Leptospirosis: Presentación de una infección fulminante y revisión de la literatura

Rev Chil Infect 2005 V.22  N.1  P.93-97

M. Cecilia Abuauad A, Guido Osorio S, Juan L. Rojas P y Lorena Pino V.

Hospital Barros Luco Trudeau, Santiago, Chile

Servicio de Gastroenterología (MCAA)

Servicio de Medicina (GOS, LPV)

Universidad de Santiago, Santiago, Chile

Unidad de Anatomía Patológica (JLRP)

Resumen

Entre las nuevas y re-emergentes enfermedades infecciosas que amenazan a la humanidad, y como resultado de este caso clínico, se hace una revisión bibliográfica acerca de leptospirosis insistiendo en la necesidad de tenerla in mente en el diagnóstico diferencial de un cuadro febril con ictericia.

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Factors influencing the normalization of CD4+ T-cell count, percentage and CD4+/CD8+ T-cell ratio in HIV-infected patients on long-term suppressive antiretroviral therapy

Clinical Microbiology and Infection Aug 2011

C. Torti1, M. Prosperi2, D. Motta1, S. Digiambenedetto2, F. Maggiolo3, G. Paraninfo4, D. Ripamonti3, G. Cologni3, M. Fabbiani2, S. L. Caputo5, L. Sighinolfi6, N. Ladisa7, I.

1 Institute of Infectious and Tropical Diseases, University of Brescia, Brescia

2 Catholic University of Sacred Heart, Rome

3 Ospedali Riuniti, Bergamo

4 Spedali Civili di Brescia, Brescia

5 S. Maria Annunziata Hospital, Florence

6 S. Anna Hospital, Ferrara

7 Policlinico di Bari, Bari, Italy

8 Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA

*Correspondence: Corresponding author: C. Torti, Clinica di Malattie Infettive e Tropicali, Piazzale Spedali Civili, 1, 25123 Brescia, Italy E-mail: torti@med.unibs.it

Abstract

We evaluated factors associated with normalization of the absolute CD4+ T-cell counts, per cent CD4+ T cells and CD4+/CD8+ T-cell ratio. A multicentre observational study was carried out in patients with sustained HIV-RNA <50 copies/mL. Outcomes were: CD4-count >500/mm3 and multiple T-cell marker recovery (MTMR), defined as CD4+ T cells >500/mm3plus%CD4 T cells >29%plus CD4+/CD8+ T-cell ratio >1. Kaplan–Meier survival analysis and Cox regression analyses to predict odds for achieving outcomes were performed. Three hundred and fifty-two patients were included and followed-up for a median of 4.1 (IQR 2.1–5.9) years, 270 (76.7%) achieving a CD4+ T-cell count >500 cells/mm3 and 197 (56%) achieving MTMR. Using three separate Cox models for both outcomes we demonstrated that independent predictors were: both absolute CD4+ and CD8+ T-cell counts, %CD4+ T cells, a higher CD4+/CD8+ T-cell ratio, and age. A likelihood-ratio test showed significant improvements in fitness for the prediction of either CD4+ >500/mm3 or MTMR by multivariable analysis when the other immune markers at baseline, besides the absolute CD4+ count alone, were considered. In addition to baseline absolute CD4+ T-cell counts, pretreatment %CD4+ T cells and the CD4+/CD8+ T-cell ratio influence recovery of T-cell markers, and their consideration should influence the decision to start antiretroviral therapy. However, owing to the small sample size, further studies are needed to confirm these results in relation to clinical endpoints.

abstract

http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03650.x/abstract

Clinical Characteristics of Bacteremia Due to Extended-Spectrum β-Lactamase (ESBL)-Producing Enterobacteriaceae in the Era of CTX-M and KPC-type β-Lactamases

Clinical Microbiology and Infection Aug 2011

Zubair A. Qureshi1, David L. Paterson1,2, Anton Y. Peleg3,4, Jennifer M. Adams-Haduch1, Kathleen A. Shutt1, Diana L. Pakstis1, Emilia Sordillo5,6, Bruce Polsky5,6, Gabriel Sandkovsky5

ABSTRACT

A multicenter, case-control study was conducted to assess risk factors and patient outcomes from bacteremia due to Enterobacteriaceae producing extended-spectrum β-lactamases (ESBL) and Klebsiella pneumoniae carbapenemases (KPCs). One hundred five and 20 patients with bacteremia due to ESBL and KPC-producing organisms were matched to controls that had bacteremia with non-ESBL/KPC-producing organisms, respectively. Independent risk factors for ESBL production included admission from a nursing home (odds ratio [OR], 4.64; 95% confidence interval [CI], 2.64-8.16), chronic renal failure (OR, 2.09; 95% CI, 1.11-3.92), the presence of a gastrostomy tube (OR, 3.36; 95% CI, 1.38-8.18), length of hospital stay before infection (OR, 1.02; 95% CI, 1.01-1.03), transplant recipients (OR, 2.48; 95% CI, 1.24-4.95) and receipt of antibiotics with Gram-negative activity in the preceding 30 days (OR, 1.76; 95% CI, 1.00-3.08). 28-day crude mortality rates for patients infected with ESBL or KPC-producing organisms and controls were 29.1% (34/117) and 19.5% (53/272), respectively (OR 1.70; 95% CI 1.04-2.80). On multivariate analysis, inadequate empiric therapy (OR, 2.26; 95% CI, 1.18-4.34), onset of bacteremia while in ICU (OR, 2.74; 95% CI, 1.47-5.11), Apache II score (OR, 1.17; 95% CI, 1.12-1.23), and malignancy (OR, 2.66; 95% CI, 1.31-5.41) were independent risk factors for mortality. CTX-M was the most common ESBL type in E. coli, whereas SHV predominated in Klebsiella spp. and Enterobacter spp.

abstract

http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03658.x/abstract

Emergence of Carbapenem-resistant Enterobacteriaceae in Austria, 2001-2010

Clinical Microbiology and Infection Aug 2011

Gernot Zarfel1, Martin Hoenigl2, Benjamin Würstl3, Eva Leitner1, Helmut J. F. Salzer2, Thomas Valentin2, Josefa Posch1, Robert Krause2, Andrea J. Grisold1,*

Abstract:

We report the emergence of carbapenem-resistant Enterobacteriaceae inAustria. Over a ten- year-period carbapenem-resistant Enterobacteriaceae were isolated from 13 hospitalized patients with the first isolation in the year 2005 and a remarkable increase of involved patients in 2010. Carbapenem-resistant Enterobacteriaceae comprise 8 Klebsiella pneumoniae, 4 Klebsiella oxytoca and one Escherichia coli isolate. Detected carbapenemases belonged to the metallo-ß-lactamases NDM-1, VIM and IMP and to serin-ß-lactamases KPC.

abstract

http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03659.x/abstract

Chorioamnionitis: from pathogenesis to treatment

Clinical Microbiology and Infection Sept 2011

REVIEW

M. J. Czikk1, F. P. McCarthy2, K. E. Murphy1

1 Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada

2 Anu Research Centre, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland

*Correspondence: Corresponding author: M. J. Czikk, Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, c/o Dr Kellie E Murphy, 700 University Avenue, Room 3278, Toronto, ON M5G 1Z5, Canada E-mail:mczikk@mtsinai.on.ca

Abstract

Chorioamnionitis refers to inflammation of the amniochorionic membrane, and is a significant cause of maternal and neonatal morbidity. Chorioamnionitis most often occurs as a result of ascending infection, and is commonly associated with premature rupture of the membranes. Chorioamnionitis is generally the result of a polymicrobial infection, with Ureaplasma urealyticum, Mycoplasma hominis and Gram-negative anaerobes being frequent causative organisms. The mainstay of treatment includes antimicrobial agents, antipyretics, expedition of delivery and supportive care. Further research is required to identify mechanistic pathways and early biomarkers that accurately predict women at higher risk of adverse maternal and neonatal outcomes, and that can thus lead to the development of additional treatment and prevention strategies.

Abstract

http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03574.x/abstract

Neonatal group B streptococcal disease: from pathogenesis to preventive strategies

Clinical Microbiology and Infection Sept 2011

REVIEW

P. Melin

Abstract

Streptococcus agalactiae, or group B streptococcus (GBS), remains the leading cause of neonatal sepsis and meningitis, as early-onset or late-onset diseases (EOD, LOD). Where consensus guidelines to detect and treat intrapartum women with GBS colonization have been widely adopted, incidence of neonatal EOD has dramatically declined. In response to both successful impacts on the incidence of GBS-EOD and analyses of missed opportunities, the first American guidelines for prevention issued in the 1990s have since been adapted in several stages to improve their efficacy. In some countries inEurope, nationwide guidelines, whether screening-based or risk-based, for the prevention of neonatal GBS diseases have also been issued and adopted, with the expected impact on incidence of GBS-EOD. In spite of universal screening, in spite of the great progress that has been made, GBS-EOD continues to occur and the GBS burden remains a significant public health issue. Continuous efforts to improve screening for GBS status continue to be important and may be able to take advantage of new rapid diagnostic technologies. The current screening-based strategy for prevention is highly effective but imperfect. Given the challenges, limitations and potential complications of maternal intrapartum prophylaxis, a new approach is still needed. Maternal immunization against GBS is an attractive alternative for the prevention of not only neonatal diseases but also stillbirths and maternal diseases. Vaccines against GBS may become the most effective and sustainable long-term preventive strategy.

abstract

http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03576.x/abstract

Update on the prevention, diagnosis and management of cytomegalovirus infection during pregnancy

Clinical Microbiology and Infection Sept 2011

REVIEW

T. Lazzarotto1, B. Guerra2,

1 Department of Haematology, Oncology and Laboratory Medicine, Operative Unit of Clinical Microbiology

2  Department of Obstetrics and Gynaecology, St Orsola Malpighi General Hospital, University of Bologna, Bologna

3 Operative Unit of Paediatrics and Neonatology, La Scaletta Hospital, Imola-Bologna, Italy

*Correspondence: Corresponding author: T. Lazzarotto, Department of Haematology, Oncology and Laboratory Medicine, Operative Unit of Clinical Microbiology, Laboratory of Virology, Policlinico S. Orsola Malpighi, Via Massarenti n. 9, 40138 Bologna, Italy E-mail: tiziana.lazzarotto@aosp.bo.it

Abstract

Human cytomegalovirus (CMV) is the leading cause of congenital infection, with morbidity and mortality at birth and sequelae. Each year approximately 1–7% (Rev Med Virol 2010; 20: 311) of pregnant women acquire a primary CMV infection. Of these, about 30–40% transmit infection to their fetuses. The risk of serious fetal injury is greatest when maternal infection develops in the first trimester or early in the second trimester. Between 10 and 15% of congenitally infected infants are acutely symptomatic at birth and most of the survivors have serious long-term complications. Until a few years ago, laboratory testing was not possible to precisely define the maternal immune status, the recent development of advanced serological tests (IgG avidity test, IgM immunoblot and neutralizing antibody testing) allow us to identify, among pregnant women with suspected CMV, those with primary infection who are therefore at high risk of transmitting CMV to the fetus. This is done with the use of a screening test. As most maternal infections are asymptomatic, the only way to disclose primary infection is to implement specific serological testing as early in pregnancy as possible (before week 12–16 of gestation). Given the high risk of mother–fetus transmission and fetal damage, prenatal diagnosis is recommended to women with primary CMV infection contracted in the first half of pregnancy and in case of fetal abnormalities suggestive of infection. The correct interpretation of serological and virological tests followed by appropriate counselling by an expert physician is an effective tool to reduce the number of unnecessary pregnancy terminations by over 70% (Am J Obstet Gynecol 2007; 196: 221.e1).

abstract

http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2011.03564.x/abstract