Posts filed under ‘Infecciones e Insuf. renal’

Reglas de interpretación de las infecciones por Candida

Acta Bioquímica Clínica Latinoamericana Oct / Dic 2007 V.41 N.4

A. Enache-Angoulvant

Laboratoire de Parasitologie, Hôpital Tenon. AP-HP. Paris

Resumen

Las candidiasis son infecciones cosmopolitas y oportunistas, debidas a levaduras del género Candida. Sus aspectos clínicos son variados cualquiera que sea su localización. El carácter comensal de algunas de ellas hace que la interpretación de los exámenes microbiológicos sea delicada. Éstos sólo pueden ser interpretados después de confrontar los datos clínicos con la existencia de factores de riesgo. Las candidiasis son infecciones cosmopolitas por levaduras del género Candida. Sus aspectos clínicos son variados, ya se trate de afecciones superficiales o profundas (o sistémicas). Estas levaduras son oportunistas porque necesitan factores favorecedores (véase 1.2) para provocar la candidiasis. Las afecciones sistémicas, esencialmente en sujetos que presentan un déficit inmunitario, no serán tratadas aquí. Tampoco nos ocuparemos del tratamiento de la candidiasis superficial, basada en general en la administración de antifúngicos tópicos y la eliminación de los factores favorecedores.

PDF

http://www.scielo.org.ar/pdf/abcl/v41n4/v41n4a16.pdf

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November 17, 2012 at 3:08 pm

Spinal epidural abscess.

N Engl J Med. 2006 Nov 9 V.355 N.19 P.2012-20.

Darouiche RO.

Source

Infectious Disease Section, the Michael E. DeBakey Veterans Affairs Medical Center, and the Center for Prostheses Infection, Baylor College of Medicine, Houston, TX 77030, USA. rdarouiche@aol.com

Despite advances in medical knowledge, imaging techniques, and surgical interventions, spinal epidural abscess remains a challenging problem that often eludes diagnosis and receives suboptimal treatment. The incidence of this disease — two decades ago diagnosed in approximately 1 of 20,000 hospital admissions — has doubled in the past two decades, owing to an aging population, increasing use of spinal instrumentation and vascular access, and the spread of injection-drug use. Still, spinal epidural abscess remains rare: the medical literature contains only 24 reported series of at least 20 cases each. This review addresses the pathogenesis, clinical features, diagnosis, treatment, common diagnostic and therapeutic pitfalls, and outcome of bacterial spinal epidural abscess …

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http://www.nejm.org/doi/pdf/10.1056/NEJMra055111

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CORRESPONDENCE

Spinal Epidural Abscess

http://www.nejm.org/doi/pdf/10.1056/NEJMc063456

October 18, 2012 at 2:38 pm

Espondilodiscitis lumbar: clınica y factores de riesgo en el diagnostico precoz

Rehabilitacion (Madir).2010 V.44 N.1  P.82–85

CASO CLINICO

A. Capa-Grasa, I. Flores-Torres y D. Gozalo-Arribas

Servicio de Medicina Fısica y Rehabilitacion, Hospital Universitario la Paz-Cantoblanco, Madrid, España

La espondilodiscitis lumbar (EDL) es una infeccion del cuerpo y el disco vertebral cuya clınica en fases iniciales se puede confundir facilmente con otros cuadros de dolor lumbar de causa menor. Es necesario un elevado grado de sospecha clınica para evitar retrasar su diagnostico, ası como tener en cuenta la presencia de factores de riesgo que pudieran favorecer su desarrollo. La deteccion y el manejo precoces pueden evitar en gran parte la discapacidad que causa este cuadro. Se presentan dos casos clınicos de EDL asociados a estreptococos del grupo viridans y Enterobacter aerogenes, respectivamente, y se destacan, a proposito de estos, los pasos clave necesarios para evitar un retraso diagnostico.

PDF

http://www.elsevier.es/sites/default/files/elsevier/pdf/120/120v44n01a13146299pdf001.pdf

 

October 18, 2012 at 9:44 am

Espondilodiscitis. Análisis de una serie de 25 casos

Revista médica de Chile Mayo 2003 V.131 N.5 P.473-482

Alberto Fica C, Francisca Bozán Pa, Magdalena Aristegui Va, Patricio Bustos G.

Background: Spondylodiscitis is a rare but prolonged inflammation of two adjacent vertebral bodies and the disk in between.

Aim: To report the clinical features of a series of patients with spondylodiscitis.

Material and methods: A retrospective analysis of medical records of patients with spondylitis, identified between 1989 and 2002.

Results: A total of 25 cases were identified, 15 female, aged 49.8 years as a mean. Their mean evolution before admission was 4.3 months. Main complaints were back or radicular pain. Mild anemia was present in most patients. Mean erythrocyte sedimentation rate and C reactive protein values were 66 mm/h and 60 mg/L, respectively. Forty four percent of patients had neurological complications. Vertebral computed tomography and scintigraphic studies were done in 72% of patients, but magnetic resonance imaging was done only in 4 (16%). In 18 patients, a tissue sample for pathological and microbiological analysis, was obtained by imaging guiding or surgically. Tuberculosis, diagnosed on pathology, was the leading cause of spondylitis in nine cases (36%), followed by Staphylococcus aureus infection in five (20%). Other agents found were E coli and group D Streptococcus (one each). Age, symptoms, evolution time and different laboratory parameters did not differ between patients with tuberculosis and patients with other causes. A microbiological cause was not established in 36% of cases. Most patients evolved satisfactorily and recovered from neurological complications (88%). One patient with tuberculosis did not improve after prolonged treatment and 2 patients infected with S aureus died (8%).

Conclusions: Spondylodiscitis is associated to a diversity of microbial agents and in most cases has a favorable prognosis.

FULL TEXT

http://www.scielo.cl/scielo.php?pid=S0034-98872003000500001&script=sci_arttext

October 18, 2012 at 9:42 am

Manejo de colonización por SAMR en pacientes y profesionales de unidad de hemodiálisis, en una situación de elevada endemia: ¿objetivo cero?

Enf Inf & Microbiol. Clin. Marzo 2012 V.30 N.3 P.124-30

Objetivos

Describir las características de la colonización por Staphylococcus aureus meticilin resistente (SARM) detectada en la Unidad de Hemodiálisis (UHD) del Complejo Hospitalario de Cáceres ante la detección de infecciones asociadas a catéter. Además, tratamos de evaluar la eficacia de las estrategias preventivas implementadas.

Métodos

Se realizaron frotis nasales para detección de colonización por SARM en pacientes y profesionales desde agosto de2008 aenero de 2009, según Consenso GEIH-SEIMC Y SEMPSPH. Se realizó vigilancia activa con tratamiento y seguimiento de portadores hasta negativización. Se elaboró documento de consenso en UHD con medidas preventivas protocolizadas y se revisaron procedimientos de trabajo. Se calcula prevalencia, incidencia acumulada, presión de colonización (ratio de portadores-día/total pacientes o profesionales-día).Test chi-cuadrado y prueba Z de comparación de proporciones.

Resultados

Frotis nasal a 54 pacientes agudos y crónicos en hemodiálisis con prevalencia inicial de portadores del 29,6%; incidencia acumulada en pacientes 42,6%. Frotis nasal en 48 profesionales con incidencia acumulada de 39,5%. Descenso paralelo de presión de colonización en pacientes y profesionales. A los 5 meses se realiza frotis nasal en 40 pacientes y 26 profesionales, con cero portadores en pacientes y uno en profesionales.

Conclusiones

Se detectó un número elevado de portadores de SARM tanto entre pacientes como entre el personal sanitario de la Unidad de Hemodiálisis. Las medidas de cribado y tratamiento fueron eficaces para la descolonización de esta población. Es importante la adopción de estrategias de vigilancia activa, mantenidas en el tiempo para la detección rápida de situaciones de alerta.

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90098220&pident_usuario=0&pcontactid=&pident_revista=28&ty=30&accion=L&origen=elsevier&web=www.elsevier.es&lan=es&fichero=28v30n03a90098220pdf001.pdf

June 24, 2012 at 2:26 pm

Atypical hemolytic uremic syndrome.

Orphanet J Rare Dis. Sept 2011  V.8 N.6 P.60.

Loirat C, Frémeaux-Bacchi V.

Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Université Paris VII, Pediatric Nephrology Department, Paris, France. chantal.loirat@rdb.aphp.fr

Abstract

Hemolytic uremic syndrome (HUS) is defined by the triad of mechanical hemolytic anemia, thrombocytopenia and renal impairment. Atypical HUS (aHUS) defines non Shiga-toxin-HUS and even if some authors include secondary aHUS due to Streptococcus pneumoniae or other causes, aHUS designates a primary disease due to a disorder in complement alternative pathway regulation. Atypical HUS represents 5 -10% of HUS in children, but the majority of HUS in adults. The incidence of complement-aHUS is not known precisely. However, more than 1000 aHUS patients investigated for complement abnormalities have been reported. Onset is from the neonatal period to the adult age. Most patients present with hemolytic anemia, thrombocytopenia and renal failure and 20% have extra renal manifestations. Two to 10% die and one third progress to end-stage renal failure at first episode. Half of patients have relapses. Mutations in the genes encoding complement regulatory proteins factor H, membrane cofactor protein (MCP), factor I or thrombomodulin have been demonstrated in 20-30%, 5-15%, 4-10% and 3-5% of patients respectively, and mutations in the genes of C3 convertase proteins, C3 and factor B, in 2-10% and 1-4%. In addition, 6-10% of patients have anti-factor H antibodies. Diagnosis of aHUS relies on 1) No associated disease 2) No criteria for Shigatoxin-HUS (stool culture and PCR for Shiga-toxins; serology for anti-lipopolysaccharides antibodies) 3) No criteria for thrombotic thrombocytopenic purpura (serum ADAMTS 13 activity > 10%). Investigation of the complement system is required (C3, C4, factor H and factor I plasma concentration, MCP expression on leukocytes and anti-factor H antibodies; genetic screening to identify risk factors). The disease is familial in approximately 20% of pedigrees, with an autosomal recessive or dominant mode of transmission. As penetrance of the disease is 50%, genetic counseling is difficult. Plasmatherapy has been first line treatment until presently, without unquestionable demonstration of efficiency. There is a high risk of post-transplant recurrence, except in MCP-HUS. Case reports and two phase II trials show an impressive efficacy of the complement C5 blocker eculizumab, suggesting it will be the next standard of care. Except for patients treated by intensive plasmatherapy or eculizumab, the worst prognosis is in factor H-HUS, as mortality can reach 20% and 50% of survivors do not recover renal function. Half of factor I-HUS progress to end-stage renal failure. Conversely, most patients with MCP-HUS have preserved renal function. Anti-factor H antibodies-HUS has favourable outcome if treated early.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198674/pdf/1750-1172-6-60.pdf

May 13, 2012 at 12:51 pm

Escherichia coli 0157 enterohaemorrhagic colitis associated with pyelonephritis: CT findings.

Br J Radiol. 2009 Apr V.82 N.976 P.63-6.

Heffernan E, Chatur N, Zwirewich C.

Department of Radiology, Vancouver General Hospital, Jim Pattison Pavillion South, 899 West 12th Avenue, Vancouver, BC V5Z1M9, Canada. ejheffernan@eircom.net

Abstract

Escherichia coli 0157:H7 is increasingly being recognized as a cause of infectious colitis, which typically results in bloody diarrhoea in an afebrile patient. The absence of fever often means that an infectious process is not considered in the differential diagnosis, particularly as this organism will not be detected in routine stool cultures. Inappropriate antibiotic therapy may increase the risk of development of haemolytic uraemic syndrome, a potentially fatal complication of this form of colitis, hence the importance of accurate diagnosis. On CT, it is characterized by severe diffuse colonic wall thickening, with little or no pericolic inflammatory changes. The radiologist may be the first to suspect the correct diagnosis and so should be aware of its imaging appearances. We report the case of a 19-year-old man who presented with typical radiological findings of enterohaemorrhagic colitis and whose CT also showed evidence of acute pyelonephritis; we suggest that this combination of abnormalities should further heighten radiologists’ suspicions of infection due to E. coli 0157:H7, despite the absence of fever.

PDF

http://bjr.birjournals.org/cgi/reprint/82/976/e63

 

November 25, 2011 at 11:30 pm Leave a comment

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