Positive Hemoculture Research Articles

Septic Shock with Chlamydia Pneumoniae Secondary to Prostatic Abscess: A Rare Case Report

Prostatic abscesses are a rare clinical entity in current practice due to the widespread use of antibiotics. Management usually imposes a challenge to urologists that is due to the difficult diagnosis, as it may mimic other diseases of the lower urinary tract and the lack of guidelines for treatment. Prostate abscess (PA) usually develops in immunocompromised patients, including diabetic and HIV patients, as a consequence of acute bacterial prostatitis. The reason for the lack of guidelines as regards PA is that most of the published data in the literature are case reports due to the declining incidence of the disease today. We presented a male patient who was not foreknown with pathological or personal antecedents or a promiscuous lifestyle. He was hospitalized in the urology section with subfebrility and lumbar pain. His general condition changed rapidly within the span of a few hours, the patient entering septic shock without an etiology or a determined infection. After careful serial investigations, hemocultures (atypical germs) for IgM antibodies Chlamydia Pneumoniae were found in the serological complement fixation (cf) test. The patient responded well to empirically initiated antibiotic treatment upon admission to Intensive Care. Due to a favorable evolution, the patient was declared clinically healthy upon discharge. This was a rare case in medical literature of septic shock of initially unspecified etiology but which, upon thorough investigations and urological reevaluation, revealed a prostatic abscess with Chlamydia Pneumoniae, exteriorized through the urethra and highlighted through positive hemocultures only.

Group B streptococcus is the most common pathogen for septic arthritis with unique clinical characteristics: data from 12\u2009years retrospective cohort study

BackgroundGroup B Streptococcus (GBS) emerged as the frequent pathogen for septic arthritis. There was no study comparing risks, clinical presentations and outcomes between GBS septic arthritis and other bacterial septic arthritis.The aim of this study is to evaluate the differences in risks, clinical presentations, and outcomes of GBS septic arthritis and other bacterial septic arthritis, and identify independent risks and clinical presentations suggesting GBS septic arthritis.MethodMedical records of patients diagnosed with non-gonococcal bacterial arthritis admitted in Phramongkutklao Hospital during 2006–2018 were reviewed. Associated risks, clinical presentations and outcomes were compared between GBS septic arthritis (GBS group) and other bacterial septic arthritis (other bacterial group).ResultTwo hundred and thirty one cases of non-gonococcal bacterial arthritis confirmed by positive joint fluid cultures and/or hemocultures were included. The three most common pathogens were GBS (37.7%), Staphylococcus aureus (23.4%) and Streptococcus viridans (7.4%). GBS group was more commonly found in rainy season than other bacterial group. Patients in GBS group were less likely to have underlying diseases and had more number of involved joints than those in other bacterial group. The clinical presentations more commonly found in GBS group than other bacterial group were oligo-polyarthritis, upper extremities joint involvement, axial joint involvement, tenosynovitis and central nervous system involvement.Multivariate analysis found the independent associated factors of GBS arthritis are tenosynovitis, oligo-polyarthritis and rainy season.ConclusionsGBS is now the most common pathogen for bacterial septic arthritis. The independent associated factors of GBS arthritis were oligo-polyarthritis, tenosynovitis and rainy season.

Sepse tardia em Unidade de Tratamento Intensivo Neonatal

Justificativa e Objetivos: É essencial conhecer os microrganismos presentes em hemoculturas de pacientes pediátricos internados para uma melhor escolha da terapêutica antibiótica. Dessa forma, este trabalho tem como objetivo verificar a associação entre parâmetros clínicos e epidemiológicos com o desenvolvimento de sepse neonatal tardia em pacientes internados em um serviço de pediatria de um hospital do sul do Brasil. Métodos: Estudo transversal, descritivo, retrospectivo e qualiquantitativo que utilizou dados secundários oriundos dos prontuários de pacientes que apresentaram critérios clínicos para sepse neonatal, internados na Unidade de Tratamento Intensivo Neonatal (UTIN) do Hospital Santa Cruz. Resultados: Dos 588 pacientes internados na UTIN do Hospital Santa Cruz no período de 01/01/2013 a 31/12/2015, 123 recém-nascidos (RNs) preencheram os critérios para sepse neonatal tardia. Destes, 59 (47,97%) apresentaram hemocultura positiva, o que foi mais frequente em RNs prematuros (39,84%) e de baixo peso (43,90%), embora não tenha havido associação estatisticamente significativa entre estes fatores e hemocultura positiva. Dentre os possíveis fatores de risco para o desenvolvimento de sepse neonatal, o uso de ventilação mecânica (p=0,005), realização de cirurgia (p=0,019) e permanência no hospital por mais de um mês (p=0,001) apresentaram associação estatística com hemocultura positiva. Os microrganismos presentes em maior frequência nas hemoculturas foram os estafilococos coagulase negativa (S. epidermidis, S. saprophyticus e S. haemolyticus), encontrados em 35,71% das hemoculturas analisadas. Conclusão: O estudo evidenciou maior prevalência de sepse neonatal tardia em RNs prematuros e de baixo peso, que necessitaram de maiores cuidados e foram submetidos a maior manipulação durante a permanência na UTIN. Procedimentos invasivos e longa permanência hospitalar se associaram significativamente com hemocultura positiva, corroborando com o descrito na literatura.

Native spondylodiscitis in adults: Six-year experience at a General Hospital in Buenos Aires

Background: Native spondylodiscitis (NS) is an infection caused mostly by pyogenic bacteria (gram-positive-cocci and less frequently gram-negative-bacilli), and occasionally by Brucella spp. and mycobacteria. Although its incidence is low, it implies high morbility due to prolonged diagnostic latency periods, hospitalization, and possible complications. We describe the clinical and epidemiological characteristics, etiological agents, risk factors (RF) and treatment of patients diagnosed with NS in our center. Methods & Materials: Retrospective, descriptive study of patients diagnosed with NS admitted to a general hospital between 2011 and 2017. Medical records were reviewed for data collection in a pre-designed sheet. The statistical analysis was performed with Epiinfo®7.2.2.2. Results: Twenty-nine patients with diagnosis of NS were included, 76% (n = 22) were men. Median age at diagnosis was 57-years (IQR 47-61). The localization was: lumbar: 62% (n = 18), dorsal: 28% (n = 8), cervical: 21% (n = 6), sacral: 10% (n = 3). Back pain was present in 96.5% of cases (n = 28), and 72.4% of patients (n = 21) had local complications when diagnosed. Sixty-two-percent of patients (n = 18) had at least one risk factor for NS being diabetes the most frequent 38% (n = 11). Regarding etiologic agents, S. aureus was isolated in 45% of cases (n = 13) Brucella spp. in 10% (n = 3) and E. coli in 7% (n = 2). Presumptive hematogenous spread was the most frequent source of infection 83% (n = 24). Findings of positive hemocultures in 62% (n = 18) and positive bone-biopsy culture in 59.8% (n = 11). One single sample was taken for culture in 10/19 (53%). Three cases had associated endocarditis. Median duration of antibiotic treatment for pyogenic NS (n = 21) was 90 days (IQR 84-168). Clinical resolution at the end of treatment was achieved in 83% of cases (n = 24). Conclusion: Although S. aureus is common in our patients, Brucella spp. has a relatively high frequency and should be considered as a potential etiologic agent of NS in our setting. The high sensitivity of blood cultures reinforces its role in the initial management. Low sensitivity of bone-biopsy culture may be related to technical issues such as only one sample for culture. High rates of local complications at the time of diagnosis shows the importance of a high clinical suspicious and early start of appropriate treatment.

Utility of routine evaluation of sterility of cellular therapy products with or without extensive manipulation: Best practices and clinical significance

BackgroundWe analyzed the results of routine sterility testing performed in our center over the last 10 years, in the context both hematopoietic stem cell transplantation (HSCT) and Advanced Therapeutic Medicinal Products (ATMPs). MethodsFor sterility tests 14-day cultures were performed in culture media detecting aerobic and anaerobic microorganisms. ResultsIn this study, 22/1643 (1.3%) of apheretic products for autologous or allogeneic HSCT were contaminated, whereas 14/73 bone marrow (BM) harvests (17.8%) were positive. In 22 cases, the contaminated HSCs were infused to patients, but there was no evidence of any adverse impact of contamination on the hematologic engraftment or on infections. Indeed none of the five positive hemocultures detected in patients following infusion could be linked to the contaminated stem cell product. Our Cell Factory also generated 286 ATMPs in good manufacturing practice (GMP) conditions since 2007 and all final products were sterile. In three cases of mesenchymal stromal cell expansions, the starting BM harvests were contaminated, but the cell products at the end of expansion were sterile, presumably thanks to the presence of an antibiotic in the culture medium. DiscussionThe decreased rate of contamination of cell harvests observed with time suggests that routine sterility testing and communication of the results to the collecting centers may improve clinical practices. Furthermore, we recommend the use of antibiotics in the medium for ATMP expansion, to decrease the likelihood of expanding microorganisms within clean rooms. Finally we discuss the costs of sterility testing of ATMPs by GMP-approved external laboratories.

High Trypanosoma spp. diversity is maintained by bats and triatomines in Espírito Santo state, Brazil.

The aim of this study was to reevaluate the ecology of an area in the Atlantic Forest, southeast Brazil, where Chagas disease (CD) has been found to occur. In a previous study, immediately after the occurrence of a CD case, we did not observe any sylvatic small mammals or dogs with Trypanosoma cruzi cruzi infections, but Triatoma vitticeps presented high T. c. cruzi infection rates. In this study, we investigated bats together with non-volant mammals, dogs, and triatomines to explore other possible T. c. cruzi reservoirs/hosts in the area. Seventy-three non-volant mammals and 186 bats were captured at three sites within the Guarapari municipality, Espírito Santo state. Rio da Prata and Amarelos sites exhibited greater richness in terms of non-volant mammals and bats species, respectively. The marsupial Metachirus nudicaudatus, the rodent Trinomys paratus, and the bats Artibeus lituratus and Carollia perspicillata were the most frequently captured species. As determined by positive hemocultures, only two non-volant mammals were found to be infected by Trypanosoma species: Monodelphis americana, which was infected by T. cascavelli, T. dionisii and Trypanosoma sp., and Callithrix geoffroyi, which was infected by T. minasense. Bats presented T. c. cruzi TcI and TcIII/V, T. c. marinkellei, T. dionisii, T. rangeli B and D, and Trypanosoma sp. infections. Seven dogs were infected with T. cruzi based only on serological exams. The triatomines T. vitticeps and Panstrongylus geniculatus were found to be infected by trypanosomes via microscopy. According to molecular characterization, T. vitticeps specimens were infected with T. c. cruzi TcI, TcII, TcIII/V, and TcIV, T. c. marinkellei and T. dionisii. We observed high trypanosome diversity in a small and fragmented region of the Atlantic Forest. This diversity was primarily maintained by bats and T. vitticeps. Our findings show that the host specificity of the Trypanosoma genus should be thoroughly reviewed. In addition, our data show that CD cases can occur without an enzootic cycle near residential areas.

Frequency of Trypanosoma cruzi parasitemia among infected blood donors with a potential association between parasite lineage and transfusion transmission.

Trypanosoma cruzi is endemic to the Americas where it demonstrates multiple lineages over a vast geographic range (i.e., United States to Argentina). These lineages possess divergent geographic and biologic characteristics, including variations in disease manifestations. Herein, we report the frequency of parasitemia among seropositive US blood donors and the potential association between parasite lineage and transfusion transmission. Blood donors identified as T.cruzi seropositive during screening were enrolled in follow-up studies, including hemoculture testing and a risk factor questionnaire. Positive hemocultures were expanded to obtain sufficient parasites for molecular lineage determination and analysis. Country of birth, obtained from the questionnaire, was used to predict parasite lineage in the absence of demonstrable parasitemia for infected donors. Eighteen (6.8%) of 263 seropositive donors were hemoculture positive. Among the 17 hemocultures expanded for lineage determination, TcV was identified more frequently (n=12), compared to TcI (n=2), TcII (n=1), and TcVI (n=2). When presumptive parasite lineages were compared to hemoculture results, only two of 157 (1.3%) TcI versus 13 of 38 (34.2%) TcII/TcV/TcVI non-US donors were parasitemic; three of 44 (6.8%) US donors were TcV or TcVI. Based on lineage determination for donors with parasitemia; hemoculture positivity associated with presumptive parasite lineage; and implicated donors from US, Canadian, and Spanish transfusion cases, donors from Southern South America are significantly more likely to have parasitemia and transmit infection to blood recipients (TcII, TcV, or TcVI vs. TcI). Thus, parasite lineage may be associated with risk of transfusion-transmitted T.cruzi.

Experimental infection with Yersinia pseudotuberculosis in European brown hare (Lepus europaeus, Pallas).

To investigate clinicopathological, bacteriological and pathological aspects of an experimental infection with Yersinia pseudotuberculosis (Y.pseudotuberculosis) in hares to verify the efficacy of serology for the invivo diagnosis. Moreover, the pathogenicity of two Y.pseudotuberculosis strains was investigated in order to detect potential differences. Twelve European brown hares (Lepus europaeus, Pallas) were experimentally infected per os and via conjunctival mucosae with Y.pseudotuberculosis: six subjects were infected with a strain isolated from a naturally infected hare (YpH) and six subjects with a strain isolated from a naturally infected rabbit (YpR). Two hares were used as negative controls. All animals were subjected to clinical, bacteriological and serological examinations during 9 weeks following the infection and, at the end of the control period, subjects still alive were euthanized and submitted to a complete post mortem examination. All faecal samples collected during the control period were positive for bacteriological examinations and to a PCR for the inv gene of Y.pseudotuberculosis, while only one YpH-infected hare showed a positive haemocultures. From the 2nd to the 9th week post infection (pi), serological analysis revealed specific antibodies with titers ranging from 1:10 to 1:160 in all YpH-infected and two YpR-infected subjects. All the YpH-infected and two YpR-infected hares scored positive for Y.pseudotuberculosis by means of bacteriological investigations. Grossly, suppurative multifocal lesions were detected in liver, spleen, kidney and sub-mandibular lymph nodes in both YpH- and YpR-infected hares and confirmed with histopathology. Pulmonary lesions were observed only in YpH-infected subjects. Immunohistochemistry confirmed the presence of bacterial antigen in all infected animals. Results of this study revealed that YpH strain is more pathogenic for hares than the YpR strain; moreover the serological test performed in this study could be used for the diagnosis of pseudotuberculosis in hares, whereas post mortem diagnosis should be confirmed by means of bacteriological examination, PCR, histopathology and immunohistochemistry.

Complexity and multi-factoriality of Trypanosoma cruzi sylvatic cycle in coatis, Nasua nasua (Procyonidae), and triatomine bugs in the Brazilian Pantanal.

BackgroundTrypanosoma cruzi is dispersed in nature through many transmission mechanisms among a high diversity of vectors and mammalian species, representing particular behaviors and habitats. Thus, each locality has a unique set of conditions underlying the maintenance of this parasite in the wild. The aim of the present study was to evaluate the life-cycle of T. cruzi in free-ranging coatis from the central region of the Brazilian Pantanal using a multi-factorial approach.MethodsThree methodological blocks were used in the present study: (i) We evaluated T. cruzi infection using serological (ELISA) and parasitological (hemoculture) tests in free-ranging coatis captured from October 2010 to March 2012. In addition, we characterized T. cruzi isolates as DTUs (Discrete Typing Units); (ii) We evaluated Trypanosoma infection in species of Triatoma and Rhodnius inhabiting coati arboreal nests from May to September 2012 using parasitological and molecular assays; and (iii) We analyzed a set of longitudinal data (from 2005 to 2012) concerning the effects of T. cruzi infection on this coati population. Herein, we investigated whether seasonality, host sex, and host age influence T. cruzi prevalence and patterns of infection.ResultsThe 2010–2012 period presented high seroprevalence on coatis (72.0 % ELISA) and a high percentage of individuals with infectivity competence (20.5 % positive hemoculture). All isolates presented TcI band patterns, occurring in single (n = 3) and mixed infections (1 TcI/T. rangeli; 4 with undefined characterization). Both male and female individuals presented the same transmission potential, expressed as positive hemoculture, which was only detected in the summer. However, overall, the data (2005–2012) highlighted the importance of females for T. cruzi maintenance in the winter. Moreover, twenty-three (67.6 %) bugs from five coati nests (71.4 %) were infected with flagellated forms. Seventeen samples were characterized as T. cruzi (TcI and TcIII genotypes).ConclusionIn the Pantanal region, T. cruzi is transmitted in a complex, multifactorial, dynamic and non-linear transmission web. The coati nests might be inserted in this web, acting as important transmission foci at the arboreal stratum to different mammal species with arboreal or scansorial behavior.

Abdominal Ultrasonogram in Typhoid Fever: A Useful Diagnostic Tool

Objectives: To See the use of abdominal ultrasonogrphic in the diagnosis of Typhoid fever.Materials and Methods: This cross sectional study on enteric fever was carried out during the period of July 2008 to June 2009 on 30 patients between 2 months 12 years of age of either sex admitted with the clinical diagnosis of enteric fever having positive hemoculture for Salmonella typhi or paratyphi and or significant Widal test. Abdominal USG was done at Centre for Nuclear Medicine and Ultrasound, Bangladesh atomic energy commission, Sir Salimullah Medical College & Mitford Hospital.Result: On ultrasonogram, hepatomegaly observed in 93.3% cases, splenomegaly in 53.3% cases, thickened bowel wall in 46.7% cases, enlarged mesenteric lymph node in 63.3% cases and 30% cases showed gall bladder changes. Ultrasonogram was done on first week of fever in 33.3% cases, on second week in 43.3% cases and third week in 23.3% cases. Out of them ultrasonogram done on first day of admission in 6.6% cases, on second day in 80% cases and third day in 13.3% cases. In first week the bowel wall thickening found in 10% cases, lymph node enlargement in 23.3% cases and gall bladder changes in 3.3% cases, in second week the bowel wall thickening found in 23.3% cases, lymph node enlargement in 26.6% cases and gall bladder changes in 20% cases, in third week the bowel wall thickening found in 13.3% cases, lymph node enlargement in 13.3% cases and gall bladder changes in 6.6% cases. Sonologic findings of bowel wall thickening, lymph node enlargement and gall bladder changes found in 23.33% cases in 1st week, 33.33% cases in 2nd week and 13.33% cases in 3rd week.Conclusion: In endemic areas like Bangladesh ultrasound findings of hepatomegaly, splenomegaly, mesenteric lymphadenopathy, bowel wall thickening, gall bladder changes are useful diagnostic features of typhoid fever.J. Paediatr. Surg. Bangladesh 5(2): 58-63, 2014 (July)

Trypanosoma cruzi and Leishmania infantum chagasi Infection in Wild Mammals from Maranhão State, Brazil.

Trypanosoma and Leishmania are obligate parasites that cause important diseases in human and domestic animals. Wild mammals are the natural reservoirs of these parasites, which are transmitted by hematophagous arthropods. The present study aimed to detect the natural occurrence of trypanosomatids through serological diagnosis, PCR of whole blood and blood culture (hemoculture), and phylogenetic relationships using small subunit ribosomal DNA (SSU rDNA), cytochrome b, and glycosomal glyceraldehyde 3-phosphate dehydrogenase (gGAPDH) genes. Samples from 131 wild animals, including rodents, marsupials, and bats, were sampled in six areas in the state of Maranhão, in a transition zone of semiarid climates northeast of the equatorial humid Amazon. Serological analysis for Leishmania (Leishmania) infantum chagasi was performed in opossums by indirect fluorescent antibody test (IFAT), and all animals were serologically negative. Nine positive hemocultures (6.77%) were isolated and cryopreserved and from mammals of the Didelphimorphia and Chiroptera orders and positioned in phylogenies on the basis of sequences from different genes with reference strains of Trypanosoma cruzi marinkellei and T. cruzi. From primary samples (blood and tissues) only one bat, Pteronotus parnellii, was positive to SSU rDNA and gGAPDH genes and grouped with the L. infantum chagasi branch. The studies conducted in Maranhão State provide knowledge of parasite diversity. It is important to determine the presence of trypanosomatids in wild mammals with synanthropic habits.

Clinical study on pathogenic flux and drug resistance of neonatal sepsis

Objective To study the characteristic of etiology and drug resistance of neonatal sepsis for rational use antibiotics in clinic. Methods The etiology and drug resistance of 167 positive hemoculture examples of 365 neonatal sepsis examples were retrospectively analyzed, and the characteristic of etiology diversify and drug resist-ance characteristic of neonatal sepsis were also analyzed. Results In 365 blood culture examples of neonatal sepsis,there were 167 positive cases, positive ratio was45.75%. Among pathogenic bacterium,the firstetiology was staphylo-coccus epidermidis,there were fifty-eight examples and account of34.73%.The second was staphylococcus haemo-lyticus and accounts twenty-nine examples and 17.37%.The third was staphylococcus aureus which had twentytwo examples and account13.17%. The annual infection rate of staphylococcus epidermidis and staphylococcus hae-molyticus in the second five years were increased obviously. Gram-positive coccus drug resistance to penicillin, cep-hazolin, oxazocilline and cefoxitin were very high and the rate of the second five years were higher than that of the first five years. Gram-positive coccus drug resistance to third-generation cephaloporins and imipenem and meropenem were higher than vancocin and the rate of the second five years were higher than that of the first five years. Grampositive coccus was 100.00% sensitive to vancomycin. Gram negative bacilli drug resistance rate to penbritin and cep-hazolin and third-generation cephaloporins was the highest. Gram negative bacilli tomeropenem and imipenem was hypersensitive in all antibiotics. Conclusion The chief pathogenic bacteria of neonatal septicemia is staphylococci. Among pathogenic bacterium, the main pathogenic bacteria is CoNS, and staphylococcus epidermidis and staphylococ-cus haemolyticus goes up significantly. Among gram-negative bacilli, the escherichia coli goes up. The drug resist-ance to bacteria goes up in neonatal sepsis, it is very important to monitor the drug resistance. Key words: Infant, Newborn; Epticemia; Etiology; Drug resistance

The multiple and complex and changeable scenarios of the Trypanosoma cruzi transmission cycle in the sylvatic environment

In this study, we report and discuss the results generated from over 20 years of studies of the Trypanosoma cruzi sylvatic transmission cycle. Our results have uncovered new aspects and reviewed old concepts on issues including reservoirs, true generalist species, association of mammalian species with distinct discrete typing units – DTUs, distribution of T. cruzi genotypes in the wild, mixed infections, and T. cruzi transmission ecology. Using parasitological and serological tests, we examined T. cruzi infection in 7,285 mammalian specimens from nine mammalian orders dispersed all over the Brazilian biomes. The obtained T. cruzi isolates were characterized by mini-exon gene sequence polymorphism and PCR RFLP to identify DTUs. Infection by T. cruzi was detected by serological methods in 20% of the examined animals and isolated from 41% of those infected, corresponding to 8% of all the examined mammals. Each mammal taxon responded uniquely to T. cruzi infection. Didelphis spp. are able to maintain high and long-lasting parasitemias (positive hemocultures) caused by TcI but maintain and rapidly control parasitemias caused by TcII to almost undetectable levels. In contrast, the tamarin species Leontopithecus rosalia and L. chrysomelas maintain long-lasting and high parasitemias caused by TcII similarly to Philander sp. The coati Nasua nasua maintains high parasitemias by both parental T. cruzi DTUs TcI or TcII and by TcII/TcIV (formerly Z3) at detectable levels. Wild and domestic canidae seem to display only a short period of reservoir competence. T. cruzi infection was demonstrated in the wild canid species Cerdocyon thous and Chrysocyon brachyurus, and positive hemoculture was obtained in one hyper carnivore species (Leopardus pardalis), demonstrating that T. cruzi transmission is deeply immersed in the trophic net. T. cruzi DTU distribution in nature did not exhibit any association with a particular biome or habitat. TcI predominates throughout (58% of the T. cruzi isolates); however, in spite of being significantly less frequent (17%), TcII is also widely distributed. Concomitant DTU infection occurred in 16% of infected mammals of all biomes and included arboreal and terrestrial species, as well as bats. TcI/TcII concomitant infection was the most common and widely dispersed, with mixed TcI/TcII infections especially common in coatis and in Didelphimorphia. The second most common pattern of concomitant infection was TcI/TcIV, observed in Chiroptera, Didelphimorphia and Primates. Taken together, our results demonstrate the complexity of T. cruzi reservoir system and its transmission strategies, indicating that there is considerably more to be learned regarding ecology of T. cruzi.

Comparison of Patients in Whom Double-J Stent Had Been Placed or Not Placed After Renal Transplantation in a Single Center: A Follow-up Study

BackgroundDouble-J (DJ) stents play an important role in modern urology to prevent undesirable side effects after surgery. We aimed to investigate the relationship of DJ stents with the demographic characteristics, surgical complications, urinary tract infection (UTI), and hematuria in the patients who underwent renal transplantation (Tx). MethodsData of 354 patients who underwent renal Tx between 2008 and 2011 at Ege University were evaluated retrospectively; 331 patients were included in this study. The term DJ (−) represents patients in whom a DJ stent was not placed. “Primary DJ term” represents patients in whom the DJ stent was placed during the first Tx. “Secondary DJ term” represents the patients who had DJ after Tx for any complication. ResultsTwo hundred fifty-four (76.7%) patients were in the DJ (−) group, 52 (15.7%) were in the primary DJ group, and 25 (7.6%) were in the secondary DJ group. There were significant differences between the groups in terms of anastomosis type (P = .000), stay-in-hospital time (P = .000), surgical complication (P = .000), re-operation (P = .000), percutaneous nephrostomy (P = .000), UTI (P = .000), first-time UTI (P = .000), recurrent UTI (P = .000), positive hemoculture (P = .000), hematuria (P = .000), duration of dialysis before Tx (P = .000), live/deceased donor (P = .000), and delayed graft function (P = .009). ConclusionsOur choice is to use the DJ stent in selected high-risk patients and to keep the indications for DJ stent wider in deceased donor transplants by considering possible surgical complications. The use of the stent only in selected cases will decrease surgical complications due to stent placement.

The Role of Angiopoietine-2 in the Diagnosis and Prognosis of Sepsis.

Angiopoietin-2 (ANG-2) is a new biomarker whose blood-serum values increase in sepsis and its expression is elevated in line with the severity of the degree of inflammation. The aim of this study was to identify the diagnostic role of ANG-2 in patients with non-surgical sepsis addmitted to an intensive care unit. This was a prospective randomized study including 74 patients admitted in the Clinic of Intensive Care of the County Clinical Emergency Hospital Tirgu Mureș, divided into two groups: Group S: patients with sepsis (n=40, 54%) and Group C:control, without sepsis (n=34, 46%). ANG-2 levels were determined in both groups. From the Group S, 14 patients (35%) had positive haemocultures. ANG-2 values varied between 1 and 43 ng/mL, with an average of 6.0 ng/mL in patients without sepsis and 10.38 ng/mL in patients with sepsis (p=0.021). A positive correlation between ANG-2 and SAPS II, SOFA and APACHE II severity scores was demonstrated, as was a positive correlation between serum levels of ANG-2 and procalcitonine. ANG-2 had a 5.71% specificity and 74.36% sensitivity for diagnosis of sepsis. ANG-2 serum levels were elevated in sepsis, being well correlated with PCT values and prognostic scores. ANG-2 should be considered as a useful biomarker for the diagnosis and the prognosis of this pathology.

Granulomatosis with Polyangiitis (Wegener Granulomatosis) Mimicking Infective Endocarditis

Introduction Infective endocarditis (IE) has been reported to mimic granulomatosis with polyangiitis (GPA) and to test positive to antineutrophil cytoplasmic antibodies (ANCA), which may lead to a misdiagnosis and inappropriate treatment. Case presentation We report a case of a 59-year-old man admitted for purpura, gangrenous digital infarcts and glomerulonephritis. The diagnosis of IE was initially considered on the basis of heart murmur and two positive haemocultures to corynebacterium. Ineffectiveness of antimicrobial therapy and further neurological and nasal manifestations supported the diagnosis of GPA. Conclusions IE should be ruled out before initiation of immunosuppressive treatment. If the disease progresses despite antimicrobial treatment, vascular diseases should be rapidly taken into account in differential diagnosis and treated early to avoid fatal complications.

High similarity of Trypanosoma cruzi kDNA genetic profiles detected by LSSP-PCR within family groups in an endemic area of Chagas disease in Brazil.

Determining the genetic similarities among Trypanosoma cruzi populations isolated from different hosts and vectors is very important to clarify the epidemiology of Chagas disease. An epidemiological study was conducted in a Brazilian endemic area for Chagas disease, including 76 chronic chagasic individuals (96.1% with an indeterminate form; 46.1% with positive hemoculture). T. cruzi I (TcI) was isolated from one child and TcII was found in the remaining (97.1%) subjects. Low-stringency single-specific-primer-polymerase chain reaction (LSSP-PCR) showed high heterogeneity among TcII populations (46% of shared bands); however, high similarities (80-100%) among pairs of mothers/children, siblings, or cousins were detected. LSSP-PCR showed potential for identifying similar parasite populations among individuals with close kinship in epidemiological studies of Chagas disease.

Role of Medical Rehabilitation in Cauda Equina Syndrome with Flaccid Paraparesis after Spinal Meningitis - A Case Report

Patient L.I., aged 47 years, with multiple hospitalizations in November 2013 for multiple neurological and infectious diseases. In October 2011, surgery was performed for vicious posttraumatic right acetabular callus, confirmed by computed tomography. Subsequently, in November 2013, the patient had lumbar pain radiating to the lower limbs, functional impotence, sphincter incontinence, septic state with positive hemocultures for Staphylococcus aureus, with multiple paravertebral abscesses involving the left iliopsoas muscle, confirmed by contrast magnetic resonance imaging of the dorsolumbar spine, operated phlegmon of the left leg, which were interpreted as diffuse secondary spinal meningitis, complicated by a cauda equina syndrome, for which adequate antibiotic treatment was administered at the Clinic of Infectious Diseases Cluj-Napoca. The patient also presented two episodes of Clostridium difficile acute enterocolitis, with two fecal transplant sessions. In May 2014, the patient was admitted to the Rehabilitation Hospital Cluj-Napoca for motor deficit of the lower limbs, walking disorders, micturition disorders, sexual dynamic disorders, pain in the lumbar spine radiating to the lower limbs, sudden onset sensitivity disorders at D10 level in a febrile context in November 2013, interpreted based on lumbar MRI as spinal meningitis secondary to dorsal and lumbar paravertebral abscesses. During the course of hospitalization, the patient received a complex medical rehabilitation treatment consisting of kinetotherapy (posturations, passive mobilizations, active mobilizations, transfers, proprioceptive neuromuscular facilitation techniques, walking rehabilitation, respiratory gymnastics, rehabilitation of sensitivity disorders), occupational therapy, massage, medium frequency currents for the rehabilitation of micturition disorders, with good results particularly in walking and urinary incontinence rehabilitation. The aim of the presentation of this case is to emphasize the fact that rehabilitation programs using physicalkinetic therapeutic methods are the only way to limit functional deficit, playing an important role in the long-term management and care of the patient. The particularity of this case consists of the fact that the patient is young, without a known personal pathological history, and symptoms occurred two years after orthopedic surgery, with sudden motor deficit in the lower limbs. The regular follow-up of the patient and his inclusion in complex medical rehabilitation programs in order to limit the functional deficit, increase the autonomy and improve the quality of life of this patient are important.

Procalcitonin as a useful biomarker for determining the need to perform emergency biliary drainage in cases of acute cholangitis.

It is important to identify biomarkers for sepsis and organ damage in acute cholangitis patients. We investigated the usefulness of procalcitonin (PCT) as a biomarker of inflammation based on the Tokyo Guidelines 2013 (TG13). A total of 110 acute cholangitis patients were categorized based on TG13, and the PCT levels and common laboratory inflammatory markers were measured. The cases undergoing hemoculture (n = 72) at the time of diagnosis also correlated with the PCT levels. The PCT and C-reactive protein levels were significantly higher in grade III cases versus grade I. The mean PCT levels for positive hemoculture cases (8.6 ng/ml) were significantly higher than those for negative cases (0.7 ng/ml). In hemoculture positive cases or when purulent bile was obtained from the duodenal papilla, i.e., cases clearly requiring emergency biliary drainage and necessitating categorization as grade III, three cases were categorized as grade I and 13 as grade II. Only PCT showed statistically significant increases in severe cases underestimated as grade I or II despite them being fundamentally grade III cases. Acute cholangitis with high PCT levels can signify the need to perform emergency biliary drainage and institute intensive care even if categorized by TG13 as not being severe cases.

Distantiae transmission of Trypanosoma cruzi: a new epidemiological feature of acute Chagas disease in Brazil.

BackgroundThe new epidemiological scenario of orally transmitted Chagas disease that has emerged in Brazil, and mainly in the Amazon region, needs to be addressed with a new and systematic focus. Belém, the capital of Pará state, reports the highest number of acute Chagas disease (ACD) cases associated with the consumption of açaí juice.Methodology/Principal FindingsThe wild and domestic enzootic transmission cycles of Trypanosoma cruzi were evaluated in the two locations (Jurunas and Val-de Cães) that report the majority of the autochthonous cases of ACD in Belém city. Moreover, we evaluated the enzootic cycle on the three islands that provide most of the açaí fruit that is consumed in these localities. We employed parasitological and serological tests throughout to evaluate infectivity competence and exposure to T. cruzi. In Val-de-Cães, no wild mammal presented positive parasitological tests, and 56% seroprevalence was observed, with low serological titers. Three of 14 triatomines were found to be infected (TcI). This unexpected epidemiological picture does not explain the high number of autochthonous ACD cases. In Jurunas, the cases of ACD could not be autochthonous because of the absence of any enzootic cycle of T. cruzi. In contrast, in the 3 island areas from which the açaí fruit originates, 66.7% of wild mammals and two dogs displayed positive hemocultures, and 15.6% of triatomines were found to be infected by T. cruzi. Genotyping by mini-exon gene and PCR-RFLP (1f8/Akw21I) targeting revealed that the mammals and triatomines from the islands harbored TcI and Trypanosoma rangeli in single and mixed infections.Conclusion/SignificanceThese findings show that cases of Chagas disease in the urban area of Belém may be derived from infected triatomines coming together with the açaí fruits from distant islands. We term this new epidemiological feature of Chagas disease as “Distantiae transmission”.