Posts filed under ‘F.O.D’

Magnetic Resonance Imaging in Differentatial Diagnosis of Pyogenic Spondylodiscitis and Tuberculous Spondylodiscitis

Pol J Radiol. February 2017 V.82 P.71-87.

Antecedentes

La espondilodiscitis infecciosa se caracteriza por la participación de dos vértebras adyacentes y el disco intermedio.

La tasa de incidencia de la enfermedad se estima en 0.4-2 casos por 100000 por año.

Staphylococcus aureus es el agente infeccioso más común que causa espondilodiscitis piógena.

Las infecciones no piógenas de la columna vertebral son causadas con mayor frecuencia por Mycobacterium tuberculosis y hongos.

Los síntomas clínicos son inespecíficos.

El diagnóstico temprano y el tratamiento adecuado pueden evitar secuelas irreversibles desfavorables para el paciente.

Los desarrollos significativos en las técnicas de imagen de tejidos patológicos aumentaron las expectativas entre los médicos con respecto a la posibilidad de distinguir entre la espondilodiscitis tuberculosa y la espondilodiscitis piógena en las imágenes de RM.

El objetivo de este estudio fue identificar y diferenciar las características de la espondilodiscitis tuberculosa y piógena en las imágenes de RM.

Material/métodos

Realizamos un análisis retrospectivo de imágenes de RM obtenidas de 34 pacientes con espondilodiscitis confirmada (18 con espondilodiscitis piógena y 16 con espondilodiscitis tuberculosa). La adquisición de datos se realizó utilizando escáneres de resonancia magnética de 1,5 T, donde se obtuvieron imágenes utilizando protocolos similares. T2 TIRM y las imágenes ponderadas en T1 con y sin realce de contraste fueron sujetas a evaluación en planos coronal, axial y sagital.

Resultados

Las características de la espondilodiscitis piógena incluyen: afectación de la columna lumbar, aumento del contraste anormal paraespinal mal definido, aumento del contraste difuso / homogéneo de los cuerpos vertebrales, destrucción de grado bajo de los cuerpos vertebrales, señal hiperintensa / homogénea de los cuerpos vertebrales en las imágenes T2 TIRM . Las características predominantes de la espondilodiscitis tuberculosa incluyeron: afectación de la columna torácica, afectación de 2 o más cuerpos vertebrales adyacentes, destrucción severa del cuerpo vertebral, realce de contraste focal / heterogéneo de los cuerpos vertebrales, señal heterogénea de los cuerpos vertebrales en imágenes T2 TIRM, bien Mejora de contraste anormal paraespinal -definido, abscesos paraespinales y epidurales, realce meníngeo a nivel de la columna afectada.

Conclusiones

La comparación de imágenes de RM de pacientes diagnosticados con espondilodiscitis piógena y espondilodiscitis tuberculosa permitió la identificación de características individuales para la diferenciación preliminar entre TB y espondilodiscitis infecciosa y, por lo tanto, permitió un tratamiento adecuado.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5317295/pdf/poljradiol-82-71.pdf

July 12, 2020 at 1:39 pm

Magnetic Resonance Imaging of Bacterial and Tuberculous Spondylodiscitis With Associated Complications and Non-Infectious Spinal Pathology Mimicking Infections: A Pictorial Review

BMC Musculoskelet Disord. June 5, 2017 V.18 N.1 P.244.

La resonancia magnética (RM) desempeña un papel importante en la evaluación de la espondilodiscitis bacteriana y tuberculosa y las complicaciones asociadas.

Debido a su alta sensibilidad y especificidad, es una poderosa herramienta de diagnóstico en el diagnóstico precoz de infecciones en curso y, por lo tanto, proporciona ayuda para el inicio inmediato de una terapia adecuada, que puede ser médica o quirúrgica, al definir el alcance de la participación y la detección de complicaciones. tales como abscesos epidurales y paraespinales.

Más específicamente, la resonancia magnética ayuda a diferenciar las infecciones bacterianas de las tuberculosas y permite el seguimiento de la progresión o resolución después del tratamiento adecuado.

Sin embargo, otra patología no infecciosa puede demostrar apariencias similares de imágenes de RM y uno debe ser consciente de estos posibles imitadores al interpretar imágenes de RM.

Los radiólogos y otros médicos deben ser conscientes de estas posibles imitaciones, que incluyen patologías tales como cambios degenerativos tipo I, trauma, enfermedad metastásica y amiloidosis.

En esta revisión pictórica, describiremos e ilustraremos los hallazgos de imágenes de la espondilodiscitis bacteriana y tuberculosa, sus complicaciones y patologías no infecciosas que imitan estas infecciones espinales.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460517/pdf/12891_2017_Article_1608.pdf

 

July 12, 2020 at 1:38 pm

From contamination to infective endocarditis—a population-based retrospective study of Corynebacterium isolated from blood cultures.

European Journal of Clinical Microbiology & Infectious Diseases January 2020 V.39 N.1 P.113-119   

Corynebacterium is a genus that can contaminate blood cultures and also cause severe infections like infective endocarditis (IE).

Our purpose was to investigate microbiological and clinical features associated with contamination and true infection.

A retrospective population-based study of Corynebacterium bacteremia 2012–2017 in southern Sweden was performed.

Corynebacterium isolates were species determined using a matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS).

Patient were, from the medical records, classified as having true infection or contamination caused by Corynebacterium through a scheme considering both bacteriological and clinical features and the groups were compared.

Three hundred thirty-nine episodes of bacteremia with Corynebacterium were identified in 335 patients of which 30 (8.8%) episodes were classified as true infection.

Thirteen patients with true bacteremia had only one positive blood culture. Infections were typically community acquired and affected mostly older males with comorbidities.

The focus of infection was most often unknown, and in-hospital mortality was around 10% in both the groups with true infection and contamination.

Corynebacterium jeikeium and Corynebacterium striatum were significantly overrepresented in the group with true infection, whereas Corynebacterium afermentans was significantly more common in the contamination group. Eight episodes of IE were identified, all of which in patients with heart valve prosthesis.

Six of the IE cases affected the aortic valve and six of seven patients were male. The species of Corynebacterium in blood cultures can help to determine if a finding represent true infection or contamination.

The finding of a single blood culture with Corynebacterium does not exclude true infection such as IE.

abstract

https://link.springer.com/article/10.1007/s10096-019-03698-6?wt_mc=alerts.TOCjournals&utm_source=toc&utm_medium=email&utm_campaign=toc_10096_39_1

PDF

https://link.springer.com/content/pdf/10.1007%2Fs10096-019-03698-6.pdf

January 19, 2020 at 8:08 pm

Perspective – Eastern Equine Encephalitis Virus — Another Emergent Arbovirus in the United States

NEJM November 21, 219 V.381 P.1989-1992

David M. Morens, M.D., Gregory K. Folkers, M.S., M.P.H., and Anthony S. Fauci, M.D.

Humans have always lived in intimate association with arthropods that transmit pathogens between humans or from animals to humans. About 700,000 deaths due to vectorborne diseases occur globally each year, according to World Health Organization estimates. In the summer and fall of 2019, nine U.S. states have reported 36 human cases (14 of them fatal) of one of the deadliest of these diseases: eastern equine encephalitis (EEE), an arthropod-borne viral (arboviral) disease transmitted by mosquitoes. In recent years, the Americas have witnessed a steady stream of other emerging or reemerging arboviruses, such as dengue, West Nile, chikungunya, Zika, and Powassan, as well as increasing numbers of travel-related cases of various other arboviral infections. This year’s EEE outbreaks may thus be a harbinger of a new era of arboviral emergences……

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMp1914328?query=TOC

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMp1914328?articleTools=true

November 21, 2019 at 8:06 am

Vertebral osteomyelitis: clinical features and diagnosis.

Clin Microbiol Infect. October 2014 V.20 N.10 P.1055-60. Jun 14.

Eren Gök S1, Kaptanoğlu E, Celikbaş A, Ergönül O, Baykam N, Eroğlu M, Dokuzoğuz B.

1 Infectious Diseases and Clinical Microbiology Clinic, Ankara Numune Training and Research Hospital, Ankara, Turkey.

Abstract

We aimed to describe clinical and diagnostic features of vertebral osteomyelitis for differential diagnosis and treatment. This is a prospective observational study performed between 2002 and 2012 in Ankara Numune Education and Research Hospital in Ankara, Turkey. All the patients with vertebral osteomyelitis were followed for from 6 months to 3 years. In total, 214 patients were included in the study, 113 out of 214 (53%) were female. Out of 214 patients, 96 (45%) had brucellar vertebral osteomyelitis (BVO), 63 (29%) had tuberculous vertebral osteomyelitis (TVO), and 55 (26%) had pyogenic vertebral osteomyelitis (PVO). Mean number of days between onset of symptoms and establishment of diagnosis was greater with the patients with TVO (266 days) than BVO (115 days) or PVO (151 days, p <0.001). In blood cultures, Brucella spp. were isolated from 35 of 96 BVO patients (35%). Among 55 PVO patients, the aetiological agent was isolated in 11 (20%) patients. For tuberculin skin test >15 mm, sensitivity was 0.66, specificity was 0.97, positive predictive value was 0.89, negative predictive value was 0.88, and receiver operating characteristics area was 0.8. Tuberculous and brucellar vertebral osteomyelitis remained the leading causes of vertebral osteomyelitis with delayed diagnosis. In differential diagnosis of vertebral osteomyelitis, consumption of unpasteurized cheese, dealing with husbandry, sweating, arthralgia, hepatomegaly, elevated alanine transaminase, and lumbar involvement in magnetic resonance imaging were found to be predictors of BVO, thoracic involvement in magnetic resonance imaging and tuberculin skin test > 15 mm were found to be predictors of TVO, and history of spinal surgery and leucocytosis were found to be predictors of PVO.

FULL TEXT

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)65378-7/fulltext

PDF

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)65378-7/pdf

September 21, 2019 at 8:09 pm

Histoplasmosis-related healthcare use, diagnosis, and treatment in a commercially insured population, United States.

Clinical Infectious Diseases April 30, 2019  

Benedict K1, Beer KD1, Jackson BR1.

Abstract

BACKGROUND:

Infections with Histoplasma can range from asymptomatic to life-threatening acute pulmonary or disseminated disease. Histoplasmosis can be challenging to diagnose and is widely under-recognized. We analyzed insurance claims data to better characterize histoplasmosis testing and treatment practices and its burden on patients.

METHODS:

We used the IBM® MarketScan® Research Databases to identify patients with histoplasmosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 115.00-115.99) during 2012-2014. We analyzed claims in the 3 months before to the 1 year after diagnosis and examined differences between probable (hospitalized or >1 outpatient visit) and suspect (1 outpatient visit) patients.

RESULTS:

Among 1,935 patients (943 probable, 922 suspect), 54% had codes for symptoms or findings consistent with histoplasmosis and 35% had ≥2 healthcare visits in the 3 months before diagnosis. Overall, 646 (33%) had any fungal-specific laboratory test: histoplasmosis antibody test (n= 349, 18%), Histoplasma antigen test (n=349, 18%), fungal smear (n=294, 15%), or fungal culture (n=223, 12%); 464 (24%) had a biopsy. Forty-nine percent of probable patients and 10% of suspect patients were prescribed antifungal medication in the outpatient setting. Total, 19% were hospitalized. Patients’ last histoplasmosis-associated healthcare visits occurred a median of 6 months after diagnosis.

CONCLUSIONS:

Some histoplasmosis patients experienced severe disease, apparent diagnostic delays, and prolonged illness, whereas other patients lacked symptoms and were likely diagnosed incidentally (e.g., via biopsy). Low rates of histoplasmosis-specific testing also suggest incidental diagnoses and low provider suspicion, highlighting the need for improved awareness about this disease.

abstract

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz324/5481778

PDF (CLIC en PDF)

May 23, 2019 at 8:16 am

Candida auris Clinical Isolates from South Korea: Identification, Antifungal Susceptibility, and Genotyping

Journal of Clinical Microbioliology March 2019 57:e01624-18

Yong Jun Kwon, Jong Hee Shin, Seung A Byun, Min Ji Choi, Eun Jeong Won, Dain Lee, Seung Yeob Lee, Sejong Chun, Jun Hyung Lee, Hyun Jung Choi, Seung Jung Kee, Soo Hyun Kim and Myung Geun Shin

Candida auris is an emerging worldwide fungal pathogen. Over the past 20 years, 61 patient isolates of C. auris (4 blood and 57 ear) have been obtained from 13 hospitals in Korea.

abstract

https://jcm.asm.org/content/57/4/e01624-18.abstract?etoc

PDF

https://jcm.asm.org/content/jcm/57/4/e01624-18.full.pdf

 

March 31, 2019 at 6:54 pm

Disminución del nivel de conciencia, fiebre y disnea en una paciente infectada con HIV.

Revista Argentina de Microbiologia 2014 V.46 N.3 P.271-272

Carta al Editor

Shock séptico con meningitis debido a la bacteriemia por Klebsiella pneumoniae y falla multiorgánica en el contexto de un síndrome de hiperinfección por Strongyloides stercoralis,

PDF

https://www.redalyc.org/pdf/2130/213032482015.pdf

March 24, 2019 at 5:31 pm

Infección por Strongyloides stercoralis: estudio epidemiológico, clínico, diagnóstico y terapéutico en 30 pacientes

Revista Chilena de Infectologia Junio 2011 V.28 N.3

Marcelo Corti, María F. Villafañe, Norberto Trione, Daniel Risso, Juan Carlos Abuín y Omar Palmieri

Hospital de Enfermedades Infecciosas Francisco J. Muñiz, Buenos Aires, Argentina

Antecedentes

Strongyloides stercoralis, parásito endémico de áreas tropicales y subtropicales del planeta, en sujetos inmunodeprimidos puede cursar con formas graves y aun mortales como el síndrome de hiperinfestación y la enfermedad diseminada.

Métodos

Análisis retrospectivo de las características epidemiológicas, manifestaciones clínicas, co-infección por virus de inmunodeficiencia humana (VIH), hallazgos microbiológicos y evolución de 30 pacientes con estrongiloidiasis, atendidos en el Hospital de Enfermedades Infecciosas F. J. Muñiz de Buenos Aires, entre enero 2004 y diciembre 2008.

Resultados

Se incluyeron en la evaluación 20 hombres y 10 mujeres con una mediana de edad de 33 años. Co-infección por VIH hubo en 21 pacientes (70%); la mediana de linfocitos T CD4+ en ellos al momento del diagnóstico de la parasitosis fue de 50 céls/mm3 (rango 7 a 355), (media de 56 céls/mm3). En los pacientes seronegativos para VIH, se comprobaron las siguientes co-morbilidades: tuberculosis (n: 3) y un caso de cada una de las siguientes afecciones: alcoholismo crónico, diabetes mellitus, reacción lepromatosa bajo corticotera-pia, y psoriasis en tratamiento inmunosupresor. Hubo dos pacientes sin aparentes enfermedades de base. Diecisiete pacientes presentaron enfermedad intestinal crónica con diarrea (57%), era asintomática y fue sospechada por la eosinofilia periférica (n: 7, 23%) y se clasificó como síndrome de hiperinfestación (n: 6, 20%) diagnosticado por la identificación de larvas en la materia fecal y secreciones broncopulmonares. Diecisiete pacientes (57%) presentaron eosinofilia periférica. El diagnóstico se efectuó por la visualización directa de las larvas en muestras de heces en fresco mediante la técnica de concentración de Baer-man (n: 20); por el examen copro-parasitológico seriado (n: 2) y por ambos métodos (n: 1); en líquido duodenal y materia fecal (n: 1) y por la identificación de larvas en materia fecal y secreciones respiratorias (n: 6). Letalidad global: 20% (6/30). Los pacientes con eosinofilia tuvieron una menor letalidad que aquellos sin esta respuesta (p < 0,001). No hubo correlación estadística entre la edad y la supervivencia. Sí fue significativa la correlación entre el recuento de CD4 y la letalidad, incluyendo 18 de los 21 pacientes seropositivos para VIH (p: 0,03). Finalmente, la correlación seropositividad para VIH y letalidad también fue significativa. Veintidós pacientes respondieron a la terapia antiparasitaria con ivermectina y evolucionaron favorablemente.

PDF

https://scielo.conicyt.cl/pdf/rci/v28n3/art03.pdf

March 24, 2019 at 5:28 pm

Antimicrobial Prophylaxis for Adult Patients With Cancer-Related Immunosuppression: ASCO and IDSA Clinical Practice Guideline Update.

J Clin Oncol. 2018 Sep 4:JCO1800374

Taplitz RA, Kennedy EB, Bow EJ, et al.

Purpose

To provide an updated joint ASCO/Infectious Diseases Society of America (IDSA) guideline on antimicrobial prophylaxis for adult patients with immunosuppression associated with cancer and its treatment.

Methods

ASCO and IDSA convened an update Expert Panel and conducted a systematic review of relevant studies from May 2011 to November 2016. The guideline recommendations were based on the review of evidence by the Expert Panel.

Results

Six new or updated meta-analyses and six new primary studies were added to the updated systematic review.

Recommendations

Antibacterial and antifungal prophylaxis is recommended for patients who are at high risk of infection, including patients who are expected to have profound, protracted neutropenia, which is defined as < 100 neutrophils/µL for > 7 days or other risk factors. Herpes simplex virus–seropositive patients undergoing allogeneic hematopoietic stem-cell transplantation or leukemia induction therapy should receive nucleoside analog-based antiviral prophylaxis, such as acyclovir. Pneumocystis jirovecii prophylaxis is recommended for patients receiving chemotherapy regimens that are associated with a > 3.5% risk for pneumonia as a result of this organism (eg, those with ≥ 20 mg prednisone equivalents daily for ≥ 1 month or on the basis of purine analog usage). Treatment with a nucleoside reverse transcription inhibitor (eg, entecavir or tenofovir) is recommended for patients at high risk of hepatitis B virus reactivation. Recommendations for vaccination and avoidance of prolonged contact with environments that have high concentrations of airborne fungal spores are also provided within the updated guideline. Additional information is available at http://www.asco.org/supportive-care-guidelines.

FULL TEXT

https://ascopubs.org/doi/full/10.1200/JCO.18.00374

PDF (CLIC en PDF)

 

March 20, 2019 at 3:44 pm

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