RESUMO
Cronobacter spp. (formerly Enterobacter sakazakii) are rare causes of infant septicemia and meningitis, resulting in death in approximately 40% of cases. Since 1958, 120 cases of Cronobacter infection in infants have been reported, an average of fewer than three cases per year worldwide. Powdered infant formula (PIF), which is not sterile, has been implicated repeatedly as a vehicle of Cronobacter infection; consequently, the World Health Organization (WHO) has issued guidelines for safer preparation, handling, and storage of PIF. This report describes isolation of Cronobacter spp. in two nonhospitalized, unrelated infants (one male and one female) in New Mexico in 2008; one infant developed severe brain injury and hydrocephalus, and the other infant died. An investigation by the New Mexico Department of Health (NMDOH) determined that PIF consumption was the only known risk factor in the two cases, although the sources of the Cronobacter spp. could not be determined. Cronobacter spp. were not isolated from sealed canisters of formula associated with the two infants, and clinical isolates from the infants differed by pulsed-field gel electrophoresis (PFGE). However, a Cronobacter organism was isolated from an opened canister of formula consumed by the male infant and was indistinguishable from an isolate from his postmortem blood culture. Education of formula preparers regarding potential PIF contamination, universal adoption of WHO PIF preparation guidelines, and continued improvement of PIF manufacturing processes might help prevent Cronobacter infection among infants.
Assuntos
Abscesso Encefálico/microbiologia , Cronobacter sakazakii/isolamento & purificação , Infecções por Enterobacteriaceae/complicações , Fórmulas Infantis , Infecções por Enterobacteriaceae/sangue , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/genética , Evolução Fatal , Feminino , Humanos , Hidrocefalia/microbiologia , Lactente , Masculino , Hipertonia Muscular/etiologia , New MexicoRESUMO
UNLABELLED: Enterococci are an uncommon cause of CNS infection. A 20 month-old boy, diagnosed with hydrocephalus with ventriculoperitoneal shunt and history of lengthy hospitalization and use of wide spectrum antibiotics, was admitted to the pediatric intensive care unit diagnosed with ventriculitis. On the 14th day of empirical antibiotic therapy (vancomycin and meropenem) the child presented fever while the CSF sample culture evidenced vancomycin-resistant Enterococcus faecium. The patient received intravenous linezolid achieving cerebrospinal fluid sterilization. CONCLUSION: Intravenous linezolid appears to be a safe and effective therapy for vancomycin-resistant enterococcus ventriculoperitoneal shunt infection.
Assuntos
Acetamidas/uso terapêutico , Anti-Infecciosos/uso terapêutico , Ventrículos Cerebrais/microbiologia , Encefalite/tratamento farmacológico , Enterococcus faecium/isolamento & purificação , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Oxazolidinonas/uso terapêutico , Resistência a Vancomicina , Encefalite/microbiologia , Enterococcus faecium/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Hidrocefalia/tratamento farmacológico , Hidrocefalia/microbiologia , Lactente , Linezolida , Masculino , Resultado do Tratamento , Derivação VentriculoperitonealRESUMO
Enterococci are an uncommon cause of CNS infection. A 20 month-old boy, diagnosed with hydrocephalus with ventriculoperitoneal shunt and history of lengthy hospitalization and use of wide spectrum antibiotics, was admitted to the pediatric intensive care unit diagnosed with ventriculitis. On the 14th day of empirical antibiotic therapy (vancomycin and meropenem) the child presented fever while the CSF sample culture evidenced vancomycin-resistant Enterococcus faecium. The patient received intravenous linezolid achieving cerebrospinal fluid sterilization. Conclusion: Intravenous linezolid appears to be a safe and effective therapy for vancomycin-resistant enterococcus ventriculoperitoneal shunt infection.
Assuntos
Humanos , Lactente , Masculino , Acetamidas/uso terapêutico , Anti-Infecciosos/uso terapêutico , Ventrículos Cerebrais/microbiologia , Encefalite/tratamento farmacológico , Enterococcus faecium/isolamento & purificação , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Oxazolidinonas/uso terapêutico , Resistência a Vancomicina , Encefalite/microbiologia , Enterococcus faecium/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/microbiologia , Hidrocefalia/tratamento farmacológico , Hidrocefalia/microbiologia , Resultado do Tratamento , Derivação VentriculoperitonealRESUMO
BACKGROUND: Paracoccidioidomycosis (PCM) is a systemic mycosis caused by Paracoccidioides brasiliensis. The involvement of the central nervous system (CNS) in paracoccidioidomycosis is higher than previously thought and 2 clinical presentations have been reported, meningitis and pseudotumoral. METHODS: Twenty medical records of patients with CNS paracoccidioidomycosis treated from 1986 to 2003 were analyzed. The follow-up ranged from 1 to 18 years (mean = 8.9 +/- 4.2). RESULTS: Besides CNS paracoccidioidomycosis, all patients but one had the chronic systemic form and the pseudotumoral clinical presentation was the most frequent. Based on computed tomography scan findings, 4 image patterns were identified: low-density lesion with ring enhancement, lesion with calcification and ring enhancement, multiloculated low-density lesion with ring enhancement, and diffuse subarachnoid enhancement. The magnetic resonance imaging was performed in 3 patients and showed subarachnoid enhancement in 1 patient and heterogeneous lesion with ring enhancement in 2 patients. Eleven patients were submitted to medical treatment and 9 needed neurosurgical treatment; ventriculoperitoneal shunts in 4 patients, brain lesions resection in 3 patients, and partial resection of spinal cord lesions in 2 patients. Eleven patients had excellent outcome, 4 patients died, 3 are in good clinical condition with residual pulmonary dysfunction, and 1 patient was lost to follow-up. CONCLUSIONS: The diagnosis of paracoccidioidomycosis with involvement of the CNS is difficult and clinical suspicion is a key point to achieve the correct diagnosis. Patients with early diagnosis have a favorable outcome with clinical or surgical treatment.
Assuntos
Encéfalo/microbiologia , Encéfalo/patologia , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Infecções Fúngicas do Sistema Nervoso Central/terapia , Paracoccidioidomicose/diagnóstico , Paracoccidioidomicose/terapia , Adulto , Idoso , Antifúngicos/uso terapêutico , Encéfalo/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico , Calcinose/diagnóstico por imagem , Calcinose/microbiologia , Calcinose/patologia , Infecções Fúngicas do Sistema Nervoso Central/mortalidade , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/microbiologia , Hidrocefalia/patologia , Imageamento por Ressonância Magnética , Masculino , Meningite Fúngica/diagnóstico por imagem , Meningite Fúngica/microbiologia , Meningite Fúngica/patologia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Paracoccidioidomicose/mortalidade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Derivação Ventriculoperitoneal/estatística & dados numéricosRESUMO
The case was that of an infant with congenital hydrocephalus who developed subdural empyema. The most outstanding items were, the age of the patient (18 months), the identification of Salmonella typhimurium, a germ rarely described responsible for this pathology, the absence of anacrobe germs and the possible hematogenous dissemination from the digestive tract when the port of entry usually associated is the infection of the paranasal sinuses. The most useful method for study was the computerized axial tomography.