Archive for September 4, 2012

Appearance of Klebsiella pneumoniae liver abscess syndrome in Argentina: case report and review of molecular mechanisms of pathogenesis.

Open Microbiol J. 2011;5:107-13.

Vila A, Cassata A, Pagella H, Amadio C, Yeh KM, Chang FY, Siu LK.

Department of Infectious Diseases, Hospital Italiano de Mendoza, Avenida Acceso Este 1070, Guaymallén, Mendoza, Argentina.


Klebsiella pneumoniae liver abscess syndrome (KLAS) is an emerging invasive infection caused by highly virulent community-acquired strains of K. pneumoniae displaying hypermucoviscosity. The salient features of this syndrome include the presence of bacteremia, primary monomicrobial liver abscess, and metastatic complications. A previously healthy Argentinean man presented with fever and found to have liver abscess caused by K. pneumoniae with metastatic seeding of gastric wall. Cultures from blood and liver abscess grew hypermucoviscous K1 K. pneumoniae with sequence type (ST) 23 by multilocus sequence typing (MLST), positive for rmpA (regulator of mucoid phenotype A), wzy(KpK1) (capsular polymerase) and aerobactin genes. The hypermucoviscous phenotype of this K. pneumoniae isolate was readily identified by the “string test” (colonies formed a long string when touched with a loop). The patient responded favourably to percutaneous drainage of the abscess and antibiotics. This is the first documented report of KLAS described in Argentina, and may signal the emergence of this syndrome in South America.


September 4, 2012 at 8:52 pm

Myopericarditis during a primary Epstein-Barr virus infection in an otherwise young adult. An unusual and insidious complication. Case report and a 60-year literature review.

Infez Med. 2012 Jun 1 V.20 N.2 P.75-81.

Sabbatani S, Manfredi R, Ortolani O, Trapani FF, Viale P.

Department of Infectious Diseases; Department of Cardiology, “Alma Mater Studiorum” University of Bologna, S. Orsola Mapighi Hospital, Bologna, Italy.


An otherwise healthy young man had infectious mononucleosis detected after an atypical clinical onset, including myocarditis and pericarditis. Our patient slowly but completely recovered from his cardiac complications after the course of his primary Epstein-Barr infection, as shown by periodical electrocardiographic and ultrasonographic studies, and a simple treatment with aspirin alone. Our case report is briefly reported, and discussed with regard to the existing literature, which has recorded such complications since the mid 1940s.

PDF (CLIC en download)


September 4, 2012 at 8:50 pm

Tattoo-Associated Nontuberculous Mycobacterial Skin Infections — Multiple States, 2011–2012

MMWR Aug.24, 2012  V.61 N.33  P.653-656

Permanent tattoos have become increasingly common, with 21% of adults in the United States reporting having at least one tattoo (1). On rare occasions, outbreaks of nontuberculous mycobacterial (NTM) skin infections have been reported after tattooing (2,3). In January 2012, public health officials in New York received reports of Mycobacterium chelonae skin infections in 14 New York residents who received tattoos during September–December 2011. All infections were associated with use of the same nationally distributed, prediluted gray ink manufactured by company A. CDC disseminated an Epi-X public health alert to identify additional tattoo-associated NTM skin infections; previously identified cases were reported from three states (Washington, Iowa, and Colorado). Public health investigations by CDC, state and local health departments, and the Food and Drug Administration (FDA) found NTM contamination in tattoo inks used in two of five identified clusters. All infected persons were exposed to one of four different brands of ink. NTM contamination of inks can occur during the manufacturing process as a result of using contaminated ingredients or poor manufacturing practices, or when inks are diluted with nonsterile water by tattoo artists. No specific FDA regulatory requirement explicitly provides that tattoo inks must be sterile. However, CDC recommends that ink manufacturers ensure ink is sterile and that tattoo artists avoid contamination of ink through dilution with nonsterile water. Consumers also should be aware of the health risks associated with getting an intradermal tattoo…..




September 4, 2012 at 8:48 pm

Poliarteritis nodosa cutánea post-estreptocócica: un simulador de la fiebre reumática

Arch.argent.pediatr 2006 V.104  N.3  P.234-239  /  234

Dres. Ricardo A.G. Russo*, Amelia M. Laterza**, María M. Katsicas*, Andrea Betina Cervini*** y Adrián M. Pierini**


La poliarteritis nodosa cutánea es una enfermedad inflamatoria que compromete vasos medianos de piel y, en ocasiones, de nervios periféricos y músculos. La frecuente presencia de artritis puede originar errores diagnósticos. El objetivo fue describir los hallazgos clínicos en pacientes con esta enfermedad.

Población, material y métodos.

Se trató de un estudio descriptivo. Se incluyeron 10 niños con diagnóstico de poliarteritis nodosa cutánea y evidencias de infección reciente por estreptococo beta hemolítico del grupo A. Los datos se recolectaron retrospectivamente.


Todos los pacientes presentaban fiebre, púrpura y nódulos subcutáneos en el debut de la enfermedad. Nueve tuvieron artritis. Las articulaciones afectadas fueron predominantemente grandes, de miembros inferiores y la duración de la inflamación articular varió entre 10 y 90 días. Seis pacientes mostraron un patrón aditivo de afección articular y en tres fue migratorio. La articulación más frecuentemente afectada fue la rodilla. Se observó leucocitosis y elevación de los reactantes de fase aguda en todos los pacientes. Los nueve niños con artritis cumplían con los criterios diagnósticos de Jones para fiebre reumática. Todos recibieron tratamiento con m-prednisona y profilaxis con penicilina benzatínica. Se observaron 17 recaídas en 8 de los pacientes, 12 de ellas relacionadas con nuevas infecciones por estreptococo y fallas en la profilaxis.


La artritis de la poliarteritis nodosa cutánea posestreptocócica puede remedar a la de la fiebre reumática. La erupción purpúrica y nódulos cutáneos rojizos y dolorosos orienta fuertemente hacia el diagnóstico, que se confirma por el hallazgo de inflamación de vasos medianos en la dermis.


September 4, 2012 at 3:49 pm

Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America.

Clin Infect Dis. 2010 Feb 1 V.50 N.3  P.291-322.

Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, Harrison TS, Larsen RA, Lortholary O, Nguyen MH, Pappas PG, Powderly WG, Singh N, Sobel JD, Sorrell TC.

Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina 27710, USA.


Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality. These guidelines for its management have been built on the previous Infectious Diseases Society of America guidelines from 2000 and include new sections. There is a discussion of the management of cryptococcal meningoencephalitis in 3 risk groups: (1) human immunodeficiency virus (HIV)-infected individuals, (2) organ transplant recipients, and (3) non-HIV-infected and nontransplant hosts. There are specific recommendations for other unique risk populations, such as children, pregnant women, persons in resource-limited environments, and those with Cryptococcus gattii infection. Recommendations for management also include other sites of infection, including strategies for pulmonary cryptococcosis. Emphasis has been placed on potential complications in management of cryptococcal infection, including increased intracranial pressure, immune reconstitution inflammatory syndrome (IRIS), drug resistance, and cryptococcomas. Three key management principles have been articulated: (1) induction therapy for meningoencephalitis using fungicidal regimens, such as a polyene and flucytosine, followed by suppressive regimens using fluconazole; (2) importance of early recognition and treatment of increased intracranial pressure and/or IRIS; and (3) the use of lipid formulations of amphotericin B regimens in patients with renal impairment. Cryptococcosis remains a challenging management issue, with little new drug development or recent definitive studies. However, if the diagnosis is made early, if clinicians adhere to the basic principles of these guidelines, and if the underlying disease is controlled, then cryptococcosis can be managed successfully in the vast majority of patients.


September 4, 2012 at 3:47 pm

An update on Cryptococcus among HIV-infected patients.

Int J STD AIDS. 2010 Oct  V.21 N.10 P.679-84.

Warkentien T, Crum-Cianflone NF.

Infectious Disease Clinic, Naval Medical Center San Diego, San Diego, CA 92134–1005, USA.


Cryptococcus remains an important opportunistic infection in HIV patients despite considerable declines in prevalence during the highly active antiretroviral therapy era. This is particularly apparent in sub-Saharan Africa, where Cryptococcus continues to cause significant mortality and morbidity. This review discusses the microbiology, epidemiology, pathogenesis and clinical presentation of cryptococcal infections in HIV patients. Additionally, a detailed approach to the management of cryptococcosis is provided.


September 4, 2012 at 3:43 pm


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