Archive for January 13, 2016

Actinomycosis: etiology, clinical features, diagnosis, treatment, and management.

Infect Drug Resist. 2014 Jul 5;7:183-97.

Valour F1, Sénéchal A2, Dupieux C3, Karsenty J2, Lustig S4, Breton P5, Gleizal A6, Boussel L7, Laurent F3, Braun E8, Chidiac C1, Ader F1, Ferry T1.

Author information

1Service des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon, France ; Université Claude Bernard Lyon 1, Lyon, France ; Centre International de Recherche en Infectiologie, CIRI, INSERM U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France.

2Service des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon, France ; Université Claude Bernard Lyon 1, Lyon, France.

3Université Claude Bernard Lyon 1, Lyon, France ; Centre International de Recherche en Infectiologie, CIRI, INSERM U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France ; Laboratoire de Bactériologie, Centre de Biologie du Nord, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon, France.

4Université Claude Bernard Lyon 1, Lyon, France ; Chirurgie Orthopédique, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon, France.

5Université Claude Bernard Lyon 1, Lyon, France ; Stomatologie et Chirurgie Maxillo-faciale, Hospices Civils de Lyon, Groupement Hospitalier Sud, Lyon, France.

6Université Claude Bernard Lyon 1, Lyon, France ; Chirurgie Maxillo-faciale, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon, France.

7Université Claude Bernard Lyon 1, Lyon, France ; Radiologie, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon, France ; Creatis, CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon, Lyon, France.

8Service des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon, France.

Abstract

Actinomycosis is a rare chronic disease caused by Actinomyces spp., anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and genital tracts. Physicians must be aware of typical clinical presentations (such as cervicofacial actinomycosis following dental focus of infection, pelvic actinomycosis in women with an intrauterine device, and pulmonary actinomycosis in smokers with poor dental hygiene), but also that actinomycosis may mimic the malignancy process in various anatomical sites. Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. Patients with actinomycosis require prolonged (6- to 12-month) high doses (to facilitate the drug penetration in abscess and in infected tissues) of penicillin G or amoxicillin, but the duration of antimicrobial therapy could probably be shortened to 3 months in patients in whom optimal surgical resection of infected tissues has been performed. Preventive measures, such as reduction of alcohol abuse and improvement of dental hygiene, may limit occurrence of pulmonary, cervicofacial, and central nervous system actinomycosis. In women, intrauterine devices must be changed every 5 years in order to limit the occurrence of pelvic actinomycosis.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4094581/pdf/idr-7-183.pdf

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January 13, 2016 at 12:28 pm

Actinomycosis in Iran: Short Narrative Review Article.

Iran J Public Health. 2014 May;43(5):556-60.

Khodavaisy S1, Zibafar E2, Hashemi SJ3, Narenji H4, Daie Ghazvini R2.

Author information

Dept. of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences , Tehran, Iran ; 2. Dept. of Medical Microbiology, Kurdistan University of Medical Sciences , Sanandaj, Iran.

Dept. of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences , Tehran, Iran.

Dept. of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences , Tehran, Iran ; 3. Food Microbiology Research Center, Tehran University of Medical Sciences , Tehran, Iran.

Dept. of Medical Microbiology, Kurdistan University of Medical Sciences , Sanandaj, Iran.

Abstract

Actinomycosis is an indolent, slowly progressive infection caused by anaerobic or microaerophilic bacteria, primarily of genus Actinomyces, which colonize the mouth, colon and vagina. Mucosal disruption may lead to infection virtually at any sites in the body. The aim of this study was to underline different features of actinomycosis and to represent total data about etiologic agents, clinical, diagnostic and therapeutic approaches these infections. From a total of 38 case reports or series, ninety one cases were obtained by using of relevant articles reported as recorded cases in Iran (1972 to 2012). Analyzed data represented 21 cases of oral-servicofacial (23.1%), 7 cases of thoracic (7.7%), 17 cases of abdominal (18.7%), 21 cases of disseminated forms (23.1%) and 25 cases of others (27.5%). Findings indicated more common of these infections in men (61.5%). Actinomyces naeslundii (21 cases) was found as the most common causative agents in comparison with A. Israeli (15 cases), A. viscosus (3 cases) and A. bovis (1 case). The most patients had been successfully treated with penicillin although some cases needed surgery along with antibiotic therapy. Since some clinical features of actinomycosis are similar to malignancies, so the differential diagnosis of invasive forms must be considered. This report emphasizes on the importance of differential diagnosis of actinomycosis from similar diseases by clinicians.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449403/pdf/IJPH-43-556.pdf

January 13, 2016 at 12:27 pm

Blood Culture Bottle and Standard Culture Bottle Methods for Detection of Bacterial Pathogens in Parapneumonic Pleural Effusion.

Jundishapur J Microbiol. 2015 Oct 29;8(10):e24893.

Charoentunyarak S1, Kananuraks S1, Chindaprasirt J2, Limpawattana P2, Sawanyawisuth K3.

Author information

1Department of Medicine, Khon Kaen Hospital, Khon Kaen, Thailand.

2Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

3Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ; Research Center in Back, Neck Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand.

Abstract

BACKGROUND:

Bacterial parapneumonic pleural effusions (PPEs) have high morbidity. The accurate identification of pathogens is vital for initiating the appropriate treatment. A previous study suggested that the use of blood culture bottles might improve the bacterial yield in PPEs.

OBJECTIVES:

The aim of this study was to compare the culture positivity rate by the blood culture bottles and the standard culture bottles in bacterial PPEs.

PATIENTS AND METHODS:

Patients diagnosed with PPEs at the Khon Kaen Hospital, Khon Kaen, Thailand, which is an endemic area of melioidosis, were enrolled consecutively and prospectively. The study period was from June first, 2012 to December 31st, 2013. The inclusion criteria were adult patients aged > 18 years, with exudative, neutrophilic parapneumonic effusion. Of the pleural fluid samples, 5 mL from all the eligible patients were collected in both blood culture bottles and the standard culture bottles. Patient baseline characteristics, laboratory results, and culture results were collected and analyzed.

RESULTS:

During the study period, 129 patients met the study criteria. The bacteria-positive rate of pleural fluid culture using the standard culture bottle was 14.0%, whereas the positive rate using blood culture bottles was 24.0% (P < 0.001).

CONCLUSIONS:

The blood culture bottle method is more effective than the standard culture bottle method for the detection of bacterial pathogens in PPE.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644317/pdf/jjm-08-10-24893.pdf

January 13, 2016 at 12:26 pm

Human melioidosis, Malawi, 2011.

Emerg Infect Dis. 2013 Jun;19(6):981-4.

Katangwe T1, Purcell J, Bar-Zeev N, Denis B, Montgomery J, Alaerts M, Heyderman RS, Dance DA, Kennedy N, Feasey N, Moxon CA.

Author information

1Queen Elizabeth Central Hospital, Blantyre, Malawi.

Abstract

A case of human melioidosis caused by a novel sequence type of Burkholderia pseudomallei occurred in a child in Malawi, southern Africa. A literature review showed that human cases reported from the continent have been increasing.

PDF

http://wwwnc.cdc.gov/eid/article/19/6/pdfs/12-0717.pdf

January 13, 2016 at 12:24 pm

Intravenous therapy duration and outcomes in melioidosis: a new treatment paradigm.

PLoS Negl Trop Dis. 2015 Mar 26;9(3):e0003586.

Pitman MC1, Luck T1, Marshall CS1, Anstey NM2, Ward L3, Currie BJ2.

Author information

1Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia.

2Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.

3Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.

Erratum in

Correction: Intravenous therapy duration and outcomes in melioidosis: a new treatment paradigm. [PLoS Negl Trop Dis. 2015]

Abstract

BACKGROUND:

International melioidosis treatment guidelines recommend a minimum 10 to 14 days’ intravenous antibiotic therapy (intensive phase), followed by 3 to 6 months’ oral therapy (eradication phase). This approach is associated with rates of relapse, defined as recurrence following the eradication phase, that can exceed 5%. Rates of recrudescence, defined as recurrence during the eradication phase, have not previously been reported. In response to low eradication phase completion rates in Australia, a local guideline has evolved over the last ten years recommending a longer minimum intensive phase duration for many cases of melioidosis.

METHODOLOGY/ PRINCIPAL FINDINGS:

This retrospective cohort study reviews antibiotic duration for the first episode of care for all patients diagnosed with melioidosis and surviving the intensive phase during a recent three year period in the tropical north of Australia’s Northern Territory; we also review adherence to the current local guideline and treatment outcomes. Of 215 first episodes of melioidosis surviving the intensive phase, the median (interquartile range) intensive phase duration was 26 (14-34) days. One hundred and eight (50.2%) patients completed eradication therapy; 58 (27.0%) patients took no eradication therapy. At 28 months’ follow-up, one (0.5%) relapse and eleven (5.1%) recrudescences had occurred. On exact logistic regression analysis, the only independent risk factors for recrudescence were self-discharge during the intensive phase (odds ratio 6.2 [95% confidence interval 1.2-30.0]) and septic shock (odds ratio 5.3 [95% confidence interval 1.1-25.7]).

CONCLUSIONS/ SIGNIFICANCE:

Relapsed melioidosis is rare in patients who receive a minimum intensive phase duration specified by our guideline and extended according to clinical progress. Recrudescence rates may improve with reductions in rates of self-discharge. Given the low relapse rate despite a high rate of eradication therapy non-adherence, the duration and necessity of eradication therapy for different patients after guideline-concordant intensive therapy should be evaluated further.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374799/pdf/pntd.0003586.pdf

 

 

PLoS Negl Trop Dis. 2015 Apr 22;9(4):e0003737.

Correction: Intravenous therapy duration and outcomes in melioidosis: a new treatment paradigm.

PLOS Neglected Tropical Diseases Staff.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4406616/pdf/pntd.0003737.pdf

 

January 13, 2016 at 12:23 pm

Pulmonary melioidosis presenting with pleural effusion: A case report and review of literature.

Respir Med Case Rep. 2015 Jul 22;16:54-6.

Soo CI1, Abdul Wahab S1, Abdul Hamid F1.

Author information

1Respiratory Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.

Abstract

Melioidosis is a serious infection, which can involve multiple systems. We report a case of pulmonary melioidosis with the initial presentation mimicking a partially treated pneumonia complicated by right-sided pleural effusion. The patient is a 49-year old man who did not respond to parenteral ceftriaxone and tazobactam/piperacillin therapy. However, upon culture and sensitivity results from blood and pleural samples isolated Burkholderia pseudomallei; antimicrobial therapy was de-escalated to parenteral ceftazidime. Within 72 h duration, his fever subsided and other respiratory symptoms improved tremendously. This case highlights the importance of early recognition of B. pseudomallei in pulmonary infection in order for prompt institution of appropriate antibiotics treatment; thus reducing morbidity and mortality

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4681969/pdf/main.pdf

January 13, 2016 at 12:21 pm

Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis

Nature Microbiology January 2016

Letter

Direk Limmathurotsakul, Nick Golding, David A. B. Dance, Jane P. Messina, David M. Pigott, Catherine L. Moyes, Dionne B. Rolim, Eric Bertherat, Nicholas P. J. Day, Sharon J. Peacock & Simon I. Hay

Burkholderia pseudomallei, a highly pathogenic bacterium that causes melioidosis, is commonly found in soil in Southeast Asia and Northern Australia1,2. Melioidosis can be difficult to diagnose due to its diverse clinical manifestations and the inadequacy of conventional bacterial identification methods3. The bacterium is intrinsically resistant to a wide range of antimicrobials, and treatment with ineffective antimicrobials may result in case fatality rates (CFRs) exceeding 70%4,5. The importation of infected animals has, in the past, spread melioidosis to non-endemic areas6,7. The global distribution of B. pseudomallei and the burden of melioidosis, however, remain poorly understood. Here, we map documented human and animal cases and the presence of environmental B. pseudomallei and combine this in a formal modelling framework8,9,10 to estimate the global burden of melioidosis. We estimate there to be 165,000 (95% credible interval 68,000–412,000) human melioidosis cases per year worldwide, from which 89,000 (36,000–227,000) people die. Our estimates suggest that melioidosis is severely underreported in the 45 countries in which it is known to be endemic and that melioidosis is probably endemic in a further 34 countries that have never reported the disease. The large numbers of estimated cases and fatalities emphasize that the disease warrants renewed attention from public health officials and policy makers. …..

FULL TEXT

http://www.nature.com/articles/nmicrobiol20158

 

January 13, 2016 at 8:05 am


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