. On the third day after admission a Klebsiella pneumoniae isolate (14652) was obtained. The isolate corresponded to a susceptible K. pneumoniae with capsular type K1 and ST23 (CG23) and exhibited a non-hypermucoviscous phenotype. The isolate 14652 was genetically related to the globally distributed lineage ST23-KL1. This study describes the first case in Mexico of K. pneumoniae capsular type K1 and ST23 with an atypical hypervirulent phenotype.