Posts filed under ‘Infecciones gastrointestinales’

Cryptosporidiosis Outbreaks — United States, 2009–2017

MMWR  June 28, 2019  V.68 N.25 P.568–572

Radhika Gharpure, DVM1,2; Ariana Perez, MPH1,3; Allison D. Miller, MPH1,4; Mary E. Wikswo, MPH5; Rachel Silver, MPH1,3; Michele C. Hlavsa, MPH1

Summary

What is already known about this topic?

Cryptosporidium is the leading cause of outbreaks of diarrhea linked to water and the third leading cause of diarrhea associated with animal contact in the United States.

What is added by this report?

During 2009–2017, 444 cryptosporidiosis outbreaks, resulting in 7,465 cases were reported by 40 states and Puerto Rico. The number of reported outbreaks has increased an average of approximately 13% per year. Leading causes include swallowing contaminated water in pools or water playgrounds, contact with infected cattle, and contact with infected persons in child care settings.

What are the implications for public health practice?

To prevent cryptosporidiosis outbreaks, CDC recommends not swimming or attending child care if ill with diarrhea and recommends hand washing after contact with animals….

FULL TEXT

https://www.cdc.gov/mmwr/volumes/68/wr/mm6825a3.htm#contribAff

PDF

https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6825a3-H.pdf

 

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July 1, 2019 at 11:03 am

A Laboratory Medicine Best Practices Systematic Review and Meta-analysis of Nucleic Acid Amplification Tests (NAATs) and Algorithms Including NAATs for the Diagnosis of Clostridioides (Clostridium) difficile in Adults

Clinical Microbiololy Reviwes July 2019 V.32 N.3

The evidence base for the optimal laboratory diagnosis of Clostridioides (Clostridium) difficile in adults is currently unresolved due to the uncertain performance characteristics and various combinations of tests. This systematic review evaluates the diagnostic accuracy of laboratory testing algorithms that include nucleic acid amplification tests (NAATs) to detect the presence of C. difficile. The systematic review and meta-analysis included eligible studies (those that had PICO [population, intervention, comparison, outcome] elements) that assessed the diagnostic accuracy of NAAT alone or following glutamate dehydrogenase (GDH) enzyme immunoassays (EIAs) or GDH EIAs plus C. difficile toxin EIAs (toxin). The diagnostic yield of NAAT for repeat testing after an initial negative result was also assessed. Two hundred thirty-eight studies met inclusion criteria. Seventy-two of these studies had sufficient data for meta-analysis. The strength of evidence ranged from high to insufficient. The uses of NAAT only, GDH-positive EIA followed by NAAT, and GDH-positive/toxin-negative EIA followed by NAAT are all recommended as American Society for Microbiology (ASM) best practices for the detection of the C. difficile toxin gene or organism. Meta-analysis of published evidence supports the use of testing algorithms that use NAAT alone or in combination with GDH or GDH plus toxin EIA to detect the presence of C. difficile in adults. There is insufficient evidence to recommend against repeat testing of the sample using NAAT after an initial negative result due to a lack of evidence of harm (i.e., financial, length of stay, or delay of treatment) as specified by the Laboratory Medicine Best Practices (LMBP) systematic review method in making such an assessment. Findings from this systematic review provide clarity to diagnostic testing strategies and highlight gaps, such as low numbers of GDH/toxin/PCR studies, in existing evidence on diagnostic performance, which can be used to guide future clinical research studies.

FULL TEXT

https://cmr.asm.org/content/32/3/e00032-18.abstract?etoc

PDF

https://cmr.asm.org/content/cmr/32/3/e00032-18.full.pdf

June 19, 2019 at 2:57 pm

Outcomes of Community and Healthcare-onset Clostridium difficile Infections

Clinical Infectious Diseases April 15, 2019 V.68 N.8 P.1343-1350  

EDITOR’S CHOICE

Between 2011 and 2014, of the Clostridium difficile infections (CDI) cases in the Veterans Health Administration system, 44% were hospital-onset and 42% were community-onset (CO). CDI prevention efforts should include interventions to reduce CO CDIs.

Background

Community-onset Clostridium difficile infections (CDI) are increasingly common, but there is little data on outcomes. The purpose of this study is to describe the epidemiology and outcomes of CDI in the Veterans Health Administration (VHA) system and compare these variables between hospital-onset (HCF) and community-onset (CO) cases.

Methods

We conducted a retrospective cohort study that included all patients with a positive test for C. difficile (toxin or toxin genes) within the VHA Corporate Data Warehouse between 2011 and 2014.

Results

We identified 19270 episodes of CDI, involving 15972 unique patients; 95% were male, 44% of the cases were HCF, and 42% were CO. Regarding severity, 31% percent of cases were non-severe, 40% were severe, and 21% were fulminant. Exposure to proton pump inhibitors was found in 53% of cases (47% in CO, 62% in HCF). Overall, 40% of patients received antibiotics in the 90 days before CDI (44% in HCF, 36% in CO). Recurrence was 18.2%, and 30-day all-cause mortality was 9.2%. Risk factors for a fulminant case were exposure to clindamycin (odds ratio [OR]: 1.23, P = .01) or proton pump inhibitors (OR: 1.20, P < .001)  in the 90 days prior to diagnosis.

Conclusions

CO accounts for a significant proportion of CDI in the VHA system. CO patients are younger and their cases are less severe, but recurrence is more common than in HCF CDI. Therefore CO CDI may account for a considerable reservoir of CDI cases, and prevention efforts should include interventions to reduce CO CDI.

FULL TEXT

https://academic.oup.com/cid/article/68/8/1343/5078569

PDF (CLIC en PDF)

May 4, 2019 at 12:19 pm

Review – Vibrio vulnificus, an important cause of severe sepsis and skin and soft-tissue infection.

International Journal of Infectious Diseases 2011 V.15 e157-e166

Michael A. Horseman a,b,c,*, Salim Surani c,d,e

aDepartment of Pharmacy Practice, College of Pharmacy, Texas A&M Health Sciences Center, Kingsville, Texas, USA

bDepartment of Family Medicine & Community Medicine, School of Medicine, University of Texas Health Sciences Center, San Antonio, Texas, USA

c Christus Spohn Hospital Corpus Christi – Memorial, 2606 Hospital Blvd, Corpus Christi, Texas 78405, USA

dDepartment of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA

eDepartment of Internal Medicine, Texas A&M Health Science Center – College of Medicine, Scott and White Hospital, Temple, Texas, USA

Vibrio vulnificus is a halophilic Gram-negative bacillus found worldwide in warm coastal waters.

The pathogen has the ability to cause primary sepsis in certain high-risk populations, including patients with chronic liver disease, immunodeficiency, iron storage disorders, end-stage renal disease, and diabetes mellitus.

Most reported cases of primary sepsis in the USA are associated with the ingestion of raw or undercooked oysters harvested from the Gulf Coast.

The mortality rate for patients with severe sepsis is high, exceeding 50% in most reported series.

Other clinical presentations include wound infection and gastroenteritis.

Mild to moderate wound infection and gastroenteritis may occur in patients without obvious risk factors.

Severe wound infection is often characterized by necrotizing skin and soft-tissue infection, including fasciitis and gangrene.

V. vulnificus possesses several virulence factors, including the ability to evade destruction by stomach acid, capsular polysaccharide, lipopolysaccharide, cytotoxins, pili, and flagellum.

The preferred antimicrobial therapy is doxycycline in combination with ceftazidime and surgery for necrotizing soft-tissue infection.

PDF

https://www.ijidonline.com/article/S1201-9712(10)02538-5/pdf

January 10, 2019 at 8:32 am

Vibrio vulnificus, una bacteria al acecho en las playas.

Highlights en investigación December 2014

Iván Renato Zúñiga Carrasco*, Janett Caro Lozano**.

*Jefe del Departamento de Epidemiología. Miembro del Comité Local de

Investigación y Ética en Salud (CLIES). H.G.Z. # 18 IMSS Playa del Carmen, Quintana

Roo.

**Jefa del Departamento de Epidemiología. Miembro del Comité Local de

Investigación y Ética en Salud (CLIES) H.G.Z. C/M.F. 1 IMSS Chetumal, Quintana Roo.

Un patógeno que puede ser transmitido por los ostiones es Vibrio vulnificus.

Descrito en 1976, se le denominó “Vibrio lactosa positivo”, posteriormente se le llamó Beneckea vulnificus y finalmente V. vulnificus. Pertenece a la familia Vibrionaceae, son bacilos Gramnegativos, rectos y curvos, móviles por la presencia de un flagelo polar, oxidasa positivos, no esporulados.

Son termolábiles y se comportan como anaerobios facultativos.

Entre las más de 30 especies del género Vibrio, se han reportado 12 como patógenas para el hombre, entre las que sobresalen V. cholerae, V. parahaemolyticus y V vulnificus . . .

PDF

http://www.medigraphic.com/pdfs/revenfinfped/eip-2014/eip144e.pdf

January 10, 2019 at 8:30 am

CASO CLINICO – Shock séptico por Vibrio vulnificus – un caso pediátrico

Revista de Enfermedades Infecciosas en Pediatría Diciembre 2013 Vol. XXVII Núm. 106

Dra. Marisol Fonseca Flores*, Dra. Sandra Luz Lizárraga López**, Dr. Agustín De Colsa Ranero***

* Médico Residente de Pediatría. Instituto Nacional de Pediatría.

** Médico Adscrito a la Unidad de Terapia Intensiva. Instituto Nacional de Pediatría.

*** Médico Adscrito al Departamento de Infectología Pediátrica. Instituto Nacional de Pediatría.

Los reportes de infección por V. vulnificus en pediatría son limitados en la literatura, y característicamente se describen 3 cuadros clínicos: Sepsis Primaria, Infección de piel y tejidos blandos e Infección gastrointestinal.

Se reporta el caso de un paciente masculino de 15 años de edad con diagnóstico de aplasia pura de serie roja y hemosiderosis, quien ingresa con cuadro febril, lesiones dérmicas, diarrea y datos de choque.

A los 4 días de su ingreso se identifica Vibrio vulnificus en hemocultivo, sin embargo, el paciente fallece a pesar del tratamiento establecido.

Con la presentación de este caso, se describen las características clínicas, epidemiológicas, factores de riesgos y evolución de la infección sistémica por V. vulnificus . . .

PDF

http://www.medigraphic.com/pdfs/revenfinfped/eip-2013/eip134g.pdf

 

January 10, 2019 at 8:28 am

PATÓGENO OPORTUNISTA VIBRIO VULNIFICUS

Revista Digital Universitaria 10 de abril 2005 • Volumen 6 Número 4 • ISSN: 1067-6079

Vibrio vulnificus es un bacteria halofílica. Tiene como reservorios ostiones, pescado, sedimento, agua y plankton.

Causa tres cuadros clínicos en humanos: septicemia, gastroenteritis e infección en heridas, de estos cuadros clínicos la septicemia tiene una mortalidad menos del 50%.

En general este tipo de enfermedades se presenta en personas inmunocomprometidas o con problemas hepáticos, por lo que se considera un patógeno oportunista, aunque se han reportado casos de infección en heridas en personas sanas.

Los moluscos en general poseen una alimentación por filtración, este sistema de nutrición permite que se acumule una gran cantidad de microorganismos y otros elementos presentes en el ambiente en donde se desarrollan. . .

PDF

http://www.revista.unam.mx/vol.6/num4/art32/abr_art32.pdf

January 10, 2019 at 8:26 am

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