Sample records for abdominal mycobacterial infection

  1. Mycobacterial Infections in AIDS

    A Ross Hill


    Full Text Available Tuberculosis (TB remains uniquely important among acquired immune deficiency syndrome (AIDS-associated opportunistic infections: it presents the greatest public health hazard worldwide, is the most readily curable, and is largely preventable with existing means. Given the expanding pool of human immunodeficiency virus (HIV seropositive persons, particularly in developing nations where Mycobacterium tuberculosis remains a leading health problem, one can expect a continued rise in TB cases during the 1990s. Global efforts to eliminate TB are now inextricably entwined with the effectiveness of measures to curtail the HIV epidemic. Mycobacterium avium complex infection, currently an intractable late complication of aids, may increase in clinical importance as success in managing other opportunistic infections and HIV disease itself improves. Understanding of the pathogenesis and management of mycobacterial diseases should increase rapidly given the renewed research spurred on by the advent of HIV.

  2. [Molecular diagnosis of mycobacterial infections].

    Fend, F; Langer, R; Hann von Weyhern, C W; Schulz, S; Miethke, T


    Tuberculosis remains a leading cause of morbidity and mortality worldwide. A rapid and reliable diagnosis and discrimination from infections with nontuberculous mycobacteria (NTM) is critical. Frequently, formalin-fixed, paraffin-embedded (FFPE) tissues remain the only source for detection of micro-organisms in suspected cases of mycobacterial infection. Recently, numerous methods, including PCR assays, in situ hybridization and immunohistochemistry have been developed for detection of mycobacteria in FFPE samples. PCR-based assays are directed either against M.tbc.-specific sequences, such as IS6110, or amplify regions common to many mycobacterial species, e.g. the 65 kDa antigen, and then require sequencing or restriction fragment length polymorphism for species identification. Whereas the detection of DNA of M.tbc. in the correct setting is always of clinical relevance, the presence of various NTM species has to be interpreted with great caution due to their ubiquitous nature. However, the routine application of molecular tests has demonstrated that NTM infections are more common than previously thought, even in non-immunosuppressed hosts. The introduction of real-time PCR technology allows precise quantification of mycobacterial DNA and can be used for species identification through melting point analysis or appropriate DNA probes. Application of these assays originally developed for clinical microbiology offer a great opportunity for diagnostic improvement in molecular pathology as compared to qualitative PCR, mainly due to an increased specificity and a lower risk of contamination. Given the clinical impact of a positive molecular result for M. tbc., future efforts have to be aimed at standardization and quality control.

  3. Polymerase chain reaction amplifying mycobacterial DNA from aspirates obtained by endoscopic ultrasound allows accurate diagnosis of mycobacterial disease in HIV-positive patients with abdominal lymphadenopathy.

    Nieuwoudt, Martin; Lameris, Roeland; Corcoran, Craig; Rossouw, Theresa M; Slavik, Tomas; Du Plessis, Johannie; Omoshoro-Jones, Jones A O; Stivaktas, Paraskevi; Potgieter, Fritz; Van der Merwe, Schalk W


    Abdominal lymphadenopathy in human immunodeficiency virus (HIV) infection remains a diagnostic challenge. We performed a prospective cohort study by recruiting 31 symptomatic HIV + patients with abdominal lymphadenopathy and assessing the diagnostic yield of endoscopic ultrasound fine-needle aspiration (EUS-FNA). Mean age was 38 years; 52% were female; and mean CD4 count and viral load were 124 cells/μL and 4 log, respectively. EUS confirmed additional mediastinal nodes in 26%. The porta hepatis was the most common abdominal site. Aspirates obtained by EUS-FNA were subjected to cytology, culture and polymerase chain reaction (PCR) analysis. Mycobacterial infections were confirmed in 67.7%, and 31% had reactive lymphadenopathy. Cytology and culture had low sensitivity, whereas PCR identified 90% of mycobacterial infections. By combining the appearance of aspirates obtained by EUS-FNA and cytologic specimens, we developed a diagnostic algorithm to indicate when analysis with PCR would be useful. PCR performed on material obtained by EUS-FNA was highly accurate in confirming mycobacterial disease and determining genotypic drug resistance.

  4. Mycobacterial infection and atopy in childhood : A systematic review

    Obihara, Charles C.; Bollen, Casper W.; Beyers, Nulda; Kimpen, Jan L. L.


    The epidemiological relation between mycobacterial infection and the prevalence of atopic disease in humans is still unclear. This is in contrast to studies in murine models in which a clear suppression of atopic symptoms was observed after exposure to mycobacteria or mycobacterial products. We ther

  5. Network Analysis of Human Genes Influencing Susceptibility to Mycobacterial Infections.

    Ettie M Lipner

    Full Text Available Tuberculosis and nontuberculous mycobacterial infections constitute a high burden of pulmonary disease in humans, resulting in over 1.5 million deaths per year. Building on the premise that genetic factors influence the instance, progression, and defense of infectious disease, we undertook a systems biology approach to investigate relationships among genetic factors that may play a role in increased susceptibility or control of mycobacterial infections. We combined literature and database mining with network analysis and pathway enrichment analysis to examine genes, pathways, and networks, involved in the human response to Mycobacterium tuberculosis and nontuberculous mycobacterial infections. This approach allowed us to examine functional relationships among reported genes, and to identify novel genes and enriched pathways that may play a role in mycobacterial susceptibility or control. Our findings suggest that the primary pathways and genes influencing mycobacterial infection control involve an interplay between innate and adaptive immune proteins and pathways. Signaling pathways involved in autoimmune disease were significantly enriched as revealed in our networks. Mycobacterial disease susceptibility networks were also examined within the context of gene-chemical relationships, in order to identify putative drugs and nutrients with potential beneficial immunomodulatory or anti-mycobacterial effects.

  6. Mycobacterial infections in a large Virginia hospital, 2001-2009

    Scully Kenneth W


    Full Text Available Abstract Background In areas where both tuberculosis (TB and nontuberculous mycobacteria (NTM are prevalent, descriptive studies of the clinical features of individual mycobacteria are needed to inform clinical triage. Methods We queried the University of Virginia Clinical Data Repository for all mycobacterial infections from 2001-2009. Results Of 494 mycobacterial infections in 467 patients there were 22 species. Patients with pulmonary Tb were more likely to be reported as immigrants (p M. kansasii, M. xenopi, and M. fortuitum were more likely than MAC to have cavities. There were at least 83 patients that met criteria for NTM lung disease and these were caused by 9 species. M. abscessus infection was associated with cystic fibrosis and M. xenopi infection was associated with male gender. Conclusions In our center mycobacterial infections were common and of diverse species. Immigrant status, cavities, and effusion were associated with TB vs. NTM.

  7. Mycobacterial infections in striped bass from Delaware Bay

    Ottinger, C.A.; Brown, J.J.; Densmore, Christine L.; Starliper, C.E.; Blazer, V.S.; Weyers, H.S.; Beauchamp, K.A.; Rhodes, M.W.; Kator, H.; Gauthier, David T.; Vogelbein, W.K.


    Eighty striped bass Morone saxatilis were obtained from Delaware Bay using commercial gill nets set adjacent to Woodland Beach (n = 70) and Bowers Beach (n = 10) in December 2003. Fish were examined for gross lesions. Total lengths (TLs) and eviscerated weights were determined to calculate condition factors (K). Portions of spleens were aseptically harvested for bacterial culture, and portions of spleens, kidneys (anterior and posterior), livers, and gonads were obtained for histological examination. The size distribution of the striped bass was relatively homogeneous; the mean TL was about 600 mm for all samples. Mean K exceeded 0.95 in all samples and was not significantly different (P > 0.05) among samples. Significant differences in mycobacterial infection prevalence (P ??? 0.05) were observed among samples; samples obtained at Woodland Beach (WB) on December 10 (53.8%, n = 13) and December 17 (7.1%, n = 42) exhibited the most striking differences in prevalence. Mycobacterial infection intensity ranged from 1 ?? 102 to 1 ?? 107 colony-forming units per gram of spleen. Acanthocephalan infection prevalence and intensity, non-acid-fast bacterial infection prevalence, and fish sex ratio were also significantly different among the samples (P ??? 0.05). Similar to the mycobacterial infections, differences in sex ratio, acanthocephalan infection, and non-acid-fast bacterial infection were observed between the WB samples taken on December 10 and 17. However, no significant associations (P > 0.05) were observed between sex ratio or these infections and mycobacterial infection. The differences in bacterial and parasite infection prevalence and intensity and fish sex ratio in some samples indicate that these fish had a different history and that the epizootiology of mycobacterial infection in striped bass from Delaware Bay may be relatively complex. ?? Copyright by the American Fisheries Society 2007.

  8. Role for mycobacterial infection in pathogenesis of primary biliary cirrhosis?

    Daniel Smyk; Eirini I Rigopoulou; Yoh Zen; Robin Daniel Abeles; Charalambos Billinis; Albert Pares; Dimitrios P Bogdanos


    Primary biliary cirrhosis (PBC) is a progressive cholestatic liver disease characterized by the immunemediated destruction of biliary epithelial cells in small intrahepatic bile ducts.The disease is characterized by circulating antimitochondrial antibodies (AMAs) as well as disease-specific antinuclear antibodies,cholestatic liver function tests,and characteristic histological features,including granulomas.A variety of organisms are involved in granuloma formation,of which mycobacteria are the most commonly associated.This has led to the hypothesis that mycobacteria may be involved in the pathogenesis of PBC,along with other infectious agents.Additionally,AMAs are found in a subgroup of patients with mycobacterial infections,such as leprosy and pulmonary tuberculosis.Antibodies against species-specific mycobacterial proteins have been reported in patients with PBC,but it is not clear whether these antibodies are specific for the disease.In addition,data in support of the involvement of the role of molecular mimicry between mycobacterial and human mitochondrial antigens as triggers of cross-reactive immune responses leading to the loss of immunological tolerance,and the induction of pathological features have been published.Thus,antibodies against mycobacterial heat shock protein appear to cross-recognize AMA-specific autoantigens,but it is not clear whether these autoantibodies are mycobacterium-species-specific,and whether they are pathogenic or incidental.The view that mycobacteria are infectious triggers of PBC is intriguing,but the data provided so far are not conclusive.

  9. An atypical mycobacterial infection of the shoulder

    Christopher L Talbot


    Full Text Available Mycobacterium malmoense is an acid-fast non-tuberculous organism that most commonly causes pulmonary infection. Extrapulmonary infection has also been reported. With an increased emphasis being placed on the clinical importance of this organism, especially within Europe, we report the first case of septic arthritis of the shoulder caused by this organism. We also highlight the importance of considering atypical mycobacterium infection in the differential diagnosis of shoulder infection and issues surrounding the management of this entity.

  10. Production of matrix metalloproteinases in response to mycobacterial infection.

    Quiding-Järbrink, M; Smith, D A; Bancroft, G J


    Matrix metalloproteinases (MMPs) constitute a large family of enzymes with specificity for the various proteins of the extracellular matrix which are implicated in tissue remodeling processes and chronic inflammatory conditions. To investigate the role of MMPs in immunity to mycobacterial infections, we incubated murine peritoneal macrophages with viable Mycobacterium bovis BCG or Mycobacterium tuberculosis H37Rv and assayed MMP activity in the supernatants by zymography. Resting macrophages secreted only small amounts of MMP-9 (gelatinase B), but secretion increased dramatically in a dose-dependent manner in response to either BCG or M. tuberculosis in vitro. Incubation with mycobacteria also induced increased MMP-2 (gelatinase A) activity. Neutralization of tumor necrosis alpha (TNF-alpha), and to a lesser extent interleukin 18 (IL-18), substantially reduced MMP production in response to mycobacteria. Exogenous addition of TNF-alpha or IL-18 induced macrophages to express MMPs, even in the absence of bacteria. The immunoregulatory cytokines gamma interferon (IFN-gamma), IL-4, and IL-10 all suppressed BCG-induced MMP production, but through different mechanisms. IFN-gamma treatment increased macrophage secretion of TNF-alpha but still reduced their MMP activity. Conversely, IL-4 and IL-10 seemed to act by reducing the amount of TNF-alpha available to the macrophages. Finally, infection of BALB/c or severe combined immunodeficiency (SCID) mice with either BCG or M. tuberculosis induced substantial increases in MMP-9 activity in infected tissues. In conclusion, we show that mycobacterial infection induces MMP-9 activity both in vitro and in vivo and that this is regulated by TNF-alpha, IL-18, and IFN-gamma. These findings indicate a possible contribution of MMPs to tissue remodeling processes that occur in mycobacterial infections.

  11. Innate Immune Effectors in Mycobacterial Infection

    Hiroyuki Saiga


    Full Text Available Tuberculosis, which is caused by infection with Mycobacterium tuberculosis (Mtb, remains one of the major bacterial infections worldwide. Host defense against Mtb is mediated by a combination of innate and adaptive immune responses. In the last 15 years, the mechanisms for activation of innate immunity have been elucidated. Toll-like receptors (TLRs have been revealed to be critical for the recognition of pathogenic microorganisms including mycobacteria. Subsequent studies further revealed that NOD-like receptors and C-type lectin receptors are responsible for the TLR-independent recognition of mycobacteria. Several molecules, such as active vitamin D3, secretary leukocyte protease inhibitor, and lipocalin 2, all of which are induced by TLR stimulation, have been shown to direct innate immune responses to mycobacteria. In addition, Irgm1-dependent autophagy has recently been demonstrated to eliminate intracellular mycobacteria. Thus, our understanding of the mechanisms for the innate immune response to mycobacteria is developing.

  12. Biomarker discovery in subclinical mycobacterial infections of cattle.

    Meetu Seth

    Full Text Available BACKGROUND: Bovine tuberculosis is a highly prevalent infectious disease of cattle worldwide; however, infection in the United States is limited to 0.01% of dairy herds. Thus detection of bovine TB is confounded by high background infection with M. avium subsp. paratuberculosis. The present study addresses variations in the circulating peptidome based on the pathogenesis of two biologically similar mycobacterial diseases of cattle. METHODOLOGY/PRINCIPAL FINDINGS: We hypothesized that serum proteomes of animals in response to either M. bovis or M. paratuberculosis infection will display several commonalities and differences. Sera prospectively collected from animals experimentally infected with either M. bovis or M. paratuberculosis were analyzed using high-resolution proteomics approaches. iTRAQ, a liquid chromatography and tandem mass spectrometry approach, was used to simultaneously identify and quantify peptides from multiple infections and contemporaneous uninfected control groups. Four comparisons were performed: 1 M. bovis infection versus uninfected controls, 2 M. bovis versus M. paratuberculosis infection, 3 early, and 4 advanced M. paratuberculosis infection versus uninfected controls. One hundred and ten differentially elevated proteins (P < or = 0.05 were identified. Vitamin D binding protein precursor (DBP, alpha-1 acid glycoprotein, alpha-1B glycoprotein, fetuin, and serine proteinase inhibitor were identified in both infections. Transthyretin, retinol binding proteins, and cathelicidin were identified exclusively in M. paratuberculosis infection, while the serum levels of alpha-1-microglobulin/bikunin precursor (AMBP protein, alpha-1 acid glycoprotein, fetuin, and alpha-1B glycoprotein were elevated exclusively in M. bovis infected animals. CONCLUSIONS/SIGNIFICANCE: The discovery of these biomarkers has significant impact on the elucidation of pathogenesis of two mycobacterial diseases at the cellular and the molecular level and

  13. [Atypical mycobacterial infection after kidney transplant: two clinical cases].

    Mele, Alessandra Antonia; Bilancio, G; Luciani, Remo; Bellizzi, Vincenzo; Palladino, Giuseppe


    Infections are an important cause of morbidity and mortality during kidney transplant. In areas where tuberculosis is not endemic, Mycobacteria other than tuberculosis (MOOT), also known as 'atypical' Mycobacteria, are more frequently involved in mycobacterial infections than M. tuberculosis. The incidence of MOOT infection in renal transplant recipients ranges from 0.16 to 0.38 percent. This low rate of reported incidence is, however, often due to delay in diagnosis and lack of therapeutic protocols. Further difficulty is caused by the interaction of antimycobacterial drugs with the post-transplant immunosuppressive regimen, necessitating close monitoring of plasma concentrations and careful dose modification. We present two cases of Mycobacterium Chelonae infection in kidney transplant recipients which differ in both clinical presentation and pharmacological approach.

  14. Biallelic JAK1 mutations in immunodeficient patient with mycobacterial infection

    Eletto, Davide; Burns, Siobhan O.; Angulo, Ivan; Plagnol, Vincent; Gilmour, Kimberly C.; Henriquez, Frances; Curtis, James; Gaspar, Miguel; Nowak, Karolin; Daza-Cajigal, Vanessa; Kumararatne, Dinakantha; Doffinger, Rainer; Thrasher, Adrian J.; Nejentsev, Sergey


    Mutations in genes encoding components of the immune system cause primary immunodeficiencies. Here, we study a patient with recurrent atypical mycobacterial infection and early-onset metastatic bladder carcinoma. Exome sequencing identified two homozygous missense germline mutations, P733L and P832S, in the JAK1 protein that mediates signalling from multiple cytokine receptors. Cells from this patient exhibit reduced JAK1 and STAT phosphorylation following cytokine stimulations, reduced induction of expression of interferon-regulated genes and dysregulated cytokine production; which are indicative of signalling defects in multiple immune response pathways including Interferon-γ production. Reconstitution experiments in the JAK1-deficient cells demonstrate that the impaired JAK1 function is mainly attributable to the effect of the P733L mutation. Further analyses of the mutant protein reveal a phosphorylation-independent role of JAK1 in signal transduction. These findings clarify JAK1 signalling mechanisms and demonstrate a critical function of JAK1 in protection against mycobacterial infection and possibly the immunological surveillance of cancer. PMID:28008925

  15. Hansen's disease (leprosy) complicated by secondary mycobacterial infection.

    Scollard, David M; Stryjewska, Barbara M; Prestigiacomo, John F; Gillis, Thomas P; Waguespack-Labiche, Jennifer


    A patient with Hansen's disease received corticosteroids for a type 1 leprosy reaction and subsequently developed a new cutaneous lesion at the original biopsy site from which Mycobacterium fortuitum was cultured. A review of the literature found only two other cases of coinfection with atypical mycobacteria and Mycobacterium leprae, although there are many reports of pulmonary tuberculosis in patients with leprosy. This case highlights the diagnostic difficulties encountered when a patient has two different mycobacterial infections of the skin. The published experience emphasizes that such coinfection is remarkably uncommon in leprosy, despite the frequent use of high doses of corticosteroids for leprosy reactions. Copyright © 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  16. Association between polyclonal and mixed mycobacterial Mycobacterium avium complex infection and environmental exposure.

    Fujita, Kohei; Ito, Yutaka; Hirai, Toyohiro; Kubo, Takeshi; Maekawa, Koichi; Togashi, Kaori; Ichiyama, Satoshi; Mishima, Michiaki


    Polyclonal and mixed mycobacterial Mycobacterium avium complex (MAC) infection is observed in pulmonary MAC disease. Human living environments contain multiple species or genotypes of nontuberculous mycobacterial strains and are considered sources of infection. To investigate the association of environmental exposure with polyclonal and mixed mycobacterial infection in pulmonary MAC disease after adjustments for potential confounding diseases and conditions and radiographic findings. We collected two separate sputum samples from 102 patients and single sputum samples from 18 patients in whom the second MAC strain was not isolated in our prospective cohort of pulmonary MAC disease. MAC isolates from sputum samples and patients' residential soils were used for variable number of tandem repeats (VNTR) analyses. Polyclonal and mixed mycobacterial MAC infections were defined as having different VNTR genotypes and other mycobacterial species, respectively. Monoclonal MAC infection was defined as all isolates showing a single VNTR genotype. Associations of the type of infection with clinical and radiographic findings and environmental exposure were measured. Polyclonal and mixed mycobacterial MAC and monoclonal infections were observed in 42 and 78 patients, respectively. By stepwise regression analysis, patients with polyclonal and mixed mycobacterial MAC infections were associated with history of asthma (odds ratio [OR], 11.56; 95% confidence interval [CI], 1.41-255.77; P = 0.021), high soil exposure (≥2 h/wk; OR, 4.31; 95% CI, 1.72-11.45; P swimming in a pool (OR, 9.69; 95% CI, 1.21-206.92; P < 0.01). Environmental exposure was associated with polyclonal and mixed mycobacterial MAC infection in pulmonary MAC disease.

  17. Nosocomial rapidly growing mycobacterial infections following laparoscopic surgery: CT imaging findings

    Volpato, Richard [Cassiano Antonio de Moraes University Hospital, Department of Diagnostic Radiology, Vitoria, ES (Brazil); Campi de Castro, Claudio [University of Sao Paulo Medical School, Department of Radiology, Cerqueira Cesar, Sao Paulo (Brazil); Hadad, David Jamil [Cassiano Antonio de Moraes University Hospital, Nucleo de Doencas Infecciosas, Department of Internal Medicine, Vitoria, ES (Brazil); Silva Souza Ribeiro, Flavya da [Laboratorio de Patologia PAT, Department of Diagnostic Radiology, Unit 1473, Vitoria, ES (Brazil); Filho, Ezequiel Leal [UNIMED Diagnostico, Department of Diagnostic Radiology, Unit 1473, Vitoria, ES (Brazil); Marcal, Leonardo P. [The University of Texas M D Anderson Cancer Center, Department of Diagnostic Radiology, Unit 1473, Houston, TX (United States)


    To identify the distribution and frequency of computed tomography (CT) findings in patients with nosocomial rapidly growing mycobacterial (RGM) infection after laparoscopic surgery. A descriptive retrospective study in patients with RGM infection after laparoscopic surgery who underwent CT imaging prior to initiation of therapy. The images were analyzed by two radiologists in consensus, who evaluated the skin/subcutaneous tissues, the abdominal wall, and intraperitoneal region separately. The patterns of involvement were tabulated as: densification, collections, nodules (≥1.0 cm), small nodules (<1.0 cm), pseudocavitated nodules, and small pseudocavitated nodules. Twenty-six patients met the established criteria. The subcutaneous findings were: densification (88.5 %), small nodules (61.5 %), small pseudocavitated nodules (23.1 %), nodules (38.5 %), pseudocavitated nodules (15.4 %), and collections (26.9 %). The findings in the abdominal wall were: densification (61.5 %), pseudocavitated nodules (3.8 %), and collections (15.4 %). The intraperitoneal findings were: densification (46.1 %), small nodules (42.3 %), nodules (15.4 %), and collections (11.5 %). Subcutaneous CT findings in descending order of frequency were: densification, small nodules, nodules, small pseudocavitated nodules, pseudocavitated nodules, and collections. The musculo-fascial plane CT findings were: densification, collections, and pseudocavitated nodules. The intraperitoneal CT findings were: densification, small nodules, nodules, and collections. (orig.)

  18. Pulmonary chondroid hamartoma with nontuberculous mycobacterial infection: two case reports.

    Lee, Yong Chul; Moon, Jin Chang; Gang, Su Jin; Park, Seung Yong; Kim, So Ri


    Solitary pulmonary nodules (SPNs) can be manifested in a variety of disorders including neoplasms, infection, inflammation, and vascular or congenital abnormalities. In addition, they are often accompanied with other pulmonary pathologic lesions such as consolidations and several pulmonary disorders present as similar pulmonary nodular lesions simultaneously. Diagnostic workup is important for these SPNs; however, many physicians often miss the second diagnosis for multiple pulmonary lesions with SPNs due to lack of clinical suspicion that each pulmonary nodule or pathologic lesion can have each other's diagnosis. Herein, we report 2 cases of coexistence of pulmonary chondroid hamartoma with nontuberculous mycobacterial (NTM) infection presenting as pulmonary nodules and multiple consolidative lesions. A 60-year-old man was admitted for the evaluation of multifocal pulmonary lesions including SPN with chronic exertional dyspnea. Multiple lung tissues were obtained from each lesion through percutaneous transthoracic needle biopsy (PTNB). At the same time, bacteriologic examination was performed using respiratory samples obtained by bronchoscopy. Based on pathologic and microbiologic results, the patient diagnosed as pulmonary chondroid hamartoma with pulmonary NTM infectious disease. In addition, a 56-year-old woman visited for the evaluation of a small SPN. The SPN was resected surgically for the pathologic examination and turned out to be pulmonary chondroid hamartoma. Interestingly, the diagnostic workup revealed that the patient had Lady Windermere syndrome which is one of features for Mycobacterium avium complex (MAC) pulmonary disease. Both patients were treated with the standard antibiotics against MAC as recommended by the ATS/IDSA guideline. This is the first report of 2 patients, as far as we know, that chondroid hamartoma and NTM disease develop simultaneously in the lung. This report emphasizes that physicians should endeavor to confirm the individual

  19. Host susceptibility factors in mycobacterial infection. Genetics and body morphotype.

    Guide, Shireen V; Holland, Steven M


    Through identification and evaluation of mutations and polymorphisms in components of the IFN gamma response pathways, a better understanding of the mechanisms and risk factors influencing the development of mycobacterial disease is gained. This may lead the way for development of therapeutic and preventative strategies. Although conventional science has focused on identifying discrete mutations, greater awareness of the impact of subtle changes, both at the genetic (polymorphisms) and physical levels (body morphotype), may prove critical in the investigative process. There has been extraordinary progress in the understanding of mycobacterial susceptibility factors over the last few years. The recognition of characteristic phenotypes will lead to the identification of new genetic bases for disease.

  20. Myeloid Growth Factors Promote Resistance to Mycobacterial Infection by Curtailing Granuloma Necrosis through Macrophage Replenishment.

    Pagán, Antonio J; Yang, Chao-Tsung; Cameron, James; Swaim, Laura E; Ellett, Felix; Lieschke, Graham J; Ramakrishnan, Lalita


    The mycobacterial ESX-1 virulence locus accelerates macrophage recruitment to the forming tuberculous granuloma. Newly recruited macrophages phagocytose previously infected apoptotic macrophages to become new bacterial growth niches. Granuloma macrophages can then necrose, releasing mycobacteria into the extracellular milieu, which potentiates their growth even further. Using zebrafish with genetic or pharmacologically induced macrophage deficiencies, we find that global macrophage deficits increase susceptibility to mycobacterial infection by accelerating granuloma necrosis. This is because reduction in the macrophage supply below a critical threshold decreases granuloma macrophage replenishment to the point where apoptotic infected macrophages, failing to get engulfed, necrose. Reducing macrophage demand by removing bacterial ESX-1 offsets the susceptibility of macrophage deficits. Conversely, increasing macrophage supply in wild-type fish by overexpressing myeloid growth factors induces resistance by curtailing necrosis. These findings may explain the susceptibility of humans with mononuclear cytopenias to mycobacterial infections and highlight the therapeutic potential of myeloid growth factors in tuberculosis.

  1. Paradoxical responses in a cohort of HIV-1-infected patients with mycobacterial disease.

    Olalla, J; Pulido, F; Rubio, R; Costa, M A; Monsalvo, R; Palenque, E; Costa, J R; Del, Palacio A


    Paradoxical worsening or relapse of opportunistic infections has been described after initiation of highly active anti-retroviral therapy (HAART) in human immunodeficiency virus (HIV) infected patients. Retrospective study of a group of 33 HIV-infected patients with mycobacterial disease analysing the incidence and characteristics of patients with and without paradoxical response after starting HAART and/or mycobacterial treatment. Nine patients in the group had paradoxical response. No significant difference of baseline characteristics was observed in these patients. The decrease in viral load was significantly greater among patients with paradoxical response than in patients without. No clinical difference was found in the evolution of HIV-infected patients with mycobacterial disease after the resolution of the episode of paradoxical response.

  2. Frequency of mycobacterial infections in retailed fish in Karaj: An Iranian perspective

    Atefeh Mobasher-Amini


    Conclusion: The detection of 15 culturable mycobacterial isolates from 100 audible fish is an indication of bacteria highly active in the colonization in fish populations. Assessing the potential zoonotic risk raised from exposure of human to fishes in Iran demands search for evidence of linkages between mycobacteria infecting human cases and fishes.

  3. Immune reconstitution inflammatory syndrome in HIV-infected patients with mycobacterial infections starting highly active anti-retroviral therapy

    Buckingham, S.J.; Haddow, L.J.; Shaw, P.J.; Miller, R.F. E-mail:


    AIM: To describe the radiological appearances of immune reconstitution inflammatory syndrome (IRIS) in human immunodeficiency virus (HIV)-infected patients with mycobacterial infections starting highly active anti-retroviral therapy (HAART). MATERIALS AND METHODS: Five consecutive HIV infected patients with IRIS due to mycobacterial infection were studied. Intercurrent infection and poor drug compliance were excluded as causes of presentation. The chest radiological appearances at the time of starting HAART and at the time of diagnosis of IRIS were compared. RESULTS: In these five patients there was clinical and radiological deterioration, occurring between 10 days and 7 months after starting HAART, leading to unmasking of previously undiagnosed mycobacterial infection or to worsening of mycobacterial disease. All five patients had HAART-induced increases in CD4+ T lymphocyte counts and reductions in peripheral blood HIV 'viral load'. Chest radiographic abnormalities due to IRIS included marked mediastinal lymphadenopathy in three patients--severe enough to produce tracheal compression in two patients (one of whom had stridor)--and was associated with new pulmonary infiltrates in two patients. The other two patients had new infiltrates, which in one patient was associated with a pleural effusion. CONCLUSION: These cases illustrate the diverse chest radiographic appearances of IRIS occurring after HAART in patients with mycobacterial and HIV co-infection. Marked mediastinal lymphadenopathy occurred in three of these five patients (with associated tracheal narrowing in two patients); four patients developed pulmonary infiltrates and one had an effusion. The cases further highlight that the onset of IRIS may be delayed for several months after HAART is started.

  4. A focus on intra-abdominal infections

    Sartelli Massimo


    Full Text Available Abstract Complicated intra-abdominal infections are an important cause of morbidity and are frequently associated with poor prognosis, particularly in higher risk patients. Well defined evidence-based recommendations for intra-abdominal infections treatment are partially lacking because of the limited number of randomized-controlled trials. Factors consistently associated with poor outcomes in patients with intra-abdominal infections include increased illness severity, failed source control, inadequate empiric antimicrobial therapy and healthcare-acquired infection. Early prognostic evaluation of complicated intra-abdominal infections is important to select high-risk patients for more aggressive therapeutic procedures. The cornerstones in the management of complicated intra-abdominal infections are both source control and antibiotic therapy. The timing and the adequacy of source control are the most important issues in the management of intra-abdominal infections, because inadequate and late control of septic source may have a negative effect on the outcomes. Recent advances in interventional and more aggressive techniques could significantly decrease the morbidity and mortality of physiologically severe complicated intra-abdominal infections, even if these are still being debated and are yet not validated by limited prospective trials. Empiric antimicrobial therapy is nevertheless important in the overall management of intra-abdominal infections. Inappropriate antibiotic therapy may result in poor patient outcomes and in the appearance of bacterial resistance. Antimicrobial management is generally standardised and many regimens, either with monotherapy or combination therapy, have proven their efficacy. Routine coverage especially against Enterococci and candida spp is not always recommended, but can be useful in particular clinical conditions. A de escalation approach may be recommended in patients with specific risk factors for multidrug

  5. Husbandry stress exacerbates mycobacterial infections in adult zebrafish, Danio rerio (Hamilton)

    Ramsay, J.M.; Watral, V.; Schreck, C.B.; Kent, M.L.


    Mycobacteria are significant pathogens of laboratory zebrafish, Danio rerio (Hamilton). Stress is often implicated in clinical disease and morbidity associated with mycobacterial infections but has yet to be examined with zebrafish. The aim of this study was to examine the effects of husbandry stressors on zebrafish infected with mycobacteria. Adult zebrafish were exposed to Mycobacterium marinum or Mycobacterium chelonae, two species that have been associated with disease in zebrafish. Infected fish and controls were then subjected to chronic crowding and handling stressors and examined over an 8-week period. Whole-body cortisol was significantly elevated in stressed fish compared to non-stressed fish. Fish infected with M. marinum ATCC 927 and subjected to husbandry stressors had 14% cumulative mortality while no mortality occurred among infected fish not subjected to husbandry stressors. Stressed fish, infected with M. chelonae H1E2 from zebrafish, were 15-fold more likely to be infected than non-stressed fish at week 8 post-injection. Sub-acute, diffuse infections were more common among stressed fish infected with M. marinum or M. chelonae than non-stressed fish. This is the first study to demonstrate an effect of stress and elevated cortisol on the morbidity, prevalence, clinical disease and histological presentation associated with mycobacterial infections in zebrafish. Minimizing husbandry stress may be effective at reducing the severity of outbreaks of clinical mycobacteriosis in zebrafish facilities. ?? 2009 Blackwell Publishing Ltd.

  6. A potential target gene for the host-directed therapy of mycobacterial infection in murine macrophages

    Bao, Zhang; Chen, Ran; Zhang, Pei; Lu, Shan; Chen, Xing; Yao, Yake; Jin, Xiaozheng; Sun, Yilan; Zhou, Jianying


    Mycobacterium tuberculosis (MTB), one of the major bacterial pathogens for lethal infectious diseases, is capable of surviving within the phagosomes of host alveolar macrophages; therefore, host genetic variations may alter the susceptibility to MTB. In this study, to identify host genes exploited by MTB during infection, genes were non-selectively inactivated using lentivirus-based antisense RNA methods in RAW264.7 macrophages, and the cells that survived virulent MTB infection were then screened. Following DNA sequencing of the surviving cell clones, 26 host genes affecting susceptibility to MTB were identified and their pathways were analyzed by bioinformatics analysis. In total, 9 of these genes were confirmed as positive regulators of collagen α-5(IV) chain (Col4a5) expression, a gene encoding a type IV collagen subunit present on the cell surface. The knockdown of Col4a5 consistently suppressed intracellular mycobacterial viability, promoting the survival of RAW264.7 macrophages following mycobacterial infection. Furthermore, Col4a5 deficiency lowered the pH levels of intracellular vesicles, including endosomes, lysosomes and phagosomes in the RAW264.7 cells. Finally, the knockdown of Col4a5 post-translationally increased microsomal vacuolar-type H+-ATPase activity in macrophages, leading to the acidification of intracellular vesicles. Our findings reveal a novel role for Col4a5 in the regulation of macrophage responses to mycobacterial infection and identify Col4a5 as a potential target for the host-directed anti-mycobacterial therapy. PMID:27432120

  7. Immunogenetics of leishmanial and mycobacterial infections: the Belem Family Study.

    BLACKWELL, J.M.; Black, G F; Peacock, C S; Miller, E. N.; Sibthorpe, D; Gnananandha, D; J. J. Shaw; Silveira, F.; Lins-Lainson, Z.; Ramos, F; Collins, A.; Shaw, M A


    In the 1970s and 1980s, analysis of recombinant inbred, congenic and recombinant haplotype mouse strains permitted us to effectively 'scan' the murine genome for genes controlling resistance and susceptibility to leishmanial infections. Five major regions of the genome were implicated in the control of infections caused by different Leishmania species which, because they show conserved synteny with regions of the human genome, immediately provides candidate gene regions for human disease susc...

  8. Nontuberculous mycobacterial infection in hematopoietic stem cell and solid organ transplant recipients.

    Doucette, Karen; Fishman, Jay A


    Nontuberculous mycobacteria (NTM) are ubiquitous environmental organisms. In immunocompetent hosts, they are a rare cause of disease. In immunocompromised hosts, disease due to NTM is well documented. Reports of NTM disease have increased in hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients. This increase may reflect increased numbers of transplants, intensification of immune suppressive regimens, prolonged survival of transplant recipients, and/or improved diagnostic techniques. The difficulty of diagnosis and the impact associated with infections due to NTM in HSCT and SOT recipients necessitates that, to ensure prompt diagnosis and early initiation of therapy, a high level of suspicion for NTM disease be maintained. The most common manifestations of NTM infection in SOT recipients include cutaneous and pleuropulmonary disease, and, in HSCT recipients, catheter-related infection. Skin and pulmonary lesions should be biopsied for histologic examination, special staining, and microbiologic cultures, including cultures for bacteria, Nocardia species, fungi, and mycobacteria. Mycobacterial infections associated with catheters may be documented by tunnel or blood (isolator) cultures. Susceptibility testing of mycobacterial isolates is an essential component of optimal care. The frequent isolation of NTM other than Mycobacterium avium complex (MAC) from transplant recipients limits the extrapolation of therapeutic data from human immunodeficiency virus-infected individuals to the population of transplant recipients. Issues involved in the management of NTM disease in transplant recipients are characterized by a case of disseminated infection due to Mycobacterium avium complex in a lung transplant recipient, with a review of the relevant literature.

  9. Host response to nontuberculous mycobacterial infections of current clinical importance.

    Orme, Ian M; Ordway, Diane J


    The nontuberculous mycobacteria are a large group of acid-fast bacteria that are very widely distributed in the environment. While Mycobacterium avium was once regarded as innocuous, its high frequency as a cause of disseminated disease in HIV-positive individuals illustrated its potential as a pathogen. Much more recently, there is growing evidence that the incidence of M. avium and related nontuberculous species is increasing in immunocompetent individuals. The same has been observed for M. abscessus infections, which are very difficult to treat; accordingly, this review focuses primarily on these two important pathogens. Like the host response to M. tuberculosis infections, the host response to these infections is of the TH1 type but there are some subtle and as-yet-unexplained differences.

  10. Assuming the role of mitochondria in mycobacterial infection.

    Dubey, Rikesh K


    Tuberculosis is one of the leading causes of death by Mycobacterium tuberculosis (Mtb) affecting millions of people worldwide. Mycobacterium species enter host macrophages during infection and target various cellular organelles and their function for their own benefit. Mitochondria appear to be among the important targets for bacterial pathogens. Mtb and other pathogenic bacteria secrete various proteins that initiate structural changes in mitochondria to modulate its function. Additionally, virulent mycobacteria interfere with the balance between pro- and anti-apoptotic factors to inhibit apoptosis and, in later stages, promote necrosis. Furthermore, mitochondria perform multiple biological functions in the cell, and the inhibition of these functions by bacterial proteins promotes Mtb survival, growth, and successful infection. Copyright © 2016 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.

  11. Macrophage Activation by Ursolic and Oleanolic Acids during Mycobacterial Infection

    Sonia López-García


    Full Text Available Oleanolic (OA and ursolic acids (UA are triterpenes that are abundant in vegetables, fruits and medicinal plants. They have been described as active moieties in medicinal plants used for the treatment of tuberculosis. In this study, we analyzed the effects of these triterpenes on macrophages infected in vitro with Mycobacterium tuberculosis (MTB. We evaluated production of nitric oxide (NO, reactive oxygen species (ROS, and cytokines (TNF-α and TGF-β as well as expression of cell membrane receptors (TGR5 and CD36 in MTB-infected macrophages following treatment with OA and UA. Triterpenes caused reduced MTB growth in macrophages, stimulated production of NO and ROS in the early phase, stimulated TNF-α, suppressed TGF-β and caused over-expression of CD36and TGR5 receptors. Thus, our data suggest immunomodulatory properties of OA and UA on MTB infected macrophages. In conclusion, antimycobacterial effects induced by these triterpenes may be attributable to the conversion of macrophages from stage M2 (alternatively activated to M1 (classically activated.

  12. Prevalence of non-tuberculous mycobacterial infections among tuberculosis suspects in Nigeria.

    Gambo Aliyu

    Full Text Available BACKGROUND: Nigeria is ranked in the top five countries for tuberculosis deaths worldwide. This study investigated the mycobacterial agents associated with presumptive clinical pulmonary tuberculosis (TB in Nigeria and evaluated the pattern and frequency of mycobacterial infections over twelve calendar months period. METHODS: Sputum samples from 1,603 consecutive new cases with presumptive diagnosis of TB were collected from August 2010 to July 2011. All sputum samples were incubated for detection of mycobacterial growth and those with positive acid fast bacilli (AFB growth were tested to detect mycobacterium tuberculosis (MTB complex and characterized to differentiate between MTB complex species. Cultures suggestive of Non-tuberculous mycobacterial infections (NTM were sub-cultured and characterized. RESULTS: Of the 1,603 patients screened, 444 (28% culture-positive cases of pulmonary tuberculosis were identified. Of these, 375 (85% were due to strains of MTB complex (354 cases of M. tuberculosis, 20 M. africanum and one case of M. bovis and 69 (15% were due to infection with NTM. In contrast to the MTB complex cases, the NTM cases were more likely to have been diagnosed during the calendar months of the Harmattan dust season (OR = 2.34, 1.28-4.29; p = 0.01, and aged older than 35 years (OR = 2.77, 1.52-5.02, p = 0.0007, but less likely to have AFB identified on their sputum smear (OR = 0.06, 0.02-0.14, p<0.0001. Among those with NTM infection, cases 35 years or younger were more likely to have co-infection with HIV (3.76, 1.72-8.22; p = 0.0009 compared to those older than 35 years. INTERPRETATION: The high proportion of younger patients with clinical pulmonary TB due to NTM and co-infection with HIV and the likely role of the seasonal dust exposure in the occurrence of the disease, present novel public health challenges for prevention and treatment.

  13. Human TYK2 deficiency: Mycobacterial and viral infections without hyper-IgE syndrome

    Kreins, Alexandra Y.; Ciancanelli, Michael J.; Okada, Satoshi; Kong, Xiao-Fei; Ramírez-Alejo, Noé; Kilic, Sara Sebnem; El Baghdadi, Jamila; Nonoyama, Shigeaki; Mahdaviani, Seyed Alireza; Ailal, Fatima; Bousfiha, Aziz; Mansouri, Davood; Nievas, Elma; Ma, Cindy S.; Rao, Geetha; Bernasconi, Andrea; Sun Kuehn, Hye; Niemela, Julie; Stoddard, Jennifer; Deveau, Paul; Cobat, Aurelie; El Azbaoui, Safa; Sabri, Ayoub; Lim, Che Kang; Sundin, Mikael; Avery, Danielle T.; Halwani, Rabih; Grant, Audrey V.; Boisson, Bertrand; Bogunovic, Dusan; Itan, Yuval; Moncada-Velez, Marcela; Martinez-Barricarte, Ruben; Migaud, Melanie; Deswarte, Caroline; Alsina, Laia; Kotlarz, Daniel; Klein, Christoph; Muller-Fleckenstein, Ingrid; Fleckenstein, Bernhard; Cormier-Daire, Valerie; Rose-John, Stefan; Picard, Capucine; Hammarstrom, Lennart; Puel, Anne; Al-Muhsen, Saleh; Abel, Laurent; Chaussabel, Damien; Rosenzweig, Sergio D.; Minegishi, Yoshiyuki; Tangye, Stuart G.; Bustamante, Jacinta; Casanova, Jean-Laurent


    Autosomal recessive, complete TYK2 deficiency was previously described in a patient (P1) with intracellular bacterial and viral infections and features of hyper-IgE syndrome (HIES), including atopic dermatitis, high serum IgE levels, and staphylococcal abscesses. We identified seven other TYK2-deficient patients from five families and four different ethnic groups. These patients were homozygous for one of five null mutations, different from that seen in P1. They displayed mycobacterial and/or viral infections, but no HIES. All eight TYK2-deficient patients displayed impaired but not abolished cellular responses to (a) IL-12 and IFN-α/β, accounting for mycobacterial and viral infections, respectively; (b) IL-23, with normal proportions of circulating IL-17+ T cells, accounting for their apparent lack of mucocutaneous candidiasis; and (c) IL-10, with no overt clinical consequences, including a lack of inflammatory bowel disease. Cellular responses to IL-21, IL-27, IFN-γ, IL-28/29 (IFN-λ), and leukemia inhibitory factor (LIF) were normal. The leukocytes and fibroblasts of all seven newly identified TYK2-deficient patients, unlike those of P1, responded normally to IL-6, possibly accounting for the lack of HIES in these patients. The expression of exogenous wild-type TYK2 or the silencing of endogenous TYK2 did not rescue IL-6 hyporesponsiveness, suggesting that this phenotype was not a consequence of the TYK2 genotype. The core clinical phenotype of TYK2 deficiency is mycobacterial and/or viral infections, caused by impaired responses to IL-12 and IFN-α/β. Moreover, impaired IL-6 responses and HIES do not appear to be intrinsic features of TYK2 deficiency in humans. PMID:26304966

  14. Improved diagnosis of mycobacterial infections in formalin-fixed and paraffin-embedded sections with nested polymerase chain reaction.

    Azov, Andrey G; Koch, Jørn; Hamilton-Dutoit, Stephen J


    Traditional histological diagnosis of mycobacterial infection in formalin-fixed and paraffin-embedded (FFPE) tissues is insensitive and poorly specific. To improve this, we developed nested polymerase chain reaction (PCR) protocols for detecting a Mycobacterium genus-specific 65-kDa heat shock protein (HSP65) sequence and the M. tuberculosis complex-specific insertion sequence IS6110 in FFPE sections. Protocols were optimized on tissues from 20 patients with a final clinical diagnosis of mycobacterial infection. Amplicons were controlled by sequencing and restriction endonuclease digestion. PCR could detect as few as three mycobacterial genomes per reaction. Assays showed 100% sensitivity and specificity for both M. tuberculosis complex and M. avium complex infection. Paraffin blocks from a second group of 26 patients with histological evidence of necrotizing granulomas of unknown etiology were then analyzed as a surrogate group to test the assay under conditions similar to those applying during routine diagnosis. Twenty-three of these blocks contained amplifiable DNA; nine were positive for M. tuberculosis complex DNA and four for other types of mycobacterial DNA. Furthermore, digestion of HSP65 amplicons with NarI could distinguish M. tuberculosis from M. avium complex. In conclusion, our nested PCR assays can be used as reliable tools for the detection of mycobacterial infections in FFPE tissues. The assays are simple and rapid to perform and show improved sensitivity and specificity compared to previously reported protocols.

  15. Cytokines in mycobacterial infections: `in vitro` and `ex vivo` studies

    Flad, H.D.; Gercken, J.; Huebner, L.; Schlueter, C.; Ernst, M. [Forschungsinstitut Borstel (Germany). Inst. fuer Experimentelle Biologie und Medizin; Pryjma, J. [Uniwersytet Jagiellonski, Cracow (Poland)


    Different species of mycobacteria differ in their capacity to induce the production of tumor necrosis factor-{alpha} (TNF-{alpha}) by human monocytes `in vitro`. Whereas `M. tuberculosis` is a potent inducer of TNF-{alpha}, `M. leprae` is much less potent. TNF-{alpha} production is found to be associated with the availability of H{sub 2}O{sub 2} generated by activated monocytes, as superoxide enhancing H{sub 2}O{sub 2} concentration increases and catalase degrading H{sub 2}O{sub 2} decreases TNF-{alpha} production. Furthermore, `M. kansasii` with high intrinsic catalase induce less TNF-{alpha} than mycobacteria with low intrinsic catalase. `In vitro` infection of monocytes with `M. tuberculosis` leads to an impairment of the antigen-presenting capacity, as determined by a reduction of antigen-induced T cell proliferation and interferon {gamma} (IFN-{gamma}) production. Of crucial importance in this impairment is the `M. tuberculosis`-induced down-modulation of MHC class II antigens. The role of TNF-{alpha} `in vivo` is reflected in patients with various forms of leprosy. In skin lesions of lepromatous leprosy patients TNF-{alpha}, interleukin 1{beta} (IL-1{beta}), and IFN-{gamma} production are found to be rare, whereas these cytokines are well expressed in skin lesions of patients with tuberculoid leprosy. After multidrug chemotherapy an increase of local cytokine production is found. Taken together, these findings suggest that components of mycobacteria may interfere with local cell-mediated immune reactions `in vivo`. The molecular mechanisms involved in these local responses need to be defined. (author). 10 refs, 3 figs, 5 tabs.

  16. Thoracoscopic management for bronchiectasis with non-tuberculous mycobacterial infection


    Background Non-tuberculous mycobacteria (NTM) have emerged as important opportunistic pathogens of the human being in recent years. Patients with pre-existing bronchiectasis are susceptible to NTM. However, information about its occurrence among bronchiectatic patients in Shenzhen, China is lacking and its impact on the course of bronchiectasis following surgical intervention is unknown. This preliminary study aimed to investigate the prevalence of NTM in bronchiectasis that required surgery in our center, evaluate the role of intraoperative routine screening for NTM, and summarize our initial experience in thoracoscopic management for bronchiectatic patients with NTM. Methods A retrospective analysis of clinical, microbiological data of our bronchiectatic patients with NTM over 5 years was made and 40 patients with bronchiectasis were studied to determine the role of intraoperative routine screening for NTM. Results The prevalence of NTM in this population of patients with bronchiectasis in our center was 6.7% (7/105). The diagnostic yield of the 40 intraoperative specimens was 7.5% (3/40). Of the 7 patients with bronchiectasis and NTM, 3 patients developed postoperative wound infections. All were cured with chemotherapy for 8-12 months along with vigorous surgical debridement. Another patient had a slow growth of mycobacteria involving double lungs and the right thoracic cavity and recovered after chemotherapy for nearly 14 months and tube drainage. The affected tissue was completely resected in the remaining 3 patients with no operative mortality and postoperative morbidity, and routine intraoperative screening for NTM was initiated in these patients. Conclusions NTM is not uncommon in bronchiectatic patients which deserves surgeons' utmost attention. Routine intraoperative screening for NTM identified otherwise unsuspected patients has shown favorable outcomes. Thoracoscopic management for bronchiectasis with NTM is technically feasible although its role

  17. Lingual ulcer as the only sign of recurrent mycobacterial infection in an HIV/AIDS-infected patient.

    Ramírez-Amador, Velia; Anaya-Saavedra, Gabriela; González-Ramírez, Imelda; Mosqueda-Gómez, Juan Luis; Esquivel-Pedraza, Lilly; Reyes-Gutiérrez, Edgardo; Sierra-Madero, Juan


    The report describes an HIV/AIDS patient seen at a referral center in Mexico City, in whom a mycobacterial infection in the oral mucosa, probably tuberculosis (TB) was identified. The purpose is to describe the clinical and histological findings in an HIV-infected patient, who after being treated successfully for tuberculous lymphangitis 4 years ago, presented with a lingual ulcer as the only suggestive sign of recurrence of mycobacterial infection, probably M. tuberculosis. A 39-year-old man seen in the HIV clinic of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" in Mexico City since 1991 for HIV infection. In 1999 the patient developed tuberculous lymphangitis; he was managed with a 4-drug regimen for 12 months, with improvement of local and systemic symptoms. In May of 2003, the patient presented a painful superficial lingual ulcer, 0.7 cm in diameter, well circumscribed, crateriform with slightly elevated, irregular and indurated borders, of 4 months duration. The histopathological examination showed chronic granulomatous inflammation with giant multinucleated cells, suggestive of mycobacterial infection, and recurrence of TB was considered. Rifampin, isoniazide, pyrazinamide, ethambutol and streptomycin were administered. The lingual lesion improved with partial healing at the first week and total remission at 45 days after the beginning of the antituberculous treatment. In June, 2003, the patient began highly active antiretroviral therapy (HAART) that included two NRTIs and one NNRTI. At 7 months of follow-up, the patient remains free of lingual lesions. The particularity of the present case is that the lingual ulcer was the only sign of infection by mycobacteria, suggestive of TB, in an HIV/AIDS patient that probably represented a recurrence of a previous episode.

  18. Infection Sources of a Common Non-tuberculous Mycobacterial Pathogen, Mycobacterium avium Complex

    Nishiuchi, Yukiko; Iwamoto, Tomotada; Maruyama, Fumito


    Numerous studies have revealed a continuous increase in the worldwide incidence and prevalence of non-tuberculous mycobacteria (NTM) diseases, especially pulmonary Mycobacterium avium complex (MAC) diseases. Although it is not clear why NTM diseases have been increasing, one possibility is an increase of mycobacterial infection sources in the environment. Thus, in this review, we focused on the infection sources of pathogenic NTM, especially MAC. The environmental niches for MAC include water, soil, and dust. The formation of aerosols containing NTM arising from shower water, soil, and pool water implies that these niches can be infection sources. Furthermore, genotyping has shown that clinical isolates are identical to environmental ones from household tap water, bathrooms, potting soil, and garden soil. Therefore, to prevent and treat MAC diseases, it is essential to identify the infection sources for these organisms, because patients with these diseases often suffer from reinfections and recurrent infections with them. In the environmental sources, MAC and other NTM organisms can form biofilms, survive within amoebae, and exist in a free-living state. Mycobacterial communities are also likely to occur in these infection sources in households. Water distribution systems are a transmission route from natural water reservoirs to household tap water. Other infection sources include areas with frequent human contact, such as soil and bathrooms, indicating that individuals may carry NTM organisms that concomitantly attach to their household belongings. To explore the mechanisms associated with the global spread of infection and MAC transmission routes, an epidemiological population-wide genotyping survey would be very useful. A good example of the power of genotyping comes from M. avium subsp. hominissuis, where close genetic relatedness was found between isolates of it from European patients and pigs in Japan and Europe, implying global transmission of this bacterium

  19. Tracheal granuloma because of infection with a novel mycobacterial species in an old FIV-positive cat.

    De Lorenzi, D; Solano-Gallego, L


    A 15-year-old domestic shorthair feline immunodeficiency virus-positive cat was presented with a five day history of productive cough and acute respiratory distress. Physical examination revealed inspiratory dyspnoea and diffuse gingivostomatitis. Radiographs showed an intratracheal mass located at the level of the sixth and the seventh cervical vertebrae. Bronchoscopy revealed a unique intratracheal mass occluding about 85 per cent of the tracheal lumen. The tracheal mass was removed bronchoscopically. A diagnosis of pyogranulomatous inflammation referable to a mycobacterial infection was made based on cytological and histopathological findings. 16S rRNA polymerase chain reaction testing and sequence analysis identified a novel mycobacterial species, likely a slow grower, with 95 per cent identity with Mycobacterium xenopi. To our knowledge, this is the first description of a tracheal mycobacterial granuloma in a cat, and the first time, a mycobacterium with this sequence has been identified.

  20. Impact of selenium status on the pathogenesis of mycobacterial disease in HIV-1-infected drug users during the era of highly active antiretroviral therapy.

    Shor-Posner, Gail; Miguez, Maria-Jose; Pineda, Luisa Maria; Rodriguez, Allan; Ruiz, Philip; Castillo, Gloria; Burbano, Ximena; Lecusay, Robert; Baum, Marianna


    The risk of mycobacterial disease is significantly increased in drug abusers as well as in immunocompromised HIV-1-infected individuals. The essential trace element selenium has an important function in maintaining immune processes and may, thus, have a critical role in clearance of mycobacteria. The impact of selenium status on the development of mycobacterial diseases in HIV-1-seropositive drug users was investigated over a 2-year period (1999-2001). Twelve cases of mycobacterial disease (tuberculosis, 9; infection due to atypical Mycobacterium species, 3) occurred; these 12 cases were compared with 32 controls with no history of respiratory infections who were matched on age, sex, and HIV status. Significant risk for development of mycobacterial disease was associated with a CD4 cell count of impact on the pathogenesis of mycobacterial disease.

  1. IL-37 Confers Protection against Mycobacterial Infection Involving Suppressing Inflammation and Modulating T Cell Activation

    Yang, Hua; He, Xin; Ji, Qun; Bai, Wenjuan; Chen, Hao; Chen, Jianxia; Peng, Wenxia; Liu, Siyu; Liu, Zhonghua; Ge, Baoxue


    Interleukin-37 (IL-37), a novel member of the IL-1 family, plays fundamental immunosuppressive roles by broadly reducing both innate inflammation and acquired immunity, but whether it is involved in the pathogenesis of tuberculosis (TB) has not been clearly elucidated. In this study, single nucleotide polymorphism (SNP) analysis demonstrated an association of the genetic variant rs3811047 of IL-37 with TB susceptibility. In line with previous report, a significant elevated IL-37 abundance in the sera and increased expression of IL-37 protein in the peripheral blood mononuclear cells (PBMC) were observed in TB patients in comparison to healthy controls. Moreover, release of IL-37 were detected in either macrophages infected with Mycobacterium tuberculosis (Mtb) or the lung of BCG-infected mice, concurrent with reduced production of proinflammatory cytokines including IL-6 and TNF-α. Furthermore, in contrast to wild-type mice, BCG-infected IL-37-Tg mice manifested with reduced mycobacterial burden and tissue damage in the lung, accompanied by higher frequency of Th1 cell and less frequencies of regulatory T cells and Th17 cells in the spleen. Taken together, our findings demonstrated that IL-37 conferred resistance to Mtb infection possibly involving suppressing detrimental inflammation and modulating T cell responses. These findings implicated that IL-37 may be employed as a new molecular target for the therapy and diagnosis of TB. PMID:28076390

  2. Bacillus calmette-guerin infection in NADPH oxidase deficiency: defective mycobacterial sequestration and granuloma formation.

    Christine Deffert


    Full Text Available Patients with chronic granulomatous disease (CGD lack generation of reactive oxygen species (ROS through the phagocyte NADPH oxidase NOX2. CGD is an immune deficiency that leads to frequent infections with certain pathogens; this is well documented for S. aureus and A. fumigatus, but less clear for mycobacteria. We therefore performed an extensive literature search which yielded 297 cases of CGD patients with mycobacterial infections; M. bovis BCG was most commonly described (74%. The relationship between NOX2 deficiency and BCG infection however has never been studied in a mouse model. We therefore investigated BCG infection in three different mouse models of CGD: Ncf1 mutants in two different genetic backgrounds and Cybb knock-out mice. In addition, we investigated a macrophage-specific rescue (transgenic expression of Ncf1 under the control of the CD68 promoter. Wild-type mice did not develop severe disease upon BCG injection. In contrast, all three types of CGD mice were highly susceptible to BCG, as witnessed by a severe weight loss, development of hemorrhagic pneumonia, and a high mortality (∼ 50%. Rescue of NOX2 activity in macrophages restored BCG resistance, similar as seen in wild-type mice. Granulomas from mycobacteria-infected wild-type mice generated ROS, while granulomas from CGD mice did not. Bacterial load in CGD mice was only moderately increased, suggesting that it was not crucial for the observed phenotype. CGD mice responded with massively enhanced cytokine release (TNF-α, IFN-γ, IL-17 and IL-12 early after BCG infection, which might account for severity of the disease. Finally, in wild-type mice, macrophages formed clusters and restricted mycobacteria to granulomas, while macrophages and mycobacteria were diffusely distributed in lung tissue from CGD mice. Our results demonstrate that lack of the NADPH oxidase leads to a markedly increased severity of BCG infection through mechanisms including increased cytokine

  3. Conserved immune recognition hierarchy of mycobacterial PE/PPE proteins during infection in natural hosts.

    H Martin Vordermeier

    Full Text Available The Mycobacterium tuberculosis genome contains two large gene families encoding proteins of unknown function, characterized by conserved N-terminal proline and glutamate (PE and PPE motifs. The presence of a large number of PE/PPE proteins with repetitive domains and evidence of strain variation has given rise to the suggestion that these proteins may play a role in immune evasion via antigenic variation, while emerging data suggests that some family members may play important roles in mycobacterial pathogenesis. In this study, we examined cellular immune responses to a panel of 36 PE/PPE proteins during human and bovine infection. We observed a distinct hierarchy of immune recognition, reflected both in the repertoire of PE/PPE peptide recognition in individual cows and humans and in the magnitude of IFN-γ responses elicited by stimulation of sensitized host cells. The pattern of immunodominance was strikingly similar between cattle that had been experimentally infected with Mycobacterium bovis and humans naturally infected with clinical isolates of M. tuberculosis. The same pattern was maintained as disease progressed throughout a four-month course of infection in cattle, and between humans with latent as well as active tuberculosis. Detailed analysis of PE/PPE responses at the peptide level suggests that antigenic cross-reactivity amongst related family members is a major determinant in the observed differences in immune hierarchy. Taken together, these results demonstrate that a subset of PE/PPE proteins are major targets of the cellular immune response to tuberculosis, and are recognized at multiple stages of infection and in different disease states. Thus this work identifies a number of novel antigens that could find application in vaccine development, and provides new insights into PE/PPE biology.


    Remo George


    Full Text Available The ability of the pathogen Mycobacterium Tuberculosis (MTB to invade and survive within macrophages of granulomas is attributed to the product of the Mammalian Cell Entry (MCE operon whose gene, mce4A, encodes a cholesterol transporter that transports host lipids into the bacterium that allows the bacterium to survive during chronic infection. Here, we proposed and tested the hypothesis that a mce4A siRNA molecular beacon can be used to attenuate mycobacterial infection in macrophages. Mce4A gene was cloned and expressed in E. coli (E. coli-4A and differentiated U937 cells were transduced with piLenti-siRNA-GFP phage expressing the mce4A siRNA for 24 h. This was followed by infection with either E. coli-4A or M. smegmatis for 3 h followed by incubation for 0, 3, 6, 24 and 48 h. The cells were lysed and the lysates were plated on LB agar plates containing ampicillin (100 µg mL-1 or on 7H11 media and incubated at 37°C overnight. Our results showed that the siRNA treatment attenuated E.coli-4A infection in macrophages at 3, 6, 24 and 48 h by 0, 77, 59.6 and 99.7%, respectively. Our results also showed that the siRNA treatment attenuated M. smegmatis infection in macrophages at 3, 6, 24 and 48 h. by 94.8, 70.3, 98.9 and 93.4%, respectively. In conclusion, a mce4A siRNA molecular beacon was successfully delivered and stably expressed in macrophages which attenuated E. coli expressing mce4A (E. coli-4A and M. smegmatis infection in macrophages.

  5. Fasciola hepatica infection reduces Mycobacterium bovis burden and mycobacterial uptake and suppresses the pro-inflammatory response.

    Garza-Cuartero, L; O'Sullivan, J; Blanco, A; McNair, J; Welsh, M; Flynn, R J; Williams, D; Diggle, P; Cassidy, J; Mulcahy, G


    Bovine tuberculosis (BTB), caused by Mycobacterium bovis, has an annual incidence in cattle of 0.5% in the Republic of Ireland and 4.7% in the UK, despite long-standing eradication programmes being in place. Failure to achieve complete eradication is multifactorial, but the limitations of diagnostic tests are significant complicating factors. Previously, we have demonstrated that Fasciola hepatica infection, highly prevalent in these areas, induced reduced sensitivity of the standard diagnostic tests for BTB in animals co-infected with F. hepatica and M. bovis. This was accompanied by a reduced M. bovis-specific Th1 immune response. We hypothesized that these changes in co-infected animals would be accompanied by enhanced growth of M. bovis. However, we show here that mycobacterial burden in cattle is reduced in animals co-infected with F. hepatica. Furthermore, we demonstrate a lower mycobacterial recovery and uptake in blood monocyte-derived macrophages (MDM) from F. hepatica-infected cattle which is associated with suppression of pro-inflammatory cytokines and a switch to alternative activation of macrophages. However, the cell surface expression of TLR2 and CD14 in MDM from F. hepatica-infected cattle is increased. These findings reflecting the bystander effect of helminth-induced downregulation of pro-inflammatory responses provide insights to understand host-pathogen interactions in co-infection.

  6. Effects of Disseminated Mycobacterial Infection on Age-Related Macular Degeneration.

    Collett, Geoffrey; Lopez, Natalia; Lopez, Pedro F


    Our patient, in the 7th decade of life, presented with worsening blurry vision over 3 weeks. The pertinent history included nonexudative age-related macular degeneration, recent pulmonary mycobacterial infection, and autoimmune pancreatitis. The patient had decreased visual acuity in both eyes; the remaining findings of our examination were relatively benign. The diagnosis of bilateral exudative age-related macular degeneration was aided by ocular imaging. Not only were exudative changes confirmed, but one modality suggested an underlying occult choroiditis, which presumably fueled a local inflammatory drive leading to evolution of the disease. Given the choroiditis developed in the setting of a recent Mycobacterium chelonae infection, dissemination of the organism must be considered a potential culprit. Additionally, a chronic inflammatory state perhaps played a simultaneous immunologic role. We feel the proposed pathogenic mechanism outlined sufficiently accounts for the rare event, that is, development of subacute bilateral exudative maculopathy. The patient responded well to bilateral intravitreal aflibercept injections. After 1 month, visual acuity was found to be near baseline and ocular imaging showed significant resolution of the exudative changes. An additional follow-up 3 months after confirmed similar stability. This case required thorough investigation of seemingly unrelated components within the patient's history. We stress the importance of obtaining appropriate documentation from fellow health care teams when suspicious clinical presentations arise. During our investigation, we identified cryptic retinal lesions by way of angiography - leading us to recommend usage of such methods in complex cases. We also summarize the implemented aflibercept course and the favorable response to such treatment.

  7. Effects of Disseminated Mycobacterial Infection on Age-Related Macular Degeneration

    Geoffrey Collett


    Full Text Available Our patient, in the 7th decade of life, presented with worsening blurry vision over 3 weeks. The pertinent history included nonexudative age-related macular degeneration, recent pulmonary mycobacterial infection, and autoimmune pancreatitis. The patient had decreased visual acuity in both eyes; the remaining findings of our examination were relatively benign. The diagnosis of bilateral exudative age-related macular degeneration was aided by ocular imaging. Not only were exudative changes confirmed, but one modality suggested an underlying occult choroiditis, which presumably fueled a local inflammatory drive leading to evolution of the disease. Given the choroiditis developed in the setting of a recent Mycobacterium chelonae infection, dissemination of the organism must be considered a potential culprit. Additionally, a chronic inflammatory state perhaps played a simultaneous immunologic role. We feel the proposed pathogenic mechanism outlined sufficiently accounts for the rare event, that is, development of subacute bilateral exudative maculopathy. The patient responded well to bilateral intravitreal aflibercept injections. After 1 month, visual acuity was found to be near baseline and ocular imaging showed significant resolution of the exudative changes. An additional follow-up 3 months after confirmed similar stability. This case required thorough investigation of seemingly unrelated components within the patient’s history. We stress the importance of obtaining appropriate documentation from fellow health care teams when suspicious clinical presentations arise. During our investigation, we identified cryptic retinal lesions by way of angiography – leading us to recommend usage of such methods in complex cases. We also summarize the implemented aflibercept course and the favorable response to such treatment.

  8. Rapid Diagnosis of Mycobacterial Infections and Quantitation of Mycobacterium tuberculosis Load by Two Real-Time Calibrated PCR Assays

    Broccolo, Francesco; Scarpellini, Paolo; Locatelli, Giuseppe; Zingale, Anna; Brambilla, Anna M.; Cichero, Paola; Sechi, Leonardo A.; Lazzarin, Adriano; Lusso, Paolo; Malnati, Mauro S.


    Sensitive and specific techniques to detect and identify Mycobacterium tuberculosis directly in clinical specimens are important for the diagnosis and management of patients with tuberculosis (TB). We developed two real-time PCR assays, based on the IS6110 multicopy element and on the senX3-regX3 intergenic region, which provide a rapid method for the diagnosis of mycobacterial infections. The sensitivity and specificity of both assays were established by using purified DNA from 71 clinical isolates and 121 clinical samples collected from 83 patients, 20 of whom were affected by TB. Both assays are accurate, sensitive, and specific, showing a complementary pattern of Mycobacterium recognition: broader for the IS6110-based assay and restricted to the M. tuberculosis complex for the senX3-regX3-based assay. Moreover, the addition of a synthetic DNA calibrator prior to DNA extraction allowed us to measure the efficiency of DNA recovery and to control for the presence of PCR inhibitors. The mycobacterial burden of the clinical samples, as assessed by direct microscopy, correlates with the M. tuberculosis DNA load measured by the senX3-regX3-based assay. In addition, reduced levels of M. tuberculosis DNA load are present in those patients subjected to successful therapy, suggesting a potential use of this assay for monitoring treatment efficacy. Therefore, these assays represent a fully controlled high-throughput system for the evaluation of mycobacterial burden in clinical specimens. PMID:14532183

  9. Differences between Mycobacterium-Host Cell Relationships in Latent Tuberculous Infection of Mice Ex Vivo and Mycobacterial Infection of Mouse Cells In Vitro.

    Ufimtseva, Elena


    The search for factors that account for the reproduction and survival of mycobacteria, including vaccine strains, in host cells is the priority for studies on tuberculosis. A comparison of BCG-mycobacterial loads in granuloma cells obtained from bone marrow and spleens of mice with latent tuberculous infection and cells from mouse bone marrow and peritoneal macrophage cultures infected with the BCG vaccine in vitro has demonstrated that granuloma macrophages each normally contained a single BCG-Mycobacterium, while those acutely infected in vitro had increased mycobacterial loads and death rates. Mouse granuloma cells were observed to produce the IFNγ, IL-1α, GM-CSF, CD1d, CD25, CD31, СD35, and S100 proteins. None of these activation markers were found in mouse cell cultures infected in vitro or in intact macrophages. Lack of colocalization of lipoarabinomannan-labeled BCG-mycobacteria with the lysosomotropic LysoTracker dye in activated granuloma macrophages suggests that these macrophages were unable to destroy BCG-mycobacteria. However, activated mouse granuloma macrophages could control mycobacterial reproduction in cells both in vivo and in ex vivo culture. By contrast, a considerable increase in the number of BCG-mycobacteria was observed in mouse bone marrow and peritoneal macrophages after BCG infection in vitro, when no expression of the activation-related molecules was detected in these cells.

  10. Infected abdominal aortic aneurysm due to Morganella morganii: CT findings.

    Kwon, Oh Young; Lee, Jong Seok; Choi, Han Sung; Hong, Hoon Pyo; Ko, Young Gwan


    An infected aortic aneurysm, or mycotic aneurysm, is a rare arterial dilatation due to destruction of the infected vessel wall. Common pathogens resulting in an infected aortic aneurysm are Salmonella and Clostridium species, as well as Staphylococcus aureus; Morganella morganii, on the other hand, is very rare. An infected abdominal aortic aneurysm has tendencies to grow rapidly and to rupture. The mortality rate is high in patients undergoing emergent surgical intervention. We report the case of a 65-year-old man who presented with an infected abdominal aortic aneurysm caused by M. morganii. A high index of suspicion and imaging tests are necessary in order to diagnose an infected aortic aneurysm.

  11. Non-tuberculous mycobacterial infection of the musculoskeletal system: pattern of infection and efficacy of combined surgical/antimicrobial treatment.

    Park, J W; Kim, Y S; Yoon, J O; Kim, J S; Chang, J S; Kim, J M; Chun, J M; Jeon, I H


    Non-tuberculous mycobacterial (NTM) infection of the musculoskeletal tissue is a rare disease. An early and accurate diagnosis is often difficult because of the indolent clinical course and difficulty of isolating pathogens. Our goal was to determine the clinical features of musculoskeletal NTM infection and to present the treatment outcomes. A total of 29 patients (nine females, 20 males between 34 and 85 years old, mean age 61.7 years; 34 to 85) with NTM infection of the musculoskeletal system between 1998 to 2011 were identified and their treatment retrospectively analysed. Microbiological studies demonstrated NTM in 29 patients: the isolates were Mycobacterium intracellulare in six patients, M. fortuitum in three, M. abscessus in two and M. marinum in one. In the remaining patients we failed to identify the species. The involved sites were the hand/wrist in nine patients the knee in five patients, spine in four patients, foot in two patients, elbow in two patients, shoulder in one, ankle in two patients, leg in three patients and multiple in one patient. The mean interval between the appearance of symptoms and diagnosis was 20.8 months (1.5 to 180). All patients underwent surgical treatment and antimicrobial medication according to our protocol for chronic musculoskeletal infection: 20 patients had NTM-specific medication and nine had conventional antimicrobial therapy. At the final follow-up 22 patients were cured, three failed to respond to treatment and four were lost to follow-up. Identifying these diseases due the initial non-specific presentation can be difficult. Treatment consists of surgical intervention and adequate antimicrobial therapy, which can result in satisfactory outcomes.

  12. Non-pathological infection of macaques by an attenuated mycobacterial vaccine is not reactivated in the setting of HIV coinfection.

    Foreman, Taylor Wayne; Veatch, Ashley Victoria; LoBato, Denae Nadine; Didier, Peter John; Doyle-Meyers, Lara Angela; Russell-Lodrigue, Kasi Elizabeth; Lackner, Andrew Alan; Kousoulas, Konstantin Gus; Khader, Shabaana Abdul; Kaushal, Deepak; Mehra, Smriti


    Failure to replace BCG with efficacious anti-TB vaccines have prompted out-of-the-box thinking, including pulmonary vaccination in order to elicit local immunity. MtbΔsigH, a stress-response attenuated strain, protected against lethal TB when used to vaccinate macaques via inhalation. While live mycobacterial vaccines show promising efficacy, HIV co-infection and the resulting immunodeficiency prompts safety concerns about their use. We assessed the persistence and safety of MtbΔsigH, delivered directly to the lungs, in the setting of HIV coinfection. Macaques were aerosol vaccinated with ΔsigH and subsequently challenged with SIVmac239. BAL and tissues were sampled for mycobacterial persistence, pathology and immune correlates. Only 35% and 3.5% lung samples were positive for live-bacilli and granulomas, respectively. Our results therefore suggest that the non-pathological infection of macaque lungs by ΔsigH was not reactivated by SIV, despite high viral titers and massive ablation of pulmonary CD4(+) T-cells. Protective pulmonary responses were retained, including vaccine-induced bronchus associated lymphoid tissue (iBALT) and CD8(+) effector memory cells. Despite acute SIV infection, all animals remained asymptomatic of pulmonary TB. These findings highlight the efficacy of mucosal vaccination of this attenuated strain and will guide its further development to potentially combat TB in HIV endemic areas. Our results also suggest that lack of pulmonary pathology is a key correlate of safety for live mycobacterial vaccines. Copyright © 2017. Published by Elsevier Inc.

  13. Novel mutation in the interferon-gamma-receptor gene and susceptibility to mycobacterial infections

    Storgaard, M; Varming, K; Herlin, Troels;


    In 1981 we presented a patient with Mycobacterium intracellulare osteomyelitis and depressed monocyte cytotoxicity. It is now demonstrated that the molecular defect was a never-before-described nucleotide deletion at position 794 (794delT) in the interferon-gamma-receptor alpha-1 gene. The genetic...... defect was passed on to his daughter who was diagnosed with non-tuberculous mycobacterial osteomyelitis at the age of 7 years....

  14. Atypical Mycobacterial Infection after Abdominoplasty Overseas: A Case Report and Literature Review

    Prabin Sharma


    Full Text Available Increasing number of medical tourists travel internationally for cosmetic procedures. Lipotourism is a form of medical tourism becoming popular among patients of developed countries due to the cost efficiency of cosmetic procedures when performed in developing nations. There is a paucity of data on quality, safety, and risks involved with these surgeries. Many cases of infections have been documented in patients following cosmetic surgeries in developing countries. We present a case of a 34-year-old female who underwent abdominoplasty in Dominican Republic that was complicated with development of multiple abdominal wall abscesses due to infection from rapidly growing mycobacteria (RGM. In the absence of clear treatment guidelines, she was treated with a combination of intermittent surgical drainage and prolonged antibiotic course. This case is of interest as more than one species of RGM was isolated from the same patient. Our case highlights the fact that identification of these organisms can be difficult requiring referral of samples to specialized laboratories and treatment duration can last several months, which is determined by clinical and microbiological response.

  15. Central memory Vgamma9Vdelta2 T lymphocytes primed and expanded by bacillus Calmette-Guérin-infected dendritic cells kill mycobacterial-infected monocytes.

    Martino, Angelo; Casetti, Rita; Sacchi, Alessandra; Poccia, Fabrizio


    In humans, innate immune recognition of mycobacteria, including Mycobacterium tuberculosis and bacillus Calmette-Guérin (BCG), is a feature of cells as dendritic cells (DC) and gammadelta T cells. In this study, we show that BCG infection of human monocyte-derived DC induces a rapid activation of Vgamma9Vdelta2 T cells (the major subset of gammadelta T cell pool in human peripheral blood). Indeed, in the presence of BCG-infected DC, Vgamma9Vdelta2 T cells increase both their expression of CD69 and CD25 and the production of TNF-alpha and IFN-gamma, in contrast to DC treated with Vgamma9Vdelta2 T cell-specific Ags. Without further exogenous stimuli, BCG-infected DC expand a functionally cytotoxic central memory Vgamma9Vdelta2 T cell population. This subset does not display lymph node homing receptors, but express a high amount of perforin. They are highly efficient in the killing of mycobacterial-infected primary monocytes or human monocytic THP-1 cells preserving the viability of cocultured, infected DC. This study provides further evidences about the complex relationship between important players of innate immunity and suggests an immunoregulatory role of Vgamma9Vdelta2 T cells in the control of mycobacterial infection.

  16. Diffuse abdominal gallium-67 citrate uptake in salmonella infections

    Garty, I.; Koren, A.


    Two pediatric patients with salmonella infections (one with typhoid fever and the second with salmonella C2 gastroenteritis), had a diffuse abdominal uptake of Ga-67 citrate. The possible explanation for this finding is discussed. Salmonella infection should be included as a cause in the differential diagnosis of diffuse accumulation of Ga-67 citrate.

  17. Pylephlebitis: An Uncommon Complication of Intra-Abdominal Infection

    Salim R Surani


    Full Text Available We herein present a case of pylephlebitis, which is an infective suppurative thrombosis of the portal vein. Pylephlebitis is an uncommon complication of intra-abdominal infections and carries with it significant morbidity and mortality. [West J Emerg Med. 2011;12(4:575–576.

  18. Pylephlebitis: a rare complication of an intra-abdominal infection

    Katherine Wong


    Full Text Available Pylephlebitis is defined as an inflamed thrombosis of the portal vein. It is a rare complication of an intra-abdominal infection, and the diagnosis is often missed due to its nonspecific clinical presentation. Symptoms may include abdominal pain, fever, chills, fatigue, nausea, and vomiting. It is important to consider this differential when a patient presents with signs of abdominal sepsis since it has a high mortality rate and is often diagnosed postmortem. Pylephlebitis can be diagnosed via abdominal ultrasound or CT demonstrating a thrombus in the portal vein, and it must be treated early and aggressively with broad-spectrum antibiotics. We are presenting a case of pylephlebitis as well as discussing the diagnosis and treatment of this potentially lethal condition.

  19. Mycobacterial and nonbacterial pulmonary complications in hospitalized patients with human immunodeficiency virus infection: A prospective, cohort study

    Afessa Bekele


    Full Text Available Abstract Background A prospective observational study was done to describe nonbacterial pulmonary complications in hospitalized patients with human immunodeficiency virus (HIV infection. Methods The study included 1,225 consecutive hospital admissions of 599 HIV-infected patients treated from April 1995 through March 1998. Data included demographics, risk factors for HIV infection, Acute Physiology and Chronic Health Evaluation (APACHE II score, pulmonary complications, CD4+ lymphocyte count, hospital stay and case-fatality rate. Results Patient age (mean ± SD was 38.2 ± 8.9 years, 62% were men, and 84% were African American. The median APACHE II score was 14, and median CD4+ lymphocyte count was 60/μL. Pulmonary complications were Pneumocystis carinii pneumonia (85 in 78 patients, Mycobacterium avium complex (51 in 38, Mycobacterium tuberculosis (40 in 35, Mycobacterium gordonae (11 in 11, Mycobacterium kansasii (10 in 9, Cytomegalovirus (10 in 10, Nocardia asteroides (3 in 3, fungus ball (2 in 2, respiratory syncytial virus (1, herpes simplex virus (1, Histoplasma capsulatum (1, lymphoma (3 in 3, bronchogenic carcinoma (2 in 2, and Kaposi sarcoma (1. The case-fatality rate of patients was 11% with Pneumocystis carinii pneumonia; 5%, Mycobacterium tuberculosis; 6%, Mycobacterium avium complex; and 7%, noninfectious pulmonary complications. Conclusion Most pulmonary complications in hospitalized patients with HIV are from Pneumocystis and mycobacterial infection.

  20. AADNMR: A Simple Method for Rapid Identification of Bacterial/Mycobacterial Infections in Antibiotic Treated Peritoneal Dialysis Effluent Samples for Diagnosis of Infectious Peritonitis

    Guleria, Anupam; Rawat, Atul; Khetrapal, C L; Prasad, Narayan; Kumar, Dinesh


    An efficient method is reported for rapid identification of bacterial or mycobacterial infection in a suspected clinical/biological sample. The method is based on the fact that the ring methylene protons of cyclic fatty acids (constituting the cell membrane of several species of bacteria and mycobacteria) resonate specifically between -0.40 and 0.68 ppm region of the 1H NMR spectrum. These cyclic fatty acids are rarely found in the eukaryotic cell membranes. Therefore, the signals from cyclic ring moiety of these fatty acids can be used as markers (a) for the identification of bacterial and mycobacterial infections and (b) for differential diagnosis of bacterial and fungal infections. However, these microbial fatty acids when present inside the membrane are not easily detectable by NMR owing to their fast T2 relaxation. Nonetheless, the problem can easily be circumvented if these fatty acids become suspended in solution. This has been achieved by abolishing the membrane integrity using broad spectrum antibiot...

  1. Antimicrobial management of intra-abdominal infections:Literature's guidelines

    Massimo Sartelli; Fausto Catena; Federico Coccolini; Antonio Daniele Pinna


    Antimicrobial management of severe intra-abdominal infections (IAIs) involves a delicate balance of optimizing empirical therapy,which has been shown to improve clinical outcomes,while simultaneously reducing unnecessary antimicrobial use.Two sets of guidelines for the management of intra-abdominal infections were recently published.In 2010,the Surgical Infection Society and the Infectious Diseases Society of America (SIS-IDSA)created guidelines for the diagnosis and management of complicated IAIs.The new SIS-IDSA guidelines replace those previously published in 2002 and 2003.The World Society of Emergency Surgery (WSES) guidelines represent additional contributions,made by specialists worldwide,to the debate regarding proper antimicrobial drug methodology.These guidelines represent the conclusions of the consensus conference held in Bologna,Italy,in July 2010 during the first congress of the WSES.

  2. Monitoring of abdominal Staphylococcus aureus infection using magnetic resonance imaging

    Kromrey, M L; Göhler, A; Friedrich, N


    complying with biosafety level 2 requirements was constructed. After intravenous infection with 10(5) colony-forming units (CFU) (n = 3), 10(6) CFU (n = 11) or 10(7) CFU (n = 6) of S. aureus strain Newman, female Balb/c mice were whole-body scanned by 7T MRI. Abdominal infections such as abscesses were...... survival rate was 33 %. An intermediate S. aureus dose showed a survival rate of 80 %, whereas at the lowest infection dose, none of the animals died. All animals with the highest infection dose exhibited hepatic abscesses 4 days after inoculation, 80 % developed renal abscesses on the 3rd day. Mice...... obtaining the intermediate S. aureus load reached a plateau at day 4 with 72 % liver and 60 % renal abscess probability. No abscesses were observed in other abdominal organs at any time point. The implemented experimental setup provides a suitable and reliable in vivo MRI method to study murine abdominal...




    Full Text Available Purpose: A prospective study of incisional surgical site infection in abdominal surgeries was conducted to find out incidence, common predisposing factors and microbiological profile. METHODS: 375 patients who underwent abdominal surgeries were studied in a span of 1 year. They were divided into two groups – group 1 – 316 cases who did not develop Surgical Site Infection (SSI, the 2nd group – 59 cases that developed SSI. These patients were studied by interviewing and examination according to a set proforma. The results were statistically analyzed by comparing averages using Chi square chart for finding significance of difference where applicable. RESULT: The overall SSI incidence was 15.7 % (59/375. In elective surgeries, the SSI rate was 5.7% and in emergency surgeries, it was 28.6%. It was found that SSI increased with increasing age linearly. Other significant factors involved were increasing class of wound (dirty > clean wound class, increased preoperative stay, presence of remote site infection, increased duration of surgery and use of drains. E. coli was found to be the most common organism causing SSI in abdominal operations. CONCLUSION: SSI can be reduced by decreasing the preoperative hospital stay, appropriate antibiotic administration policies, preoperative control of remote site infections, adequate preoperative patient preparation, reducing the duration of surgery to minimum, judicious use of drains and intraoperative maintenance of asepsis and following operation theatre discipline properly.

  4. Mycobacterial infection in Northern snakehead (Channa argus) from the Potomac River catchment

    Densmore, Christine L.; Iwanowicz, L.R.; Henderson, A.P.; Iwanowicz, D.D.; Odenkirk, J.S.


    The Northern snakehead, Channa argus (Cantor), is a non-native predatory fish that has become established regionally in some temperate freshwater habitats within the United States. Over the past decade, Northern snakehead populations have developed within aquatic ecosystems throughout the eastern USA, including the Potomac River system within Virginia, Maryland and Washington, D.C. Since this species was initially observed in this region in 2002, the population has expanded considerably (Odenkirk & Owens 2007). In the Chesapeake Bay watershed, populations of Northern snakehead exist in the lower Potomac River and Rappahannock Rivers on the Western shore of the Bay, and these fish have also been found in middle or upper reaches of river systems on the Eastern shore of the Bay, including the Nanticoke and Wicomico Rivers among others. Over the past several years, many aspects of Northern snakehead life history in the Potomac River have been described, including range and dispersal patterns, microhabitat selection and diet (Lapointe, Thorson & Angermeier 2010; Saylor, Lapointe & Angermeier 2012; Lapointe, Odenkirk & Angermeier 2013). However, comparatively little is known about their health status including susceptibility to parasitism and disease and their capacity to serve as reservoirs of disease for native wildlife. Although considered hardy by fisheries biologists, snakehead fish have demonstrated susceptibility to a number of described piscine diseases within their native range and habitat in Asia. Reported pathogens of significance in snakehead species in Asia include snakehead rhabdovirus (Lio-Po et al. 2000), aeromonad bacteria (Zheng, Cao & Yang 2012), Nocardia (Wang et al. 2007) andMycobacterium spp. (Chinabut, Limsuwan & Chantatchakool 1990; ). Mycobacterial isolates recovered from another snakehead species (Channa striata) in the previous studies have included M. marinum and M. fortuitum, as identified through molecular

  5. Progressing features of atypical mycobacterial infection in the lung on conventional and high resolution CT (HRCT) images

    Tanaka, Daizo; Niwatsukino, Hiroshi; Nakajo, Masayuki [Kagoshima Univ. (Japan). Faculty of Medicine; Oyama, Takao


    The aim of this study was to clarify the localization of abnormalities within secondary pulmonary lobules and the changes in follow-up studies of pulmonary atypical mycobacterial infection (AMI) by conventional and high-resolution computed tomography (HRCT). Forty-six patients (16 men and 30 women; 43-84 years) with pulmonary AMI (M. intracellulare 36; M. avium 10) in the lung were examined by conventional and HRCT. In peripheral zones, all patients had the nodule located in the terminal or lobular bronchiole, and most of the patients also had nodules accompanied with a wedge-shaped or linear shadow connected with the pleura. In the follow-up scans, new centrilobular nodules appeared in other segments, and consolidation or ground-glass pattern appeared newly and was preceded by nodules. Bronchiectasis became more severe in five of 38 follow-up patients. The common HRCT findings of AMI were centrilobular, peribronchovascular nodules, bronchiectasis, consolidation, and pleural thickening/adhesion. The nodules frequently connected with the pleura. The initial and follow-up studies suggest that the disease may begin in the terminal bronchiole or as preexisting bronchiectasis and spread transbronchially along the draining bronchus or towards the pleura to produce lesions such as new nodules, cavities, consolidation, pleuritis, and bronchiectasis, or more severe bronchiectasis. (author)

  6. Impact of mycobacterial culture among HIV-infected adults with presumed TB in Uganda: a prospective cohort study.

    Semitala, FC; Chaisson, LH; den Boon, S.; Walter, N.; Cattamanchi, A.; Awor, M.; Katende,J.; Huang, L.; Joloba, M; Albert, H.; Kamya, MR; Davis, JL


    Implementation of new tuberculosis (TB) diagnostic strategies in resource-constrained settings is challenging. We measured the impact of solid and liquid mycobacterial cultures on treatment practices for patients undergoing TB evaluation in Kampala, Uganda.We enrolled consecutive smear-negative, human immunodeficiency virus positive adults with cough of ⩾2 weeks from September 2009 to April 2010. Laboratory technicians performed mycobacterial cultures on solid and liquid media. We compared em...

  7. A novel mycobacterial In Vitro infection assay identifies differences of induced macrophage apoptosis between CD4+ and CD8+ T cells

    Nkwouano, Vanesa; Witkowski, Sven; Rehberg, Nidja; Kalscheuer, Rainer; Nausch, Norman; Mayatepek, Ertan


    Macrophages are natural host cells for pathogenic mycobacteria, like Mycobacterium tuberculosis (M.tb). Immune surveillance by T cells and interaction with M.tb infected macrophages is crucial for protection against M.tb reactivation and development of active tuberculosis. Several factors play a role in the control of M.tb infection but reliable biomarkers remain elusive. One major obstacle is the absence of functional in vitro assays which allow concomitant determination of i) mycobacterial eradication; ii) cytotoxic effects on host macrophages; and iii) effector T-cell functions. We established a novel functional in vitro assay based on flow cytometry analysis of monocyte-derived macrophages (MDM) infected with a Mycobacterium bovis BCG strain containing a tetracycline inducible live/dead reporter plasmid (LD-BCG). MDM of healthy human donors were generated in vitro and infected with defined LD-BCG numbers. After short-term MDM/LD-BCG co-incubation with autologous effector T cells or in the presence of antibiotics, proportions of MDM containing live or dead LD-BCG were determined by flow cytometry. Concomitant measure of defined numbers of added beads allowed comparison of absolute MDM numbers between samples. Differential effects of T-cell subpopulations on anti-mycobacterial cytotoxicity and on MDM apoptosis were determined. Flow cytometry measure of MDM/LD-BCG treated with rifampicin correlated well with mycobacterial colony forming units and fluorescence microscopy results. Co-culture with pre-activated effector T cells reduced viability of both, LD-BCG and MDM, in a concentration-dependent manner. M.tb protein specific CD4+ and CD8+ T-cells contributed similarly to anti-mycobacterial cytotoxicity but CD4+ T cells induced higher levels of apoptosis in infected MDMs. This novel assay enables rapid quantification of anti-mycobacterial cytotoxicity and characterization of effector functions. Our functional in vitro assay has the potential to contribute to the

  8. Nontuberculous Mycobacterial Infections in a French Hospital: A 12-Year Retrospective Study

    Blanc, Peggy; Dutronc, Hervé; Peuchant, Olivia; Dauchy, Frédéric-Antoine; Cazanave, Charles; Neau, Didier; Wirth, Gaëtane; Pellegrin, Jean-Luc; Morlat, Philippe; Mercié, Patrick; Tunon-de-Lara, José-Manuel; Doutre, Marie-Sylvie; Pélissier, Philippe; Dupon, Michel


    Background Nontuberculous mycobacteria (NTM) are environmental organisms associated with a range of infections. Reports of NTM epidemiology are mainly focused on pulmonary infections and isolations, and extrapulmonary infections are less frequently described. Methods We conducted a retrospective study of NTM infections at the Bordeaux University Hospital, France, between January 2002 and December 2013. We used the microbiologic component of the American Thoracic Society/Infectious Diseases Society of America's pulmonary NTM disease criteria to define cases of pulmonary NTM, and patients with isolates from a normally sterile site were classified as having extrapulmonary disease. Results In our setting, 170 patients were included. Pulmonary cases predominated (54.1%), followed by skin and soft tissue infections (22.9%), disseminated cases (10.6%), lymphadenitis (7.7%), bone and joint infections (2.9%) and the remaining 1.8% catheter-related infections. Overall, 16 NTM species were isolated. Mycobacterium avium (31.8%) and M. intracellulare (20%) were the most common species identified, followed by M. marinum (13.5%), M. kansasii (10.6%), M. xenopi (9.4%), rapidly growing mycobacteria (9.4%) and other slowly growing mycobacteria (5.3%). In general, NTM isolates were largely prevalent in people older than 50 (62.4%); patients aged 1–10 year-old exclusively yielded M. avium from lymph nodes, almost cases having being diagnosed after 2007. Among the 121 patients with complete follow-up, 78 (64.5%), 24 (19.8%), and 19 (15.7%) were cured, experienced relapse, or died, respectively. Conclusion In our study, extrapulmonary NTM infections represented almost half of cases, consisting mainly in skin and soft tissue infections. The increase lymphadenitis cases in children after 2007 could be linked to the cessation of mandatory BCG vaccination in France. We observed similar cure rates (64%) between pulmonary and extrapulmonary infections. PMID:27959960

  9. Mycobacterial endocarditis: a comprehensive review

    Shi-Min, Yuan


    Objective A systematic analysis was made in view of the epidemiology, clinical features, diagnosis, treatment and main outcomes of mycobacterial endocarditis. Methods The data source of the present study was based on a comprehensive literature search in MEDLINE, Highwire Press and Google search engine for publications on mycobacterial endocarditis published between 2000 and 2013. Results The rapidly growing mycobacteria become the predominant pathogens with Mycobacterium chelonae being the most common. This condition has changed significantly in terms of epidemiology since the 21st century, with more broad patient age range, longer latency, prevailed mitral valve infections and better prognosis. Conclusion Mycobacterial endocarditis is rare and the causative pathogens are predominantly the rapidly growing mycobacteria. Amikacin, ciprofloxacin and clarithromycin are the most frequently used targeted antimicrobial agents but often show poor responses. Patients with deep infections may warrant a surgical operation or line withdrawal. With periodic multidrug therapy guided by drug susceptibility testing, and surgical managements, patients may achieve good therapeutic results. PMID:25859873

  10. Bystander activation of CD8+ T lymphocytes during experimental mycobacterial infection.

    Gilbertson, Brad; Germano, Susie; Steele, Pauline; Turner, Steven; Fazekas de St Groth, Barbara; Cheers, Christina


    Infection of C57BL/6 mice with Mycobacterium avium leads to the activation of both CD4+ and CD8+ gamma interferon (IFN-gamma)-producing T cells, although the CD8+ cells play no role in protection against infection. Using transfer of different lines of transgenic T cells with T-cell receptors (TCRs) which recognize irrelevant antigens, we show here that transferred CD8+ T cells from two of the three lines were activated to the same degree as the host cells, suggesting that the majority of the IFN-gamma-producing CD8+ T cells of the host represented bystander activation. The third line, specific for the male HY antigen, showed no activation. Activation required the participation of the CD28 coreceptor on T cells and was unaffected by the removal of CD44(hi) (memory phenotype) T cells. The transferred CD8+ T cells proliferated in vivo, although this was not essential for IFN-gamma production. Taken together, these data are highly reminiscent of homeostatic proliferation of TCR transgenic T cells upon transfer to lymphopenic hosts, and suggest low-affinity stimulation through the TCR, possibly by self peptides. The findings are discussed in relation to homeostatic proliferation and their significance in the possible induction of autoimmune disease.

  11. Factors associated with pastoral community knowledge and occurrence of mycobacterial infections in Human-Animal Interface areas of Nakasongola and Mubende districts, Uganda

    Biffa Demelash


    Full Text Available Abstract Background Nontuberculous mycobacteria (NTM are emerging opportunistic pathogens whose role in human and animal disease is increasingly being recognized. Major concerns are their role as opportunistic pathogens in HIV/AIDS infections. The role of open natural water sources as source and livestock/wildlife as reservoirs of infections to man are well documented. This presents a health challenge to the pastoral systems in Africa that rely mostly on open natural water sources to meet livestock and human needs. Recent study in the pastoral areas of Uganda showed infections with same genotypes of NTM in pastoralists and their livestock. The aim of this study was to determine the environmental, animal husbandry and socio-demographic factors associated with occurrence and the pastoral community knowledge of mycobacterial infections at the human-environment-livestock/wildlife interface (HELI areas in pastoral ecosystems of Uganda. Methods Two hundred and fifty three (253 individuals were subjected to a questionnaire survey across the study districts of Nakasongola and Mubende. Data were analyzed using descriptive statistics and multivariable logistic regression analysis. Results Humans sharing of the water sources with wild animals from the forest compared to savannah ecosystem (OR = 3.3, the tribe of herding pastoral community (OR = 7.9, number of rooms present in household (3-5 vs. 1-2 rooms (OR = 3.3 were the socio-demographic factors that influenced the level of knowledge on mycobacterial infections among the pastoral communities. Tribe (OR = 6.4, use of spring vs. stream water for domestic use (OR = 4.5, presence of sediments in household water receptacle (OR = 2.32, non separation of water containers for drinking and domestic use (OR = 2.46, sharing of drinking water sources with wild animals (OR = 2.1, duration of involvement of >5 yrs in cattle keeping (OR = 3.7 and distance of household to animal night shelters (>20 meters (OR = 3

  12. Impact of mycobacterial culture among HIV-infected adults with presumed TB in Uganda: a prospective cohort study.

    Semitala, F C; Chaisson, L H; den Boon, S; Walter, N; Cattamanchi, A; Awor, M; Katende, J; Huang, L; Joloba, M; Albert, H; Kamya, M R; Davis, J L


    Implementation of new tuberculosis (TB) diagnostic strategies in resource-constrained settings is challenging. We measured the impact of solid and liquid mycobacterial cultures on treatment practices for patients undergoing TB evaluation in Kampala, Uganda. We enrolled consecutive smear-negative, human immunodeficiency virus positive adults with cough of ⩾2 weeks from September 2009 to April 2010. Laboratory technicians performed mycobacterial cultures on solid and liquid media. We compared empiric treatment decisions with solid and liquid culture in terms of diagnostic yield and time to results, and assessed impact on patient management. Of 200 patients enrolled, 26 (13%) had culture-confirmed TB: 22 (85%) on solid culture alone, 2 (8%) on liquid culture alone, and 2 (8%) on both solid and liquid culture. Thirty-four patients received empiric anti-tuberculosis treatment, but only 10 (29%) were culture-positive. Median time to a positive result on solid culture was 92 days (interquartile range [IQR] 69-148) compared to 106 days (IQR 66-157) for liquid culture. No patients initiated treatment following a positive result on liquid culture. The introduction of mycobacterial culture did not influence care for patients undergoing evaluation for TB in Kampala, Uganda. Attention to contextual factors surrounding implementation is needed to ensure the effective introduction of new testing strategies in low-income countries.

  13. Abdominal infections in the intensive care unit: characteristics, treatment and determinants of outcome

    Waele, J. De; Lipman, J.; Sakr, Y.; Marshall, J.C.; Vanhems, P.; Barrera Groba, C.; Leone, M.; Vincent, J.L.; Pickkers, P.


    BACKGROUND: Abdominal infections are frequent causes of sepsis and septic shock in the intensive care unit (ICU) and are associated with adverse outcomes. We analyzed the characteristics, treatments and outcome of ICU patients with abdominal infections using data extracted from a one-day point preva

  14. Incidence of active mycobacterial infections in Brazilian patients with chronic inflammatory arthritis and negative evaluation for latent tuberculosis infection at baseline - A longitudinal analysis after using TNFα blockers

    Gomes, Carina Mori Frade; Terreri, Maria Teresa; de Moraes-Pinto, Maria Isabel; Barbosa, Cássia; Machado, Natália Pereira; Melo, Maria Roberta; Pinheiro, Marcelo Medeiros


    Several studies point to the increased risk of reactivation of latent tuberculosis infection (LTBI) in patients with chronic inflammatory arthritis (CIAs) after using tumour necrosis factor (TNF)α blockers. To study the incidence of active mycobacterial infections (aMI) in patients starting TNF α blockers, 262 patients were included in this study: 109 with rheumatoid arthritis (RA), 93 with ankylosing spondylitis (AS), 44 with juvenile idiopathic arthritis (JIA) and 16 with psoriatic arthritis (PsA). All patients had indication for anti-TNF α therapy. Epidemiologic and clinical data were evaluated and a simple X-ray and tuberculin skin test (TST) were performed. The control group included 215 healthy individuals. The follow-up was 48 months to identify cases of aMI. TST positivity was higher in patients with AS (37.6%) than in RA (12.8%), PsA (18.8%) and JIA (6.8%) (p < 0.001). In the control group, TST positivity was 32.7%. Nine (3.43%) patients were diagnosed with aMI. The overall incidence rate of aMI was 86.93/100,000 person-years [95% confidence interval (CI) 23.6-217.9] for patients and 35.79/100,000 person-years (95% CI 12.4-69.6) for control group (p < 0.001). All patients who developed aMI had no evidence of LTBI at the baseline evaluation. Patients with CIA starting TNF α blockers and no evidence of LTBI at baseline, particularly with nonreactive TST, may have higher risk of aMI. PMID:26560983

  15. A Subgroup of Latently Mycobacterium tuberculosis Infected Individuals Is Characterized by Consistently Elevated IgA Responses to Several Mycobacterial Antigens

    Ralf Baumann


    Full Text Available Elevated antibody responses to Mycobacterium tuberculosis antigens in individuals with latent infection (LTBI have previously been linked to an increased risk for progression to active disease. Studies in the field focussed mainly on IgG antibodies. In the present study, IgA and/or IgG responses to the mycobacterial protein antigens AlaDH, NarL, 19 kDa, PstS3, and MPT83 were determined in a blinded fashion in sera from 53 LTBI controls, 14 healthy controls, and 42 active TB subjects. Among controls, we found that elevated IgA levels against all investigated antigens were not randomly distributed but concentrated on a subgroup of <30%—with particular high levels in a small subgroup of ~5% comprising one progressor to active TB. Based on a specificity of 100%, anti-NarL IgA antibodies achieved with 78.6% sensitivity the highest accuracy for the detection of active TB compared to healthy controls. In conclusion, the consistently elevated IgA levels in a subgroup of controls suggest higher mycobacterial load, a risk factor for progression to active TB, and together with high IgG levels may have prognostic potential and should be investigated in future large scale studies. The novel antigen NarL may also be promising for the antibody-based diagnosis of active TB cases.

  16. Tuberculous abdominal abscess in an HIV-infected man: Neither infection previously diagnosed

    Kuo-Yao Kao


    Full Text Available A 38-year-old man had a 1-week history of right lower quadrant abdominal pain; the initial impression was that he had diverticulitis of the ascending colon with an intra-abdominal abscess. Signs of peritonitis mandated an immediate right hemicolectomy. The unusual location of the abscess and the patient’s unusual postoperative course suggested that he might also have a systemic disease. Testing for HIV infection was positive. After 2 weeks in hospital, he was treated as an outpatient for both tuberculosis and HIV with a favourable outcome. In Taiwan a pre-operative HIV test is not performed routinely, and the HIV seroprevalence in surgical patient populations is unknown. Surgeons should keep the possibility of HIV infection in mind in a patient with an unusual clinical course.

  17. 77 FR 59928 - Draft Guidance for Industry on Complicated Intra-Abdominal Infections: Developing Drugs for...


    ... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry on Complicated Intra-Abdominal... guidance for industry entitled ``Complicated Intra-Abdominal Infections: Developing Drugs for Treatment.'' The purpose of this guidance is to assist sponsors in the clinical development of drugs for...

  18. Growth of mycobacteria in urine determined by isothermal microcalorimetry: implications for urogenital tuberculosis and other mycobacterial infections.

    Bonkat, Gernot; Bachmann, Alexander; Solokhina, Anna; Widmer, Andreas F; Frei, Reno; Gasser, Thomas C; Braissant, Olivier


    To overcome the limitations of current urine-based diagnostic assays of urogenital tuberculosis, we used isothermal microcalorimetry to detect the metabolic activity of Mycobacterium tuberculosis and other commonly neglected pathogenic mycobacteria in urine and accurately determine their growth parameters. A microcalorimeter equipped with 48 channels was used. Detection was accomplished, and growth was monitored for 4 different Mycobacterium species in sterilized and modified urine at 37 °C by measuring metabolic heat flow (μW = μJ/s) as a function of time. These strains were M. smegmatis, M. phlei, M. kansasii, and M. tuberculosis. The data were integrated to perform curve fitting and extract the growth parameter from the raw data. In sterilized urine, M. smegmatis showed the fastest growth rate (0.089 ± 0.017 [h(-1)]), followed by M. phlei (0.072 ± 0.016 [h(-1)]) and M. kansasii (0.007 ± 0.001 [h(-1)]). No growth of M. tuberculosis was detected in sterilized urine. However, in serum-supplemented urine, growth of M. tuberculosis was observed within 3 weeks at a growth rate of 0.008 ± 0.001 [h(-1)]. Biofilm formation was enhanced in the serum supplemented urine. Isothermal microcalorimetry allows rapid and accurate detection of mycobacterial growth in urine. Given the absence of data on the mycobacterial growth in urine, isothermal microcalorimetry could be used to unravel key aspects of Mycobacterium physiology in the urinary tract and potentially contribute to improvement in the diagnosis and treatment of urogenital tuberculosis. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. T Cell Reactivity against Mycolyl Transferase Antigen 85 of M. tuberculosis in HIV-TB Coinfected Subjects and in AIDS Patients Suffering from Tuberculosis and Nontuberculous Mycobacterial Infections

    Pascal Launois


    Full Text Available The mycolyl transferase antigen 85 complex is a major secreted protein family from mycobacterial culture filtrate, demonstrating powerful T cell stimulatory properties in most HIV-negative, tuberculin-positive volunteers with latent M.tuberculosis infection and only weak responses in HIV-negative tuberculosis patients. Here, we have analyzed T cell reactivity against PPD and Ag85 in HIV-infected individuals, without or with clinical symptoms of tuberculosis, and in AIDS patients with disease caused by nontuberculous mycobacteria. Whereas responses to PPD were not significantly different in HIV-negative and HIV-positive tuberculin-positive volunteers, responses to Ag85 were significantly decreased in the HIV-positive (CDC-A and CDC-B group. Tuberculosis patients demonstrated low T cell reactivity against Ag85, irrespective of HIV infection, and finally AIDS patients suffering from NTM infections were completely nonreactive to Ag85. A one-year follow-up of twelve HIV-positive tuberculin-positive individuals indicated a decreased reactivity against Ag85 in patients developing clinical tuberculosis, highlighting the protective potential of this antigen.

  20. Efficacy of tigecycline versus ceftriaxone plus metronidazole for the treatment of complicated intra-abdominal infections

    Qvist, Niels; Warren, Brian; Leister-Tebbe, Heidi;


    This randomized, open-label, multi-center trial compared tigecycline (TGC), a broad-spectrum glycylcycline, with ceftriaxone-metronidazole (CTX/MET) for the treatment of complicated intra-abdominal infections (cIAI)....

  1. tuberculous abdominal abscess in an hiv-infected man: neither ...


    Sep 1, 2010 ... of the two diseases surgery can be successful, recovery ..... Laboratory Service, Tshwane Academic Division .... in abdominal TB range from insidious nonspecific complaints that may be mistaken for the constitutional ...

  2. The ubiquitin ligase TRIM27 functions as a host restriction factor antagonized by Mycobacterium tuberculosis PtpA during mycobacterial infection

    Wang, Jing; Teng, Jade L. L.; Zhao, Dongdong; Ge, Pupu; Li, Bingxi; Woo, Patrick C. Y.; Liu, Cui Hua


    Macrophage-mediated innate immune responses play crucial roles in host defense against pathogens. Recent years have seen an explosion of host proteins that act as restriction factors blocking viral replication in infected cells. However, the essential factors restricting Mycobacterium tuberculosis (Mtb) and their regulatory roles during mycobacterial infection remain largely unknown. We previously reported that Mtb tyrosine phosphatase PtpA, a secreted effector protein required for intracellular survival of Mtb, inhibits innate immunity by co-opting the host ubiquitin system. Here, we identified a new PtpA-interacting host protein TRIM27, which is reported to possess a conserved RING domain and usually acts as an E3 ubiquitin ligase that interferes with various cellular processes. We further demonstrated that TRIM27 restricts survival of mycobacteria in macrophages by promoting innate immune responses and cell apoptosis. Interestingly, Mtb PtpA could antagonize TRIM27-promoted JNK/p38 MAPK pathway activation and cell apoptosis through competitively binding to the RING domain of TRIM27. TRIM27 probably works as a potential restriction factor for Mtb and its function is counteracted by Mtb effector proteins such as PtpA. Our study suggests a potential tuberculosis treatment via targeting of the TRIM27-PtpA interfaces. PMID:27698396

  3. Helicobacter pylori infection, serum pepsinogens, and pediatric abdominal pain: a pilot study.

    Kassem, Eias; Naamna, Medhat; Mawassy, Kadri; Beer-Davidson, Gany; Muhsen, Khitam


    The significance of Helicobacter pylori (H. pylori) infection in pediatric abdominal pain remains poorly recognized. We examined associations of H. pylori infection and serum pepsinogens (PGs), as non-invasive markers of gastritis, with pediatric abdominal pain. A case-control study was conducted among 99 children aged 5-17 years admitted to one hospital for abdominal pain (cases) without an apparent organic reason. Using enzyme-linked immunosorbent assays, sera were tested and compared with 179 controls for anti-H. pylori immunoglobulin G (IgG) antibodies and PGI and PGII levels. Multivariable analysis was performed to adjust for potential confounders. H. pylori IgG sero-positivity was 34.3 and 36.3% in cases and controls, respectively, P = 0.7. H. pylori-infected children had higher median PGI and PGII levels and a lower PGI/PGII ratio than uninfected children. Cases infected with H. pylori had a higher median PGII level (P pylori. The percentage of cases with PGII ≥7.5 μg/L, as indication for antral inflammation, was higher than in controls: 58.6 versus 44.7%, P = 0.027. Children with PGII levels ≥7.5 μg/L had increased risk for abdominal pain: adjusted prevalence ratio 1.73 [95% confidence intervals 1.02, 2.93], P = 0.039. Children with increased serum PGII levels, as an indication of gastritis, are more likely to have abdominal pain. Serum PGs can be a useful non-invasive marker for gastritis, in evaluating children with severe abdominal pain with no apparent organic reason. What is Known: • The significance of Helicobacter pylori infection in pediatric abdominal pain remains debated. • Serum pepsinogens (PGs), non-invasive markers of gastric inflammation, were rarely utilized in assessing the association between H. pylori in pediatric abdominal pain of unknown origin. What is New: • High serum PGII level, as an indication of gastritis, rather than H. pylori infection itself, was associated with increased risk for abdominal pain.

  4. Nitric oxide inhibits the accumulation of CD4+CD44hiTbet+CD69lo T cells in mycobacterial infection

    Pearl, John E.; Torrado, Egidio; Tighe, Michael; Fountain, Jeffrey J.; Solache, Alejandra; Strutt, Tara; Swain, Susan; Appelberg, Rui; Cooper, Andrea M


    Summary Animals lacking the inducible nitric oxide synthase gene (nos2−/−) are less susceptible to M. avium strain 25291 and lack nitric oxide-mediated immunomodulation of CD4+ T cells. Here we show that the absence of nos2 results in increased accumulation of neutrophils and both CD4+ and CD8+ T cells within the M. avium-containing granuloma. Examination of the T-cell phenotype in M. avium-infected mice demonstrated that CD4+CD44hi effector T cells expressing the Th1 transcriptional regulator T-bet (T-bet+) were specifically reduced by the presence of nitric oxide. Importantly, the T-bet+ effector population could be separated into CD69hi and CD69lo populations, with the CD69lo population only able to accumulate during chronic infection within infected nos2−/− mice. Transcriptomic comparison between CD4+CD44hiCD69hi and CD4+CD44hiCD69lo populations revealed that CD4+CD44hiCD69lo cells had higher expression of the integrin itgb1/itga4 (VLA-4, CD49d/CD29). Inhibition of Nos2 activity allowed increased accumulation of the CD4+CD44hiT-bet+CD69lo population in WT mice as well as increased expression of VLA-4. These data support the hypothesis that effector T cells in mycobacterial granulomata are not a uniform effector population but exist in distinct subsets with differential susceptibility to the regulatory effects of nitric oxide. PMID:22890814

  5. Multistate US Outbreak of Rapidly Growing Mycobacterial Infections Associated with Medical Tourism to the Dominican Republic, 2013-2014(1).

    Schnabel, David; Esposito, Douglas H; Gaines, Joanna; Ridpath, Alison; Barry, M Anita; Feldman, Katherine A; Mullins, Jocelyn; Burns, Rachel; Ahmad, Nina; Nyangoma, Edith N; Nguyen, Duc B; Perz, Joseph F; Moulton-Meissner, Heather A; Jensen, Bette J; Lin, Ying; Posivak-Khouly, Leah; Jani, Nisha; Morgan, Oliver W; Brunette, Gary W; Pritchard, P Scott; Greenbaum, Adena H; Rhee, Susan M; Blythe, David; Sotir, Mark


    During 2013, the Maryland Department of Health and Mental Hygiene in Baltimore, MD, USA, received report of 2 Maryland residents whose surgical sites were infected with rapidly growing mycobacteria after cosmetic procedures at a clinic (clinic A) in the Dominican Republic. A multistate investigation was initiated; a probable case was defined as a surgical site infection unresponsive to therapy in a patient who had undergone cosmetic surgery in the Dominican Republic. We identified 21 case-patients in 6 states who had surgery in 1 of 5 Dominican Republic clinics; 13 (62%) had surgery at clinic A. Isolates from 12 (92%) of those patients were culture-positive for Mycobacterium abscessus complex. Of 9 clinic A case-patients with available data, all required therapeutic surgical intervention, 8 (92%) were hospitalized, and 7 (78%) required ≥3 months of antibacterial drug therapy. Healthcare providers should consider infection with rapidly growing mycobacteria in patients who have surgical site infections unresponsive to standard treatment.

  6. Deoxyfluoro-D-trehalose (FDTre) analogues as potential PET probes for imaging mycobacterial infection: rapid synthesis and purification, conformational analysis, and uptake by mycobacteria

    Rundell, Sarah R.; Wagar, Zachary L.; Meints, Lisa M.; Olson, Claire D.; O’Neill, Mara K.; Piligian, Brent F.; Poston, Anne W.; Hood, Robin J.; Woodruff, Peter J.


    Mycobacterium tuberculosis, the etiological agent of human tuberculosis, requires the non-mammalian disaccharide trehalose for growth and virulence. Recently, detectable trehalose analogues have gained attention as probes for studying trehalose metabolism and as potential diagnostic imaging agents for mycobacterial infections. Of particular interest are deoxy-[18F]fluoro-D-trehalose (18F-FDTre) analogues, which have been suggested as possible positron emission tomography (PET) probes for in vivo imaging of M. tuberculosis infection. Here, we report progress toward this objective, including the synthesis and conformational analysis of four non-radioactive deoxy-[19F]fluoro-D-trehalose (19F-FDTre) analogues, as well as evaluation of their uptake by M. smegmatis. The rapid synthesis and purification of several 19F-FDTre analogues was accomplished in high yield using a one-step chemoenzymatic method. Conformational analysis of the 19F-FDTre analogues using NMR and molecular modeling methods showed that fluorine substitution had a negligible effect on the conformation of the native disaccharide, suggesting that fluorinated analogues may be successfully recognized and processed by trehalose metabolic machinery in mycobacteria. To test this hypothesis and to evaluate a possible route for delivery of FDTre probes specifically to mycobacteria, we showed that 19F-FDTre analogues are actively imported into M. smegmatis via the trehalose-specific transporter SugABC-LpqY. Finally, to demonstrate the applicability of these results to the efficient preparation and use of short-lived 18F-FDTre PET radiotracers, we carried out 19F-FDTre synthesis, purification, and administration to M. smegmatis in 1 hour. PMID:27560008

  7. Lower respiratory tract infection and rapid expansion of an abdominal aortic aneurysm: a case report

    Puppala Sapna


    Full Text Available Abstract Introduction The rate of abdominal aortic aneurysm expansion is related to multiple factors. There is some evidence that inflammation can accelerate aneurysm expansion. However, the association between pulmonary sepsis and rapid abdominal aortic aneurysm expansion is rarely reported. Case presentation Here we present a case of a rapidly expanding abdominal aortic aneurysm in a 68-year-old Caucasian man with a concomitant lower respiratory tract infection and systemic sepsis requiring intensive monitoring and urgent endovascular intervention. Our patient had an uncomplicated post-operative recovery and a follow-up computed tomography scan at one month demonstrated no evidence of an endoleak. Conclusion This case highlights the potential association between pulmonary sepsis and rapid abdominal aortic aneurysm expansion. In such cases, a policy of frequent monitoring should be adopted to identify those patients requiring definitive management.

  8. Postoperative infection of an abdominal mesh due to methicillin resistant Staphylococcus Aureus - A case report

    Ashok R


    Full Text Available Methicillin resistant Stephylococcus aureus (MRSA infection has now become a major problem in hospitals. We present a case of postoperative infection MRSA where the primary source of the infection was found to be an abdominal mesh that was used to reinforce the abdominal wall. After one year of surgery, the patient developed wound dehiscence and discharge. MRSA was isolated from the wound, mesh, external nares, throat and axilla. Initially she was started on clindamycin and discharged from the hospital. After 5 months, patient came back to the hospital with infection at the same site. The patient was then treated with vancomycin and MRSA clearance. She responded to the treatment with complete healing of the wound and clearance of MRSA.

  9. Treatment of complicated intra-abdominal infections in the era of multi-drug resistant Bacteria

    Herzog T


    Full Text Available Abstract The management of severe intra-abdominal infections remains a major challenge facing surgeons and intensive care physicians, because of its association with high morbidity and mortality. Surgical management and intensive care medicine have constantly improved, but in the recent years a rapidly continuing emergence of resistant pathogens led to treatment failure secondary to infections with multi-drug resistant bacteria. In secondary peritonitis the rate of resistant germs at the initial operation is already 30%. The lack of effective antibiotics against these pathogens resulted in the development of new broad-spectrum compounds and antibiotics directed against resistant germs. But so far no "super-drug" with efficacy against all resistant bacteria exists. Even more, soon after their approval, reports on resistance against these novel drugs have been reported, or the drugs were withdrawn from the market due to severe side effects. Since pharmaceutical companies reduced their investigations on antibiotic research, only few new antimicrobial derivates are available. In abdominal surgery you may be in fear that in the future more and more patients with tertiary peritonitis secondary to multi-drug resistant species are seen with an increase of mortality after secondary peritonitis. This article reviews the current treatment modalities for complicated intra-abdominal infections with special reference to the antibiotic treatment of complicated intra-abdominal infections with multi-drug resistant species.

  10. A standardised and reproducible model of intra-abdominal infection and abscess formation in rats

    Bosscha, K; Nieuwenhuijs, VB; Gooszen, AW; van Duijvenbode-Beumer, H; Visser, MR; Verweij, Willem; Akkermans, LMA


    Objective: To develop a standardised and reproducible model of intra-abdominal infection and abscess formation in rats. Design: Experimental study. Setting: University hospital, The Netherlands. Subjects: 36 adult male Wistar rats. Interventions: In 32 rats, peritonitis was produced using two differ

  11. Mycotic Abdominal Aortic Aneurysm Secondary to Septic Embolism of a Thoracic Aorta Graft Infection.

    Blanco Amil, Carla Lorena; Vidal Rey, Jorge; López Arquillo, Irene; Pérez Rodríguez, María Teresa; Encisa de Sá, José Manuel


    Mycotic aneurysms account for 1% of abdominal aortic aneurysms. There are very few cases published that describe the formation of mycotic aneurysms after septic embolism due to graft infection. We present the first case to our knowledge to be described in the literature of a mycotic aneurysm caused by septic embolism derived from a thoracic aorta graft infection, treated with conventional surgery leading to a successful outcome and evolution.

  12. Complicated intra-abdominal infection caused by extended drug-resistant Achromobacter xylosoxidans.

    Teng, Sing-On; Ou, Tsong-Yih; Hsieh, Yu-Chia; Lee, Wuan-Chan; Lin, Yi-Chun; Lee, Wen-Sen


    Achromobacter xylosoxidans (formerly Alcaligenes xylosoxidans) is a rare but important nosocomial pathogen. Antibiotic resistance has been increasing during the past decade. A. xylosoxidans may be confused with Pseudomonas spp. but, unlike Pseudomonas spp., this organism has peritrichous flagella. Complicated intra-abdominal infection with A. xylosoxidans has rarely been reported in the literature. This report is of an immunocompetent patient with acute cholecystitis complicated by an intra-abdominal abscess after surgery. Culture of both blood and ascites yielded extended drug-resistant A. xylosoxidans, which was only sensitive to colistin. The clinical and laboratory characteristics of A. xylosoxidans are presented.

  13. Potential biomarkers for identification of mycobacterial cultures by proton transfer reaction mass spectrometry analysis

    Crespo, E.; de Ronde, H.; Kuijper, S.; Pol, A.; Kolk, A.H.J.; Cristescu, S. M.; Anthony, R.M.; Harren, F. J. M.


    RATIONALE Several mycobacterial species can produce serious infections in humans, and the treatment required depends on the infecting species. Fast identification, ideally with minimal manipulation of the infecting species, is therefore critical; here, we propose a method potentially allowing cultur

  14. Laparoscopic management of intra-abdominal infections:Systematic review of the literature

    Federico; Coccolini; Cristian; Tranà; Massimo; Sartelli; Fausto; Catena; Salomone; Di; Saverio; Roberto; Manfredi; Giulia; Montori; Marco; Ceresoli; Chiara; Falcone; Luca; Ansaloni


    AIM: To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections.METHODS: A systematic review of the literature was performed including studies where intra abdominal infections were treated laparoscopically.RESULTS: Early laparoscopic approaches have become the standard surgical technique for treating acute cholecystitis. The laparoscopic appendectomy has been demonstrated to be superior to open surgery in acute appendicitis. In the event of diverticulitis, laparoscopic resections have proven to be safe and effective procedures for experienced laparoscopic surgeons and may be performed without adversely affecting morbidity and mortality rates. However laparoscopic resection has not been accepted by the medical community as the primary treatment of choice. In high-risk patients, laparoscopic approach may be used for exploration or peritoneal lavage and drainage. The successful laparoscopic repair of perforated peptic ulcers for experienced surgeons, is demonstrated to be safe and effective. Regarding small bowel perforations, comparative studies contrasting open and laparoscopic surgeries have not yet been conducted. Successful laparoscopic resections addressing iatrogenic colonic perforation have been reported despite a lack of literature-based evidence supporting such procedures. In post-operative infections, laparoscopic approaches may be useful in preventing diagnostic delay and controllingthe source.CONCLUSION: Laparoscopy has a good diagnostic accuracy and enables to better identify the causative pathology; laparoscopy may be recommended for the treatment of many intra-abdominal infections.

  15. Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA).

    Sartelli, Massimo; Weber, Dieter G; Ruppé, Etienne; Bassetti, Matteo; Wright, Brian J; Ansaloni, Luca; Catena, Fausto; Coccolini, Federico; Abu-Zidan, Fikri M; Coimbra, Raul; Moore, Ernest E; Moore, Frederick A; Maier, Ronald V; De Waele, Jan J; Kirkpatrick, Andrew W; Griffiths, Ewen A; Eckmann, Christian; Brink, Adrian J; Mazuski, John E; May, Addison K; Sawyer, Rob G; Mertz, Dominik; Montravers, Philippe; Kumar, Anand; Roberts, Jason A; Vincent, Jean-Louis; Watkins, Richard R; Lowman, Warren; Spellberg, Brad; Abbott, Iain J; Adesunkanmi, Abdulrashid Kayode; Al-Dahir, Sara; Al-Hasan, Majdi N; Agresta, Ferdinando; Althani, Asma A; Ansari, Shamshul; Ansumana, Rashid; Augustin, Goran; Bala, Miklosh; Balogh, Zsolt J; Baraket, Oussama; Bhangu, Aneel; Beltrán, Marcelo A; Bernhard, Michael; Biffl, Walter L; Boermeester, Marja A; Brecher, Stephen M; Cherry-Bukowiec, Jill R; Buyne, Otmar R; Cainzos, Miguel A; Cairns, Kelly A; Camacho-Ortiz, Adrian; Chandy, Sujith J; Che Jusoh, Asri; Chichom-Mefire, Alain; Colijn, Caroline; Corcione, Francesco; Cui, Yunfeng; Curcio, Daniel; Delibegovic, Samir; Demetrashvili, Zaza; De Simone, Belinda; Dhingra, Sameer; Diaz, José J; Di Carlo, Isidoro; Dillip, Angel; Di Saverio, Salomone; Doyle, Michael P; Dorj, Gereltuya; Dogjani, Agron; Dupont, Hervé; Eachempati, Soumitra R; Enani, Mushira Abdulaziz; Egiev, Valery N; Elmangory, Mutasim M; Ferrada, Paula; Fitchett, Joseph R; Fraga, Gustavo P; Guessennd, Nathalie; Giamarellou, Helen; Ghnnam, Wagih; Gkiokas, George; Goldberg, Staphanie R; Gomes, Carlos Augusto; Gomi, Harumi; Guzmán-Blanco, Manuel; Haque, Mainul; Hansen, Sonja; Hecker, Andreas; Heizmann, Wolfgang R; Herzog, Torsten; Hodonou, Adrien Montcho; Hong, Suk-Kyung; Kafka-Ritsch, Reinhold; Kaplan, Lewis J; Kapoor, Garima; Karamarkovic, Aleksandar; Kees, Martin G; Kenig, Jakub; Kiguba, Ronald; Kim, Peter K; Kluger, Yoram; Khokha, Vladimir; Koike, Kaoru; Kok, Kenneth Y Y; Kong, Victory; Knox, Matthew C; Inaba, Kenji; Isik, Arda; Iskandar, Katia; Ivatury, Rao R; Labbate, Maurizio; Labricciosa, Francesco M; Laterre, Pierre-François; Latifi, Rifat; Lee, Jae Gil; Lee, Young Ran; Leone, Marc; Leppaniemi, Ari; Li, Yousheng; Liang, Stephen Y; Loho, Tonny; Maegele, Marc; Malama, Sydney; Marei, Hany E; Martin-Loeches, Ignacio; Marwah, Sanjay; Massele, Amos; McFarlane, Michael; Melo, Renato Bessa; Negoi, Ionut; Nicolau, David P; Nord, Carl Erik; Ofori-Asenso, Richard; Omari, AbdelKarim H; Ordonez, Carlos A; Ouadii, Mouaqit; Pereira Júnior, Gerson Alves; Piazza, Diego; Pupelis, Guntars; Rawson, Timothy Miles; Rems, Miran; Rizoli, Sandro; Rocha, Claudio; Sakakhushev, Boris; Sanchez-Garcia, Miguel; Sato, Norio; Segovia Lohse, Helmut A; Sganga, Gabriele; Siribumrungwong, Boonying; Shelat, Vishal G; Soreide, Kjetil; Soto, Rodolfo; Talving, Peep; Tilsed, Jonathan V; Timsit, Jean-Francois; Trueba, Gabriel; Trung, Ngo Tat; Ulrych, Jan; van Goor, Harry; Vereczkei, Andras; Vohra, Ravinder S; Wani, Imtiaz; Uhl, Waldemar; Xiao, Yonghong; Yuan, Kuo-Ching; Zachariah, Sanoop K; Zahar, Jean-Ralph; Zakrison, Tanya L; Corcione, Antonio; Melotti, Rita M; Viscoli, Claudio; Viale, Perluigi


    Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.

  16. Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study

    Sartelli Massimo


    Full Text Available Abstract The CIAO Study (“Complicated Intra-Abdominal infection Observational” Study is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012. Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs were included in the study. 2,152 patients with a mean age of 53.8 years (range: 4–98 years were enrolled in the study. 46.3% of the patients were women and 53.7% were men. Intraperitoneal specimens were collected from 62.2% of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified. The overall mortality rate was 7.5% (163/2.152. According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular perforation, complicated diverticulitis, small bowel perforation, a delayed initial intervention (a delay exceeding 24 hours, sepsis and septic shock in the immediate post-operative period, and ICU admission. Given the sweeping geographical distribution of the participating medical centers, the CIAO Study gives an accurate description of the epidemiological, clinical, microbiological, and treatment profiles of complicated intra-abdominal infections (IAIs throughout Europe.

  17. Obesity and the Risk for Surgical Site Infection in Abdominal Surgery.

    Winfield, Robert D; Reese, Stacey; Bochicchio, Kelly; Mazuski, John E; Bochicchio, Grant V


    Obesity is a risk factor for surgical site infection (SSI) after abdominal procedures; however, data characterizing the risk of SSI in obese patients during abdominal procedures are lacking. We hypothesized that obesity is an independent risk factor for SSI across wound classes. We analyzed American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data for 2011. We calculated body mass index (BMI), classifying patients according to National Institute of Health (NIH) BMI groups. We excluded records in which height/weight was not recorded and patients with BMI less than 18.5. We examined patients undergoing open abdominal procedures, performing univariate and multivariate analyses to assess the relative contribution of obesity to SSI. Study criteria were met by 89,148 patients. Obese and morbidly obese patients had significantly greater SSI rates in clean and clean-contaminated cases but not contaminated or dirty/infected cases. Logistic regression confirmed obesity and morbid obesity as being independently associated with the overall SSI development, specifically in clean [Obesity odds ratio (OR) = 1.757, morbid obesity OR = 2.544, P obesity OR = 1.239, morbid obesity OR = 1.287, P Obesity is associated with increased risk of SSI overall, specifically in clean and clean-contaminated abdominal procedures; this is independent of diabetes mellitus. Novel techniques are needed to reduce SSI in this high-risk patient population.

  18. Complicated acute appendicitis presenting as a rapidly progressive soft tissue infection of the abdominal wall: a case report.

    Beerle, Corinne; Gelpke, Hans; Breitenstein, Stefan; Staerkle, Ralph F


    We report a case of a rare complication of acute appendicitis with perforation through the abdominal wall. The case points out that an intraabdominal origin should be considered in patients presenting with rapidly spreading soft tissue infections of the trunk. A 58-year-old European woman presented to our hospital with a 1-week history of severe abdominal pain accompanied by rapidly spreading erythema and emphysema of the lower abdomen. On admission, the patient was in septic shock with leukocytosis and elevation of C-reactive protein. Among other diagnoses, necrotizing fasciitis was suspected. Computed tomography showed a large soft tissue infection with air-fluid levels spreading through the lower abdominal wall. During the operation, we found a perforated appendicitis breaking through the fascia and causing a rapidly progressive soft tissue infection of the abdominal wall. Appendicitis was the origin of the soft tissue infection. The abdominal wall was only secondarily involved. Even though perforated appendicitis as an etiology of a rapidly progressive soft tissue infection of the abdominal wall is very rare, it should be considered in the differential diagnosis of abdominal wall cellulitis. The distinction between rapidly spreading subcutaneous infection with abscess formation and early onset of necrotizing fasciitis is often difficult and can be confirmed only by surgical intervention.

  19. In vitro activity of moxifloxacin against 923 anaerobes isolated from human intra-abdominal infections.

    Goldstein, Ellie J C; Citron, Diane M; Warren, Yumi A; Tyrrell, Kerin L; Merriam, C Vreni; Fernandez, Helen


    The in vitro activity of moxifloxacin against 923 recent anaerobic isolates obtained from pretreatment cultures in patients with complicated intra-abdominal infections was studied using the CLSI M11-A-6 agar dilution method. Moxifloxacin was active against 87% (96 of 110) Bacteroides fragilis strains at accounting for most of the resistant isolates; excluding the aforementioned four resistant species, 86% (303 of 363) of Bacteroides species isolates and 94% (417 of 450) of all other genera and species were susceptible to < or = 2 microg/ml of moxifloxacin. Overall, moxifloxacin was active against 763 of 923 (83%) of strains at < or = 2 microg/ml, supporting its use as a monotherapy for some community-acquired intra-abdominal infections.

  20. The Changing Pattern of Nontuberculous Mycobacterial Disease

    Joseph O Falkinham


    Full Text Available Nontuberculous mycobacteria are human opportunistic pathogens whose source of infection is the environment. These include both slow-growing (eg, Mycobacterium kansasii and Mycobacterium avium and rapid-growing (eg, Mycobacterium abscessus and Mycobacterium fortuitum species. Transmission is through ingestion or inhalation of water, particulate matter or aerosols, or through trauma. The historic presentation of pulmonary disease in older individuals with predisposing lung conditions and in children has been changing. Pulmonary disease in elderly individuals who lack the classic predisposing lung conditions is increasing. Pulmonary disease and hypersensitivity pneumonitis have been linked with occupational or home exposures to nontuberculous mycobacteria. There has been a shift from Mycobacterium scrofulaceum to M avium in children with cervical lymphadenitis. Further, individuals who are immunosuppressed due to therapy or HIV-infection are at a greatly increased risk for nontuberculous mycobacterial infection. The changing pattern of nontuberculous mycobacterial disease is due in part to the ability of these pathogens to survive and proliferate in habitats that they share with humans, such as drinking water. The advent of an aging population and an increase in the proportion of immunosuppressed individuals suggest that the prevalence of nontuberculous mycobacterial disease will increase.

  1. [Pylephlebitis: a rare but possible complication of intra-abdominal infections].

    Pérez-Bru, Susana; Nofuentes-Riera, Carmen; García-Marín, Andrés; Luri-Prieto, Paloma; Morales-Calderón, Miguel; García-García, Salvador


    Pylephlebitis or septic thrombophlebitis of the portal venous system is a rare but serious complication of intra-abdominal infections which drain into the portal venous system. Its diagnosis is based on clinical suspicion and imaging tests, mainly a computed tomography scan, given the lack of specificity of the signs and symptoms. Spread of septic emboli is the major cause of morbidity and mortality. The aim of the study was to analyse patients diagnosed in our hospital. Retrospective descriptive study of patients diagnosed with pylephlebitis in our hospital. Four patients were included, 3 men and one woman. In 3 cases it was acute cholecystitis that led to the diagnosis of pylephlebitis at the same time as the intra-abdominal infection. Emergency surgery was performed in one case, whilst the other 2 were treated conservatively. Blood cultures were performed in all cases, and empirical antibiotic treatment was used. In the only case of acute appendicitis, diagnosis of pylephlebitis was achieved during the study of postoperative fever, with empirical antibiotic treatment also being started. The haematologist was requested to start the required anticoagulation therapy in all cases. Pylephlebitis is a rare complication of intra-abdominal infections that may make lead to a worse outcome. A high level of suspicion is required as well as imaging tests to make an early diagnosis and appropriate treatment. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  2. Management of Infected Mesh After Abdominal Hernia Repair: Systematic Review and Single-Institution Experience.

    Shubinets, Valeriy; Carney, Martin J; Colen, David L; Mirzabeigi, Michael N; Weissler, Jason M; Lanni, Michael A; Braslow, Benjamin M; Fischer, John P; Kovach, Stephen J


    Mesh infection after abdominal hernia repair is a devastating complication that affects general and plastic surgeons alike. The purpose of this study was 3-fold: (1) to determine current evidence for treatment of infected abdominal wall mesh via systematic review of literature, (2) to analyze our single-institution experience with treatment of infected mesh patients, and (3) to establish a framework for how to approach this complex clinical problem. Literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, followed by single-institution retrospective analysis of infected mesh patients. A total of 3565 abstracts and 92 full-text articles were reviewed. For qualitative and quantitative assessment, articles were subdivided on the basis of treatment approach: "conservative management," "excision of mesh with primary closure," "single-stage reconstruction," "immediate staged repair," and "repair in contaminated field." Evidence for each treatment approach is presented. At our institution, most patients (40/43) were treated by excision of infected mesh and single-stage reconstruction with biologic mesh. When the mesh was placed in a retrorectus or underlay fashion, 21.4% rate of hernia recurrence was achieved. Bridged repairs were highly prone to recurrence (88.9%; P = 0.001), but the bridging biologic mesh seemed to maintain domain and potentially contribute to a more effective repair in the future. Of the patients who underwent additional ("secondary") repairs after recurrence, 75% were eventually able to achieve "hernia-free" state. This study reviews the literature and our single-institution experience regarding treatment of infected abdominal wall mesh. Framework is developed for how to approach this complex clinical problem.

  3. Children with mycobacterial cervical lymphadenitis: a case series

    Şule Çağlayan Sözmen


    Full Text Available Introduction: Lymphadenopathy is a common clinical problem in pediatric age group. Tuberculous lymphadenopathy is a prominent cause of peripheral adenopathy amongst children in the developing countries. Tuberculous lymphadenitis is among the most frequent presentations of extrapulmonary tuberculosis. In this article, we presented five pediatric cases with mycobacterial infection detected in cervical lymph nodes.Case Presentation: First case admitted with a painless swelling in cervical and axillar regions and pathologic examination of the extirpated lymph node showed necrotizing granulomatous lymphadenitis. Second case presented with two months history of abdominal pain and painless swelling of right cervical region and Mycobacterium tuberculosis (MTB was grown in culture from the lymph node. Third case admitted with a painless cervical mass, her sputum was found positive for MTB. Fourth case was admitted with one year history of swelling that became fistulized in 6 months and lymph node culture was found positive for MTB. Fifth case, admitted with a painful swelling in left upper gingival mucosa and extirpated lymph node showed chronic granulomatous inflammation.Conclusion: Pathological and microbiological examination of tissues such as cervical enlarged lymph nodes should be evaluated for diagnosis of tuberculous infections.




    Full Text Available A 27-year-old man presented with a two-week history of central colicky abdominal pain associated with loose stools. Further history revealed that he had been exposed to contaminated waters. Stool investigation by direct wet stool smears revealed the presence of Entamoeba histolytica and Blastocystis hominis cysts. A diagnosis of amoebiasis secondary to E. histolytica and concurrent B. hominis infestation was made. We would like to emphasise the importance of clinical history including recent travel to endemic areas. Any suspicion of parasitic infection should prompt the clinician to investigate. Early diagnosisand management would prevent serious complications associated with E. Histolytica infection.

  5. Prevention of abdominal wound infection (PROUD trial, DRKS00000390: study protocol for a randomized controlled trial

    Heger Ulrike


    Full Text Available Abstract Background Wound infection affects a considerable portion of patients after abdominal operations, increasing health care costs and postoperative morbidity and affecting quality of life. Antibacterial coating has been suggested as an effective measure to decrease postoperative wound infections after laparotomies. The INLINE metaanalysis has recently shown the superiority of a slowly absorbable continuous suture for abdominal closure; with PDS plus® such a suture has now been made available with triclosan antibacterial coating. Methods/Design The PROUD trial is designed as a randomised, controlled, observer, surgeon and patient blinded multicenter superiority trial with two parallel groups and a primary endpoint of wound infection during 30 days after surgery. The intervention group will receive triclosan coated polydioxanone sutures, whereas the control group will receive the standard polydioxanone sutures; abdominal closure will otherwise be standardized in both groups. Statistical analysis is based on intention-to-treat population via binary logistic regression analysis, the total sample size of n = 750 is sufficient to ensure alpha = 5% and power = 80%, an interim analysis will be carried out after data of 375 patients are available. Discussion The PROUD trial will yield robust data to determine the effectiveness of antibacterial coating in one of the standard sutures for abdominal closure and potentially lead to amendment of current guidelines. The exploration of clinically objective parameters as well as quality of life holds immediate relevance for clinical management and the pragmatic trial design ensures high external validity. Trial Registration The trial protocol has been registered with the German Clinical Trials Register (DRKS00000390.

  6. Mycobacterial Signaling through Toll-like Receptors

    Joyoti eBasu


    Full Text Available Studies over the past decade have helped to decipher molecular networks dependent on Toll-like receptor (TLR signaling, in mycobacteria-infected macrophages. Stimulation of TLRs by mycobacteria and their antigenic components rapidly induces intracellular signaling cascades involved in the activation of nuclear factor-κB and mitogen-activated protein kinase pathways, which play important roles in orchestrating proinflammatory responses and innate defense through generation of a variety of antimicrobial effector molecules. Recent studies have provided evidence that mycobacterial TLR-signaling cross talks with other intracellular antimicrobial innate pathways, the autophagy process and functional vitamin D receptor signaling. In this article we describe recent advances in the recognition, responses, and regulation of mycobacterial signaling through TLRs.

  7. The Incidence, Clinical Outcomes, and Risk Factors of Thrombocytopenia in Intra-Abdominal Infection Patients: A Retrospective Cohort Study.

    Qin Wu

    Full Text Available Studies on the incidence and risk factors of thrombocytopenia among intra-abdominal infection patients remain absent, hindering efficacy assessments regarding thrombocytopenia prevention strategies.We retrospectively studied 267 consecutively enrolled patients with intra-abdominal infections. Occurrence of thrombocytopenia was scanned for all patients. All-cause 28-day mortality was recorded. Variables from univariate analyses that were associated with occurrence of hospital-acquired thrombocytopenia were included in a multivariable logistic regression analysis to determine thrombocytopenia predictors.Median APACHE II score and SOFA score of the whole cohort was 12 and 3 respectively. The overall ICU mortality was 7.87% and the 28-day mortality was 8.98%. The incidence of thrombocytopenia among intra-abdominal infection patients was 21.73%. Regardless of preexisting or hospital-acquired one, thrombocytopenia is associated with an increased ICU mortality and 28-day mortality as well as length of ICU or hospital stay. A higher SOFA and ISTH score at admission were significant hospital-acquired thrombocytopenia risk factors.This is the first study to identify a high incidence of thrombocytopenia in patients with intra-abdominal infections. Our findings suggest that the inflammatory milieu of intra-abdominal infections may uniquely predispose those patients to thrombocytopenia. More effective thrombocytopenia prevention strategies are necessary in intra-abdominal infection patients.


    Jovanović Dušan


    Full Text Available Intra-abdominal infections are multifactorial and present an complex inflammatory response of the peritoneum to microorganisms followed by exudation in the abdominal cavity and systemic response Despite advances in management and critical care of patients with acute generalized peritonitis due to hollow viscus perforation, prognosis is still very poor, with high mortality rate. Early detection and adequate treatment is essential to minimize complications in the patient with acute abdomen. Prognostic evaluation of complicated IAI by modern scoring systems is important to assess the severity and the prognosis of the disease. Control of the septic source can be achieved either by nonoperative or operative means. Nonoperative interventional procedures include percutaneous drainages of abscesses. The management of primary peritonitis is non-surgical and antibiotic- treatment. The management of secondary peritonitis include surgery to control the source of infection, removal of toxins, bacteria, and necrotic tissue, antibiotic therapy, supportive therapy and nutrition. "Source control" is sine qua non of success and adequate surgical procedure involves closure or resection of any openings into the gastrointestinal tract, resection of inflamed tissue and drainage of all abdominal and pelivic collections.

  9. Patients with Risk Factors for Complications Do Not Require Longer Antimicrobial Therapy for Complicated Intra-Abdominal Infection.

    Rattan, Rishi; Allen, Casey J; Sawyer, Robert G; Mazuski, John; Duane, Therese M; Askari, Reza; Banton, Kaysie L; Claridge, Jeffrey A; Coimbra, Raul; Cuschieri, Joseph; Dellinger, E Patchen; Evans, Heather L; Guidry, Christopher A; Miller, Preston R; O'Neill, Patrick J; Rotstein, Ori D; West, Michaela A; Popovsky, Kimberley; Namias, Nicholas


    A prospective, multicenter, randomized controlled trial found that four days of antibiotics for source-controlled complicated intra-abdominal infection resulted in similar outcomes when compared with a longer duration. We hypothesized that patients with specific risk factors for complications also had similar outcomes. Short-course patients with obesity, diabetes, or Acute Physiology and Chronic Health Evaluation II ≥15 from the STOP-IT trial were compared with longer duration patients. Outcomes included incidence of and days to infectious complications, mortality, and length of stay. Obese and diabetic patients had similar incidences of and days to surgical site infection, recurrent intra-abdominal infection, extra-abdominal infection, and Clostridium difficile infection. Short- and long-course patients had similar incidences of complications among patients with Acute Physiology and Chronic Health Evaluation II ≥15. However, there were fewer days to the diagnosis of surgical site infection (9.5 ± 3.4 vs 21.6 ± 6.2, P = 0.010) and extra-abdominal infection (12.4 ± 6.9 vs 21.8 ± 6.1, P = 0.029) in the short-course group. Mortality and length of stay was similar for all groups. A short course of antibiotics in complicated intra-abdominal infection with source control seems to have similar outcomes to a longer course in patients with diabetes, obesity, or increased severity of illness.

  10. Postoperative abdominal wound infection – epidemiology, risk factors, identification, and management

    Azoury SC


    Full Text Available Saïd C Azoury,1 Norma Elizabeth Farrow,2 Qing L Hu,2 Kevin C Soares,1 Caitlin W Hicks,1 Faris Azar,1 Nelson Rodriguez-Unda,3 Katherine E Poruk,1 Peter Cornell,1 Karen K Burce,1 Carisa M Cooney,3 Hien T Nguyen,1 Frederic E Eckhauser1 1Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA; 2School of Medicine, Johns Hopkins University, Baltimore, MD, USA; 3Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA Abstract: Surgical site infections (SSIs complicate the postoperative course of a significant proportion of general abdominal surgical patients and are associated with excessive health care costs. SSIs increase postoperative morbidity and mortality, and may require hospital admission, intravenous antibiotics, and even surgical reintervention. Risks associated with SSIs are related to both host and perioperative factors. However, a vast majority of these infections are preventable. More recently, quality initiative programs such as American College of Surgeons National Surgical Quality Improvement Program are expanding their roles to help better monitor adherence to improvement measures. Indeed, standardizing preoperative antibiotic prophylaxis timing is perhaps the most persuasive example and this has been integral to reducing postoperative SSI rates. Herein, the authors provide an update on the epidemiology, risk factors, identification, and management of wound infections following abdominal surgery. Keywords: surgical site infection, diagnosis, treatment, prevention

  11. Abdominal aortic endograft infection: report of two cases and review of the literature.

    Veraldi, Gian Franco; Genco, Bruno; Minicozzi, Annamaria; Zecchinelli, Marco Paolo; Segattini, Christian; Momo, Rostand Emmanuel; Pacca, Rosario


    Endovascular prosthesis infection after exclusion of an abdominal aortic aneurysm is a rare, dramatic event and its diagnosis and treatment are extremely complex. This particular complication has been less well explored in the literature than others such as endoleaks, migration or stent rupture. The incidence of aorto-iliac stent-graft infection is almost 0.7%, while the infection rate in open surgery varies from 0.6% to 3%. Moreover, the infection can be early when it arises within 4 months of the implant or late when it arises after 4 months. Since 1991 only 94 cases of endograft infections have been reported in the world literature, to which our two cases need to be added, making a total of 96 cases. The first of our patients was diagnosed with an early infection that was successfully treated by explanting the infected graft followed by aortic reconstruction with a homograft. Six months after the operation the patient died of cardiac failure. The second case was a late infection which developed 8 years after the first intervention in a patient with chronic renal failure treated with dialytic therapy. After aneurysmectomy and stent-graft removal, a bifurcated dacron silver graft was implanted. The patient died of cardiogenic shock 40 days after surgery. The surgical treatment of this serious complication is associated with high perioperative morbidity and mortality rates and requires very careful planning of the operation.

  12. Common errors in the treatment of intra-abdominal infections: the irrational use of antimicrobial agents

    Belinda De Simone


    Full Text Available Antimicrobial resistance (AR is a global, emergent problem because an increasing numbers of serious community acquired and nosocomial infections are caused by resistant bacterial pathogens. It is a direct consequence of the excessive and irrational use of antibiotics. The use of antimicrobial agents – aimed to decrease morbidity and mortality rate related to intra-abdominal infections – is very high, often improper, in the Departments of General and Emergency Surgery and Intensive Cure Units. Source control and empiric antibiotic therapy have to be administrated as early as possible to decrease high mortality rates in patients with severe sepsis or septic shock and, in this, the general surgeon has a crucial role. Proper antimicrobial stewardship in selecting an appropriate antibiotic and optimizing its dose and duration to cure intraabdominal infections may prevent the emergence of AR and decrease costs for antibiotics.

  13. The Challenge of Antimicrobial Resistance in Managing Intra-Abdominal Infections.

    Sartelli, Massimo; Catena, Fausto; di Saverio, Salomone; Ansaloni, Luca; Coccolini, Federico; Tranà, Cristian; Kirkby-Bott, James


    In recent years, there has been a worldwide increase in infections caused by microorganisms resistant to multiple antimicrobial agents. In the past few decades, an increased prevalence of infections caused by antibiotic-resistant pathogens, including Enterococcus spp., carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii, extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella spp., carbapenemase-producing Klebsiella pneumoniae, and resistant Candida spp., also has been observed among intra-abdominal infections (IAIs). The increasing prevalence of multi-drug resistance is responsible for a substantial increase in morbidity and mortality rates associated with IAIs. It is necessary for every surgeon treating IAIs to understand the underlying epidemiology and clinical consequences of antimicrobial resistance. Emergence of drug resistance, combined with the lack of new agents in the drug development pipeline, indicates that judicious antimicrobial management will be necessary to preserve the utility of the drugs available currently.

  14. Treatment Modalities and Antimicrobial Stewardship Initiatives in the Management of Intra-Abdominal Infections

    Hoffmann, Charles; Zak, Matthew; Avery, Lisa; Brown, Jack


    Antimicrobial stewardship programs (ASPs) focus on improving the utilization of broad spectrum antibiotics to decrease the incidence of multidrug-resistant Gram positive and Gram negative pathogens. Hospital admission for both medical and surgical intra-abdominal infections (IAIs) commonly results in the empiric use of broad spectrum antibiotics such as fluoroquinolones, beta-lactam beta-lactamase inhibitors, and carbapenems that can select for resistant organisms. This review will discuss the management of uncomplicated and complicated IAIs as well as highlight stewardship initiatives focusing on the proper use of broad spectrum antibiotics. PMID:27025526

  15. Treatment Modalities and Antimicrobial Stewardship Initiatives in the Management of Intra-Abdominal Infections

    Charles Hoffmann


    Full Text Available Antimicrobial stewardship programs (ASPs focus on improving the utilization of broad spectrum antibiotics to decrease the incidence of multidrug-resistant Gram positive and Gram negative pathogens. Hospital admission for both medical and surgical intra-abdominal infections (IAIs commonly results in the empiric use of broad spectrum antibiotics such as fluoroquinolones, beta-lactam beta-lactamase inhibitors, and carbapenems that can select for resistant organisms. This review will discuss the management of uncomplicated and complicated IAIs as well as highlight stewardship initiatives focusing on the proper use of broad spectrum antibiotics.

  16. Role of F-18 FDG PET/CT in the management of infected abdominal aortic aneurysm due to salmonella

    Choi, Seung Jin; Lee, Jin Soo; Cheong, Moon Hyun; Byun, Sung Su; Hyun, In Young [Inha University College of Medicine, Incheon (Korea, Republic of)


    We present a case of infected abdominal aortic aneurysm due to salmonella enteritidis. F-18 FDG PET/CT was performed to diagnosis and during follow-up after antibiotic treatment. Computed tomography (CT) is considered to be the best diagnostic imaging modality in infected aortic lesions. In this case, a combination of CT and FDG PET/CT provided accurate information for the diagnosis of infected abdominal aortic aneurysm. Moreover, FDG PET/CT made an important contribution of monitoring disease activity during antibiotic treatment.

  17. Unusual perigraft abscess formation associated with stent graft infection after endovascular aortic repair of abdominal aortic aneurysm: A case report

    Lee, Hyo Jin; Kim, Song Soo; Ahn, Moon Sang; Lee, Jae Hwan; Shin, Byung Seok; KIm, Jin Hwan [Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon (Korea, Republic of)


    Although a stent graft infection after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) is a rare complication, it carries a high mortality and morbidity rate. We report a rare case of stent graft infection that led to an unusual perigraft abscess formation without any associated aortoenteric fistula two years after the EVAR of AAA.

  18. Disseminated BCG infection in a patient with severe combined immunodeficiency

    Han, Tae Il [Eulji University School of Medicine, Taejon (Korea, Republic of); Kim, In One; Kim, Woo Sun; Yeon, Kyung Mo [Seoul National University College of Medicine, Seoul (Korea, Republic of)


    Disseminated mycobacterial infection after bacillus Calmette-Guerin (BCG) accination is a very rare disorder, occurring mostly in patients with immunologic eficiency. We report a case of disseminated BCG infection in a 16-month-old girl with severe combined immunodeficiency. Plain radiographs showed multiple osteolytic lesions in the femora, tibiae, humerus, and phalanges. Abdominal sonography and CT scanning revealed multiple nodules in the spleen, and portocaval lymphadenopathy.

  19. Disseminated BCG Infection in a patient with Severe Combined Immunodeficiency

    Han, Tae Il; Kim, In-One; Kim, Woo Sun; Yeon, Kyung Mo


    Disseminated mycobacterial infection after bacillus Calmette-Guerin (BCG) vaccination is a very rare disorder, occurring mostly in patients with immunologic deficiency. We report a case of disseminated BCG infection in a 16-month-old girl with severe combined immunodeficiency. Plain radiographs showed multiple osteolytic lesions in the femora, tibiae, humerus, and phalanges. Abdominal sonography and CT scanning revealed multiple nodules in the spleen, and portocaval lymphadenopathy.

  20. Antibiotic management of complicated intra-abdominal infections in adults: The Asian perspective

    Asok Kurup


    Full Text Available Regional epidemiological data and resistance profiles are essential for selecting appropriate antibiotic therapy for intra-abdominal infections (IAIs. However, such information may not be readily available in many areas of Asia and current international guidelines on antibiotic therapy for IAIs are for Western countries, with the most recent guidance for the Asian region dating from 2007. Therefore, the Asian Consensus Taskforce on Complicated Intra-Abdominal Infections (ACT-cIAI was convened to develop updated recommendations for antibiotic management of complicated IAIs (cIAIs in Asia. This review article is based on a thorough literature review of Asian and international publications related to clinical management, epidemiology, microbiology, and bacterial resistance patterns in cIAIs, combined with the expert consensus of the Taskforce members. The microbiological profiles of IAIs in the Asian region are outlined and compared with Western data, and the latest available data on antimicrobial resistance in key pathogens causing IAIs in Asia is presented. From this information, antimicrobial therapies suitable for treating cIAIs in patients in Asian settings are proposed in the hope that guidance relevant to Asian practices will prove beneficial to local physicians managing IAIs.

  1. Abdominal actinomycosis.

    Wagenlehner, F M E; Mohren, B; Naber, K G; Männl, H F K


    Intra-abdominal and extraperitoneal actinomycosis are rare infections, caused by different Actinomyces species. However, they have been diagnosed more frequently in the last ten years. We report three cases of abdominal actinomycosis and a literature review of the last eight years. All three patients were diagnosed by means of histopathologic examination only. In one case, an intrauterine device (IUD) was associated with the infection. Therapy consisted of surgical resection of the inflammatory, infected tissue, and long-term antibiotic therapy. All patients are free of recurrence. Abdominal actinomycosis should be included in the differential diagnosis of an abdominal pathology of insidious onset, especially when an IUD is in place. Even when infection had spread extensively, combined operative and antibiotic therapy cured most of the cases.

  2. Abdominal surgical site infections: incidence and risk factors at an Iranian teaching hospital

    Sabouri Kashani Ahmad


    Full Text Available Abstract Background Abdominal surgical site infections are among the most common complications of inpatient admissions and have serious consequences for outcomes and costs. Different risk factors may be involved, including age, sex, nutrition and immunity, prophylactic antibiotics, operation type and duration, type of shaving, and secondary infections. This study aimed to determine the risk factors affecting abdominal surgical site infections and their incidence at Imam Khomeini, a major referral teaching hospital in Iran. Methods Patients (n = 802 who had undergone abdominal surgery were studied and the relationships among variables were analyzed by Student's t and Chi-square tests. The subjects were followed for 30 days and by a 20-item questionnaire. Data were collected through pre- and post-operative examinations and telephone follow-ups. Results Of the 802 patients, 139 suffered from SSI (17.4%. In 40.8% of the cases, the wound was dirty infected. The average age for the patients was 46.7 years. The operations were elective in 75.7% of the cases and 24.7% were urgent. The average duration of the operation was 2.24 hours, the average duration of pre-operative hospital stay 4.31 days and the average length of (pre- and post-operation hospital stay 11.2 days. Three quarters of the cases were shaved 12 hours before the operation. The increased operation time, increased bed stay, electivity of the operation, septicity of the wound, type of incision, the administration of prophylactic antibiotic, type of operation, background disease, and the increased time lapse between shaving and operation all significantly associated with SSI with a p-value less than 0.001. Conclusion In view of the high rate of SSI reported here (17.4% compared with the 14% quoted in literature, this study suggests that by reducing the average operation time to less than 2 hours, the average preoperative stay to 4 days and the overall stay to less than 11 days, and

  3. Immunodeficiency in non-tuberculous mycobacterial disease.

    Froebel, K S; Böllert, F G; Jellema, J; Bird, A G; Greening, A P


    T-cell immunity was investigated in eight patients with non-tuberculous mycobacterial disease, to see whether impaired immune function might be the explanation for their infection. Cellular immune function was evaluated in vitro by measuring the proliferation of peripheral blood mononuclear cells in response to both non-specific mitogens (phytohaemagglutinin and pokeweed mitogen) and specific recall antigens (streptokinase-streptodornase and purified protein derivative from Mycobacterium tuberculosis), and in vivo, by measuring the skin test response to a panel of recall antigens. Functionally relevant T-lymphocyte sub-populations (CD4, CD8, activated CD3 and gamma/delta T-cells) were enumerated by two-colour flow cytometry. The results were compared with those for a group of patients with pulmonary tuberculosis, with groups of controls matched for age and smoking habit, and with a patient group receiving steroid treatment. The patients with non-tuberculous mycobacterial disease had poor or absent skin test responses; in vitro, their response to recall antigens was depressed, although their response to mitogens was normal. The patients had significantly raised levels of CD8 lymphocytes and activated T-cells, but lacked any circulating gamma/delta T-cells. There were also differences between the various control groups. In conclusion, this study demonstrates a deficiency in the cellular immune system of these patients, which is most readily detectable by skin testing, or by measuring lymphocyte proliferative responses to recall antigens. However, the study also shows changes in cellular immune responses in controls matched for age and smoking and in patients on steroid treatment, and underscores the need for matched controls. Further work needs to be done to ascertain whether the cellular immune deficiency is a cause of, or is caused by, the mycobacterial infections, and also to investigate the pathological significance of the alterations in T-cell sub-populations.

  4. An Intra-Abdominal Pseudocyst around a Ventriculoperitoneal Shunt due to Streptococcus Infection 7 Years after Shunt Surgery

    Arata Tomiyama


    Full Text Available In 1999, a 50-year-old woman underwent ventriculoperitoneal (VP shunt surgery for hydrocephalus after subarachnoid hemorrhage. She was hospitalized for fever and recurrent systemic seizures in November 2006. Head computed tomography (CT showed only old changes. The seizures and fever were controlled by medicinal therapy. However, in December, her consciousness level suddenly decreased, and she showed progressive lower abdominal distension. Head CT showed marked ventriculomegaly, and abdominal CT showed a giant cystic mass at the shunt-tube tip in the lower abdominal cavity. Because thick pus was aspirated from the intra-abdominal mass, we diagnosed the patient with acute obstructive hydrocephalus due to an infected abdominal pseudocyst. Laparotomy and direct cyst drainage were performed, and antibiotic therapy against Streptococcus, the causative pathogen, was administered. The VP shunt tube was replaced. The postoperative course was uneventful, and postoperative CT showed hydrocephalus improvement and no pseudocyst recurrence. Abdominal pseudocysts, which are rare after VP shunt surgeries, usually occur after the subacute postoperative course in younger cerebral hemorrhagic cases. Our case was quite rare because the cyst developed in the chronic phase in an older patient and was caused by streptococcal infection. The cyst components should be examined before cyst drainage when choosing surgical strategies.

  5. Reconstruction of Abdominal Wall of a Chronically Infected Postoperative Wound with a Rectus Abdominis Myofascial Splitting Flap

    Sung Kyu Bae


    Full Text Available BackgroundIf a chronically infected abdominal wound develops, complications such as peritonitis and an abdominal wall defect could occur. This could prolong the patient's hospital stay and increase the possibility of re-operation or another infection as well. For this reason, a solution for infection control is necessary. In this study, surgery using a rectus abdominis muscle myofascial splitting flap was performed on an abdominal wall defect.MethodsFrom 2009 to 2012, 5 patients who underwent surgery due to ovarian rupture, cesarean section, or uterine myoma were chosen. In each case, during the first week after operation, the wound showed signs of infection. Surgery was chosen because the wounds did not resolve with dressing. Debridement was performed along the previous operation wound and dissection of the skin was performed to separate the skin and subcutaneous tissue from the attenuated rectus muscle and Scarpa's fascial layers. Once the anterior rectus sheath and muscle were adequately mobilized, the fascia and muscle flap were advanced medially so that the skin defect could be covered for reconstruction.ResultsUpon 3-week follow-up after a rectus abdominis myofascial splitting flap operation, no major complication occurred. In addition, all of the patients showed satisfaction in terms of function and esthetics at 3 to 6 months post-surgery.ConclusionsUsing a rectus abdominis myofascial splitting flap has many esthetic and functional benefits over previous methods of abdominal defect treatment, and notably, it enabled infection control by reconstruction using muscle.

  6. Reconstruction of Abdominal Wall of a Chronically Infected Postoperative Wound with a Rectus Abdominis Myofascial Splitting Flap

    Sung Kyu Bae


    Full Text Available Background If a chronically infected abdominal wound develops, complications such asperitonitis and an abdominal wall defect could occur. This could prolong the patient’s hospitalstay and increase the possibility of re-operation or another infection as well. For this reason,a solution for infection control is necessary. In this study, surgery using a rectus abdominismuscle myofascial splitting flap was performed on an abdominal wall defect.Methods From 2009 to 2012, 5 patients who underwent surgery due to ovarian rupture,cesarean section, or uterine myoma were chosen. In each case, during the first week afteroperation, the wound showed signs of infection. Surgery was chosen because the wounds didnot resolve with dressing. Debridement was performed along the previous operation woundand dissection of the skin was performed to separate the skin and subcutaneous tissue fromthe attenuated rectus muscle and Scarpa’s fascial layers. Once the anterior rectus sheath andmuscle were adequately mobilized, the fascia and muscle flap were advanced medially sothat the skin defect could be covered for reconstruction.Results Upon 3-week follow-up after a rectus abdominis myofascial splitting flap operation,no major complication occurred. In addition, all of the patients showed satisfaction in termsof function and esthetics at 3 to 6 months post-surgery.Conclusions Using a rectus abdominis myofascial splitting flap has many esthetic andfunctional benefits over previous methods of abdominal defect treatment, and notably, itenabled infection control by reconstruction using muscle.

  7. Infection of endovascular abdominal aortic aneurysm stent graft after urosepsis: case report and review of the literature.

    Veger, H T C; Hedeman Joosten, P Ph; Thoma, S R; Visser, M J T


    Infection of endovascular abdominal aneurysm stent grafts is an uncommon but known complication. Inoculation with bacteria of the endovascular abdominal aneurysm stent graft during the actual implantation, in the periprocedural hospitalization or later due to an aortoenteric fistula, has been described in the literature. We report a case of endovascular abdominal aortic aneurysm stent graft infection occurring 40 months after implantation in a patient doing well up to an episode of urosepsis. In conclusion, we postulate that poor intraluminal healing of stent grafts, as observed in several explant studies, may result in a higher susceptibility to episodes of bacteremia than prosthetic vascular grafts inserted during open repair. We therefore consider the administration of prophylactic antibiotics in patients with endovascular stent grafts during periods with a likelihood of bacteremia.

  8. Partial overlap of anti-mycobacterial, and anti-Saccharomyces cerevisiae mannan antibodies in Crohn's disease

    Stefan Müller; Thomas Schaffer; Alain M Schoepfer; Annamarie Hilty; Thomas Bodmer; Frank Seibold


    AIM: To test whether humoral immune reaction against mycobacteria may play a role in anti-Saccharomyces cerevisiae antibodies (ASCA) generation in Crohn's disease (CD) and/or whether it correlates with clinical subtypes.METHODS: The dominant ASCA epitope was detected by Galanthus nivalis lectin (GNL)-binding assay. ASCA and IgG against mycobacterial lysates (M avium, M smegmatis, M chelonae, M bovis BCG, M avium ssp. paratuberculosis (MAP)] or purified lipoarabinomannans (LAM) were detected by ELISA. ASCA and anti-mycobacterial antibodies were affinity purified to assess cross-reactivities. Anti-mycobacterial IgG were induced by BCG-infection of mice.RESULTS: GNL bound to different extents to mycobacterial lysates, abundantly to purified mannose-capped (Man) I_AM from M tuberculosis, but not to uncapped LAM from M smegmatis. Fifteen to 45% of CD patients but only 0%-6% of controls were seropositive against different mycobacterial antigens. Anti-mycobacterial IgG correlated with ASCA (r=0.37-0.64; P=0.003-P<0.001). ASCA-positivity and deficiency for mannan-binding lectin synergistically associated with anti-mycobacterial IgG. In some patients, anti-mycobacterial antibodies represent cross-reactive ASCA. Vice-versa, the predominant fraction of ASCA did not cross-react with mycobacteria. Finally, fistulizing disease associated with antibodies against M avium, M smegmatis and MAP (P=0.024,0.004 and 0.045, respectively).CONCLUSION: Similar to ASCA, seroreactivity against mycobacteria may define CD patients with complicated disease and a predisposition for immune responses against ubiquitous antigens. While in some patients anti-mycobacterial antibodies strongly cross-react with yeast mannan; these cross-reactive antibodies only represent a minor fraction of total ASCA. Thus, mycobacterial infection unlikely plays a role in ASCA induction.

  9. Decreased Risk of Ventilator-Associated Pneumonia in Sepsis Due to Intra-Abdominal Infection.

    François Philippart

    Full Text Available Experimental studies suggest that intra-abdominal infection (IAI induces biological alterations that may affect the risk of lung infection.To investigate the potential effect of IAI at ICU admission on the subsequent occurrence of ventilator-associated pneumonia (VAP.We used data entered into the French prospective multicenter Outcomerea database in 1997-2011. Consecutive patients who had severe sepsis and/or septic shock at ICU admission and required mechanical ventilation for more than 3 days were included. Patients with acute pancreatitis were not included.Of 2623 database patients meeting the inclusion criteria, 290 (11.1% had IAI and 2333 (88.9% had other infections. The IAI group had fewer patients with VAP (56 [19.3%] vs. 806 [34.5%], P<0.01 and longer time to VAP (5.0 vs.10.5 days; P<0.01. After adjustment on independent risk factors for VAP and previous antimicrobial use, IAI was associated with a decreased risk of VAP (hazard ratio, 0.62; 95% confidence interval, 0.46-0.83; P<0.0017. The pathogens responsible for VAP were not different between the groups with and without IAI (Pseudomonas aeruginosa, 345 [42.8%] and 24 [42.8%]; Enterobacteriaceae, 264 [32.8%] and 19 [34.0%]; and Staphylococcus aureus, 215 [26.7%] and 17 [30.4%], respectively. Crude ICU mortality was not different between the groups with and without IAI (81 [27.9%] and 747 [32.0%], P = 0.16.In our observational study of mechanically ventilated ICU patients with severe sepsis and/or septic shock, VAP occurred less often and later in the group with IAIs compared to the group with infections at other sites.

  10. Enfermedades micobacterianas diseminadas en pacientes con VIH/SIDA. Evaluación de los hemocultivos por método rápido Disseminated mycobacterial infections in patients with HIV/AIDS. Evaluation of blood cultures

    C. Coitinho


    Full Text Available Mil cuarenta hemocultivos correspondientes a 451 enfermos uruguayos con SIDA y diagnóstico clínico de micobacteriosis diseminada fueron evaluados entre 1999 y 2003. Las muestras fueron procesadas en el Centro de Referencia Nacional para Micobacterias (Montevideo, Uruguay, utilizando el sistema de hemocultivos automatizado para micobacterias MB - BacT (BioMérieux. Se detectaron 45 muestras positivas (4,3% correspondientes a 26 enfermos (promedio 2,3 muestras por paciente. En 10/26 casos se identificó M. avium complex (MAC y en 13/26 el germen aislado fue M. tuberculosis. El tiempo medio de incubación fue de 12,4 días (intervalo 6-19 días para MAC y de 22,6 días (intervalo 7-35 días para M. tuberculosis. El hemocultivo ha demostrado ser la mejor muestra para la confirmación bacteriológica de las enfermedades micobacterianas diseminadas cuando se estudian por lo menos 2 muestras por paciente. La frecuencia de aislamientos de M. tuberculosis y MAC aislados en pacientes con SIDA en Uruguay, corresponde a la de un país con una moderada prevalencia de tuberculosis.One thousand-forty blood cultures corresponding to 451 Uruguayan patients with AIDS and clinic diagnosis of disseminated mycobacterial infection were evaluated between 1999 and 2003. Samples were processed in the NationalReferenceCenter for Mycobacteria (Montevideo, Uruguay, using the automated blood culture system for mycobacteria MB -BacT (BioMérieux. Forty-five positive samples were detected (4.3% corresponding to 26 patients with AIDS (average 2.3 samples per patient. In 10/26 patients M. avium complex (MAC was identified and in 13/26 the isolated germ was M. tuberculosis. The average time of incubation was of 12.4 days (range 6-19 days for MAC and of 22.6 days (range 7-35 days for M. tuberculosis. Blood culture has demonstrated to be the best sample for the bacteriological confirmation of the disseminated mycobacterial infections when at least 2 samples by patient are

  11. Abdominal Hysterectomy: Reduced Risk of Surgical Site Infection Associated with Robotic and Laparoscopic Technique.

    Colling, Kristin P; Glover, James K; Statz, Catherine A; Geller, Melissa A; Beilman, Greg J


    Hysterectomy is one of the most common procedures performed in the United States. New techniques utilizing laparoscopic and robotic technology are becoming increasingly common. It is unknown if these minimally invasive surgical techniques alter the risk of surgical site infections (SSI). We performed a retrospective review of all patients undergoing abdominal hysterectomy at our institution between January 2011 and June 2013. International Classification of Diseases, Ninth edition (ICD-9) codes and chart review were used to identify patients undergoing hysterectomy by open, laparoscopic, or robotic approach and to identify patients who developed SSI subsequently. Chi-square and analysis of variance (ANOVA) tests were used to identify univariate risk factors and logistic regression was used to perform multivariable analysis. During this time period, 986 patients were identified who had undergone abdominal hysterectomy, with 433 receiving open technique (44%), 116 laparoscopic (12%), 407 robotic (41%), and 30 cases that were converted from minimally invasive to open (3%). Patients undergoing laparoscopic-assisted hysterectomy were significantly younger and had lower body mass index (BMI) and American Society of Anesthesiologists (ASA) scores than those undergoing open or robotic hysterectomy. There were no significant differences between patients undergoing open versus robotic hysterectomy. The post-operative hospital stay was significantly longer for open procedures compared with those using laparoscopic or robotic techniques (5.1, 1.7, and 1.6 d, respectively; physterectomy procedures was 4.2%. More SSI occurred in open cases (6.5%) than laparoscopic (0%) or robotic (2.2%) (pobesity were all associated with increased risk of SSI. Laparoscopic and robotic hysterectomies were associated with a significantly lower risk of SSI and shorter hospital stays. Body mass index, advanced age, and wound class were also independent risk factors for SSI.

  12. Abdominal Sepsis.

    De Waele, Jan J


    Abdominal infections are an important challenge for the intensive care physician. In an era of increasing antimicrobial resistance, selecting the appropriate regimen is important and, with new drugs coming to the market, correct use is important more than ever before and abdominal infections are an excellent target for antimicrobial stewardship programs. Biomarkers may be helpful, but their exact role in managing abdominal infections remains incompletely understood. Source control also remains an ongoing conundrum, and evidence is increasing that its importance supersedes the impact of antibiotic therapy. New strategies such as open abdomen management may offer added benefit in severely ill patients, but more data are needed to identify its exact role. The role of fungi and the need for antifungal coverage, on the other hand, have been investigated extensively in recent years, but at this point, it remains unclear who requires empirical as well as directed therapy.

  13. Molecular-based mycobacterial identification in a clinical laboratory setting: a comparison of two methods.

    O'Donnell, N


    Many mycobacterial species are pathogenic to humans, with infection occurring worldwide. Infection with Mycobacterium tuberculosis is a well-described global phenomenon, but other mycobacterial species are increasingly shown to be the cause of both pulmonary and extrapulmonary infection and are managed differently from M. tuberculosis infection. Rapid and accurate differentiation of mycobacterial species is, therefore, critical to guide timely and appropriate therapeutic and public health management. This study evaluates two commercially available DNA strip assays, the Genotype Common Mycobacteria (CM) assay (Hain Lifescience, Nehren, Germany) and the Speed-oligo Mycobacteria assay (Vircell, Spain) for their usefulness in a clinical laboratory setting. Both assays were evaluated on 71 clinical mycobacterial isolates, previously identified using Gen-Probe AccuProbe and through a UK mycobacteriology reference laboratory, as well as 29 non-mycobacterial isolates. Concordant results were obtained for 98% of isolates using both assays. The sensitivity was 97% (95% confidence interval [CI]: 93.3-100%) for the CM assay and 98.6% (95% CI: 95.9-100%) for the Speed-oligo assay. Overall, both assays proved to be useful tools for rapid and sensitive mycobacterial species identification, although interpretation of results was easier with the CM assay. Finally, results were available within one day, compared to current identification times which range between seven days and four weeks.

  14. Multiple intestinal perforations as a primary manifestation of abdominal tuberculosis in a HIV-infected patient

    Amir Hossein Sarrami


    Full Text Available Abdominal tuberculosis (TB is the sixth commonest extra-pulmonary TB form after lymphatic, genitourinary, bone and joint, miliary and meningeal tuberculosis. Perforation is a serious and uncommon complication of abdominal tuberculosis which can occur even during the treatment. A 30-year-old man was admitted with a three-day history of abdominal pain who had emergency surgery for multiple perforations of the distal ileum.

  15. Effect of lactobacillus on the gut microfiora and barrier function of the rats with abdominal infection

    Huan-Long Qin; Tong-Yi Shen; Zhi-Guang Gao; Xiao-Bing Fan; Xiao-Min Hang; Yan-Qun Jiang; Hui-Zhen Zhang


    AIM: To investigate the effect of probiotics supplemented by gut on the tight junctions of epithelial cells, barrier function and the microflora of rats with abdominal infection. METHODS: After the model of cecal ligation and perforation established, SD rats were divided into two groups: parenteral nutrition (PN) group and PN+probiotics (probiotics) group, PN solution was supplemented by neck vein and probiotics was delivered via the jejunostomy tube for five days. Vena cava blood and the homogenated tissue of liver, lung and mesenteric lymph nodes were cultured to determine the bacterial translocation rate (BTR). The ultrastructure of epithelial tight junctions and microvilli of the gut were observed by electron microscopy; occluding expression was measured by indirect-immune fluorescence method; anaerobic bacterial growth by anaerobic culture and DNA fingerprint of bacterial colonies of the feces by PCR. RESULTS: The quantity of lactobacteria and bifydobacteria in probiotics group was higher than that of PN group. The profiles of DNA fingerprint expression in probiotics group were similar to that in the normal group, a new 16S rDNA sequence appeared in the profile in PN group. The occludin expression, the integrality of the gut epithelial tight junctionand microvilli in probiotics group were improved as compared with PN group. The BTR and endotoxin in blood were reduced more significantly in probiotics group as compared with PN group.CONCLUSION: The probiotics could improve the gut microflora disturbance, increase occludin expression, maintain the gut epithelial tight junction and decrease the bacterial translocations rate.

  16. Mycobacterial Arthritis and Synovitis in Painted Reed Frogs (Hyperolius marmoratus).

    Barrows, M; Koeppel, K; Michel, A; Mitchell, E


    Several species of atypical mycobacteria have been isolated from wild and captive amphibians. In captive anurans, cutaneous and visceral mycobacteriosis are common and can result in significant mortality, particularly when animals are immunocompromised. Mycobacterial arthritis and synovitis are reported rarely in amphibians. We describe 20 cases in painted reed frogs (Hyperolius marmoratus), which presented with cachexia, limb paresis or paralysis or 'spindly leg syndrome'. Histopathology revealed multifocal histiocytic to granulomatous synovitis affecting appendicular, rib or spinal intervertebral joints. Periarticular granulomata, granulomatous cellulitis and skeletal muscle atrophy, necrosis and degeneration were also present. In one case, granulomatous spinal osteomyelitis was recorded. Ziehl-Neelsen stains showed large numbers of acid-fast bacteria in macrophages and histiocytes. The mycobacterial isolates obtained from culture were identified as members of the Mycobacterium chelonae complex (either M. chelonae or Mycobacteriumabscessus). This was confirmed by 5'-16S ribosomal ribonucleic acid (rRNA) sequencing. In 17 cases mycobacterial lesions were present only in the joints and skeleton, highlighting the importance of not ruling out mycobacterial infection on the basis of absence of cutaneous or visceral lesions.

  17. Ceftolozane/Tazobactam: A Review in Complicated Intra-Abdominal and Urinary Tract Infections.

    Scott, Lesley J


    Globally, the increasing prevalence of multidrug-resistant pathogens continues to pose major problems in healthcare systems and, at least in part, is driving an initiative to develop new antibacterials, such as ceftolozane (a cephalosporin β-lactam). Adding a β-lactamase inhibitor (e.g. tazobactam) to a β-lactam extends its spectrum of activity against β-lactamase-producing microorganisms (a key mechanism of resistance to β-lactams). Ceftolozane/tazobactam (Zerbaxa™), a β-lactam/β-lactamase inhibitor combination, is indicated for the treatment of adults with complicated intra-abdominal infections (cIAI) or complicated urinary tract infections (cUTI), including pyelonephritis. In multinational, phase 3 noninferiority trials, intravenous ceftolozane/tazobactam was an effective and generally well tolerated treatment in patients with cIAI or cUTI. In the ASPECT-cIAI trial, ceftolozane/tazobactam plus metronidazole was noninferior to meropenem in terms of clinical cure rates at the test-of-cure (TOC) visit, with clinical cure rates in subgroup analyses consistent with those in the primary analysis. In the ASPECT-cUTI trial, ceftolozane/tazobactam was superior to levofloxacin in terms of composite cure rates (clinical cure plus microbiological eradiation) at the TOC visit. Further clinical experience should help to more definitively position ceftolozane/tazobactam in the treatment of cIAI and cUTI, including in patients with renal impairment. In the meantime, given its very good in vitro activity against extended-spectrum β-lactamase-producing Enterobacteriaceae and drug-resistant Pseudomonas aeruginosa isolates, ceftolozane/tazobactam provides a potential alternative to currently approved antibacterials for empirical treatment of cIAI and cUTI in adults.

  18. cGAS-STING-TBK1-IRF3/7 induced interferon-β contributes to the clearing of non tuberculous mycobacterial infection in mice.

    Ruangkiattikul, Nanthapon; Nerlich, Andreas; Abdissa, Ketema; Lienenklaus, Stefan; Suwandi, Abdulhadi; Janze, Nina; Laarmann, Kristin; Spanier, Julia; Kalinke, Ulrich; Weiss, Siegfried; Goethe, Ralph


    Type I interferons (IFN-I), such as IFN-α and IFN-β are important messengers in the host response against bacterial infections. Knowledge about the role of IFN-I in infections by nontuberculous mycobacteria (NTM) is limited. Here we show that macrophages infected with pathogens of the Mycobacterium avium complex produced significantly lower amounts of IFN-β than macrophages infected with the opportunistic pathogen M. smegmatis. To dissect the molecular mechanisms of this phenomenon, we focused on the obligate pathogen Mycobacterium avium ssp paratuberculosis (MAP) and the opportunistic M. smegmatis. Viability of both bacteria was required for induction of IFN-β in macrophages. Both bacteria induced IFN-β via the cGAS-STING-TBK1-IRF3/7-pathway of IFN-β activation. Stronger phosphorylation of TBK1 and higher amounts of extracellular bacterial DNA in the macrophage cytosol were found in M. smegmatis infected macrophages than in MAP infected macrophages. After intraperitoneal infection of mice, a strong Ifnb induction by M. smegmatis correlated with clearance of the bacteria. In contrast, MAP only induced weak Ifnb expression which correlated with bacterial persistence and increased number of granulomas in the liver. In mice lacking the type I interferon receptor we observed improved survival of M. smegmatis while survival of MAP was similar to that in wildtype mice. On the other hand, treatment of MAP infected wildtype mice with the IFN-I inducer poly(I:C) or recombinant IFN-β impaired the survival of MAP. This indicates an essential role of IFN-I in clearing infections by MAP and M. smegmatis. The expression level of IFN-I is decisive for transient versus persistent NTM infection.

  19. Fatores de Risco para Infecção Pós-histerectomia Total Abdominal Risk Factors for Infection after Total Abdominal Hysterectomy

    Melania Maria Ramos de Amorim


    with the occurrence of surgical site infection in patients submitted to total abdominal hysterectomy at the Instituto Materno ¾ Infantil de Pernambuco (iMIP. Methods: a cross-sectional study was conducted, enrolling patients submitted to total abdominal hysterectomy at IMIP who returned to postsurgical consultation for infection control, between January, 1995 and December, 1998 (n = 414. The frequency of surgical site infection (defined according to the CDC criteria, 1998 was 10% (42 cases. Prevalence risk (PR of infection (dependent variable and its 95% confidence interval (CI were calculated for independent variables: age, obesity, hypertension, diabetes, malignant pathology, type of incision, duration of surgery and antibiotic prophylaxis. Multiple logistic regression analysis was used to determine adjusted risk of infection. Results: a significantly increased risk of infection was found for the following variables: age >60 years (PR = 2.39, 95% CI = 1.15-4.94, obesity (PR = 3.2, 95% CI = 1.83-5.59, duration of surgery >2 hours (PR = 2.35, 95% CI = 1.32-4.21 and diabetes (PR = 6.0, 95% CI = 3.41-10.57. On the other hand, risk of infection was significantly reduced when antibiotic prophylaxis was administered (PR = 0.38, 95% CI = 0.21-0.68. Type of incision, malignant disease and hypertension were not associated with infection. Conclusions: the factors associated with increased risk of surgical site infection after total abdominal hysterectomy at IMIP were: age >60 years, obesity, diabetes and surgical duration >2 hours. Antibiotic prophylaxis showed a protective effect with reduction of risk of infection.

  20. Trans-abdominal ultrasonic findings correlated with CD4+ counts in adult HIV-infected patients in Benin, Nigeria

    B O-E Igbinedion


    Full Text Available Objective: The objective of this study is to document the abdominal ultrasound findings in HIV infected patients and compare it with their CD4+ count. Patients and method: 300 confirmed HIV positive patients had abdominal ultrasonography done at the University of Benin Teaching Hospital from November 2007 to January 2008. Each patient’s sonographic findings were correlated with their CD4+ category using the WHO’s HIV classification index. Result: Splenomegaly, hepatomegaly, renomegaly, hyperechoic splenic parenchyma, increased renal echogenicity and lymphadenopathy are among the common sonographic findings. However, few of these findings correlated statistically with the CD4+ count. Conclusion: The versatile diagnostic tool, ultrasound, should continue to be an important imaging equipment in several impoverished communities. In the evaluation of HIV infected patients, its use is invaluable and should be promoted.

  1. Autoimmune Hemolytic Anemia Triggered by Infection with Human Parvovirus B19 after Total Abdominal Colectomy for Ulcerative Colitis.

    Iida, Tomoya; Satoh, Shuji; Nakagaki, Suguru; Shimizu, Haruo; Kaneto, Hiroyuki


    A 50-year-old man was admitted to our hospital for an adhesive ileus 14 years after total abdominal colectomy for ulcerative colitis (UC). The ileus decreased with conservative treatment, however, autoimmune hemolytic anemia (AIHA) was diagnosed due to worsening anemia, a positive direct Coombs test, low haptoglobin, high lactase dehydrogenase, reticulocytosis, and an increase in the erythroblastic series in a bone-marrow examination. Human parvovirus B19 (PV-B19) IgM and PV-B19 DNA were present, indicating the development of AIHA triggered by an infection with PV-B19. The patient is currently being monitored after spontaneous remission. This is the first report of UC after total abdominal colectomy complicated by AIHA triggered by PV-B19 infection.

  2. The omentum-polypropylene sandwich technique: an attractive method to repair large abdominal-wall defects in the presence of contamination or infection.

    Bleichrodt, R.P.; Malyar, A.W.; Vries Reilingh, T.S. de; Buyne, O.R.; Bonenkamp, J.J.; Goor, H. van


    BACKGROUND: Repair of abdominal wall defects in the presence of contamination or infection continues to be a significant problem for surgeons. The loss of tissue warrants reinforcement of the abdominal wall, preferably by autologous material. However, autologous repair often requires extensive

  3. The omentum-polypropylene sandwich technique: an attractive method to repair large abdominal-wall defects in the presence of contamination or infection.

    Bleichrodt, R.P.; Malyar, A.W.; Vries Reilingh, T.S. de; Buyne, O.R.; Bonenkamp, J.J.; Goor, H. van


    BACKGROUND: Repair of abdominal wall defects in the presence of contamination or infection continues to be a significant problem for surgeons. The loss of tissue warrants reinforcement of the abdominal wall, preferably by autologous material. However, autologous repair often requires extensive opera

  4. Use of negative pressure wound therapy in the management of infected abdominal wounds containing mesh: an analysis of outcomes.

    Baharestani, Mona Mylene; Gabriel, Allen


    The purpose of this study was to examine the clinical outcomes of negative pressure wound therapy (NPWT) using reticulated open-cell foam (ROCF) in the adjunctive management of abdominal wounds with exposed and known infected synthetic mesh. A non randomised, retrospective review of medical records for 21 consecutive patients with infected abdominal wounds treated with NPWT was conducted. All abdominal wounds contained exposed synthetic mesh [composite, polypropylene (PP), or knitted polyglactin 910 (PG) mesh]. Demographic and bacteriological data, wound history, pre-NPWT and comparative post-NPWT, operative procedures and complications, hospital length of stay (LOS) and wound healing outcomes were all analysed. Primary endpoints measured were (1) hospital LOS prior to initiation of NPWT, (2) total time on NPWT, (3) hospital LOS from NPWT initiation to discharge and (4) wound closure status at discharge. A total of 21 patients with abdominal wounds with exposed, infected mesh were treated with NPWT. Aetiology of the wounds was ventral hernia repair (n = 11) and acute abdominal wall defect (n = 10). Prior to NPWT initiation, the mean hospital LOS for the composite, PP and PG meshes were 76 days (range: 21-171 days), 51 days (range: 32-62 days) and 19 days (range: 12-39 days), respectively. The mean hospital LOS following initiation of NPWT for wounds with exposed composite, PP and PG mesh were 28, 31 and 32 days, respectively. Eighteen of the 21 wounds (86%) reached full closure after a mean time of 26 days of NPWT and a mean hospital LOS of 30 days postinitiation of NPWT. Three wounds, all with composite mesh left in situ, did not reach full closure, although all exhibited decreased wound dimensions, granulating beds and decreased surface area exposure of mesh. During NPWT/ROCF, one hypoalbuminemic patient with exposed PP mesh developed an enterocutaneous fistula over a prior enterotomy site. This patient subsequently underwent total mesh extraction, takedown of

  5. The Effect of Vaginal Preparation with Povidone Iodine with Routine Abdominal Preparation on Post Cesarean Infection

    M. Mirteimoori


    Full Text Available Introduction & Objective: The most common complications of cesarean section are post operative fever and endometritis. This study was undertaken to assess the effect of preoperative vaginal preparation with povidone iodine on these complications. Materials & Methods: A double blind clinical trial study was conducted on 430 term singleton pregnant women who referred to obstetric department of Ali Ebne Abitaleb Hospital in Zahedan city in 2006-2007 for elective cesarean. All patients received prophylactic antibiotic after umbilical cord clamping. In the control group (215 cases we did only abdominal scrub, but in the case group (215 cases we did additional vaginal preparation with povidone iodine solution before the beginning of cesarean. The exclusion criteria were: placenta previa, gestational or overt diabetes mellitus, corticosteroids usage, morbid obesity and fever before and at cesarean, presence of bloody or meconium-stained amniotic fluid or prolonged surgery. We investigated the patients after first post operative day until removing surgical sutures for development of febrile morbidity (temperature>38C, clinical symptoms and signs of endometritis (fever persisting in association with uterine tenderness and foul lochia, in the absence of physical or laboratory evidence of other infections, wound inflammation (erythematic or tenderness of wound edges, wound infection (signs of inflammation in association with purulent drainage. The statistical data were analyzed by the SPSS software and P.value <0.05 considered significant. Results: There was no significant differentiation between the two groups regarding socioeconomic situation, weight, age, length, parity and time of operation. The results of our study showed that preparation with povidone iodine in elective cesarean before the beginning of surgery, significantly reduces the post operative fever (13.9% in the control group and 2.3% in the case group, P=0.0001 and post operative

  6. Emergence of a unique group of necrotizing mycobacterial diseases.

    Dobos, K. M.; Quinn, F D; Ashford, D. A.; Horsburgh, C R; King, C. H.


    Although most diseases due to pathogenic mycobacteria are caused by Mycobacterium tuberculosis, several other mycobacterial diseases-caused by M. ulcerans (Buruli ulcer), M. marinum, and M. haemophilum-have begun to emerge. We review the emergence of diseases caused by these three pathogens in the United States and around the world in the last decade. We examine the pathophysiologic similarities of the diseases (all three cause necrotizing skin lesions) and common reservoirs of infection (sta...

  7. A species-specific activation of Toll-like receptor signaling in bovine and sheep bronchial epithelial cells triggered by Mycobacterial infections.

    Ma, Yan; Han, Fei; Liang, Jinping; Yang, Jiali; Shi, Juan; Xue, Jing; Yang, Li; Li, Yong; Luo, Meihui; Wang, Yujiong; Wei, Jun; Liu, Xiaoming


    Pulmonary tuberculosis caused by a Mycobacterium infection remains a major public health problem in most part of the world, in part owing to the transmission of its pathogens between hosts including human, domestic and wild animals. To date, molecular mechanisms of the pathogenesis of TB are still incompletely understood. In addition to alveolar macrophages, airway epithelial cells have also been recently recognized as main targets for Mycobacteria infections. In an effort to understand the pathogen-host interaction between Mycobacteria and airway epithelial cells in domestic animals, in present study, we investigated the Toll-like receptor (TLR) signaling in bovine and sheep airway epithelial cells in response to an infection of Mycobacterium tuberculosis avirulent H37Ra stain or Mycobacterium bovis BCG vaccine strain, using primary air-liquid interface (ALI) bronchial epithelial culture models. Our results revealed a host and pathogen species-specific TLR-mediated recognition of pathogen-associated molecular patterns (PAMPs), induction and activation of TLR signaling pathways, and substantial induction of inflammatory response in bronchial epithelial cells in response to Mycobacteria infections between these two species. Interestingly, the activation TLR signaling in bovine bronchial epithelial cells induced by Mycobacteria infection was mainly through a myeloid differentiation factor 88 (MyD88)-independent TLR signaling pathway, while both MyD88-dependent and independent TLR signaling cascades could be induced in sheep epithelial cells. Equally noteworthy, a BCG infection was able to induce both MyD88-dependent and independent signaling in sheep and bovine airway epithelial cells, but more robust inflammatory responses were induced in sheep epithelial cells relative to the bovines; whereas an H37Ra infection displayed an ability to mainly trigger a MyD88-independent TLR signaling cascade in these two host species, and induce a more extent expression of

  8. Specific recognition of mycobacterial protein and peptide antigens by gamma-delta T cell subsets following infection with virulent Mycobacterium bovis

    Promoting effective immunity to Mycobacterium tuberculosis complex pathogens is a challenge that is of interest to the fields of human and veterinary medicine alike. We report that gamma delta T cells from virulent Mycobacterium bovis-infected cattle respond specifically and directly to complex, pro...

  9. Complement depletion deteriorates clinical outcomes of severe abdominal sepsis: a conspirator of infection and coagulopathy in crime?

    Jianan Ren

    Full Text Available BACKGROUND: The complement depletion commonly occurred during sepsis, but it was often underestimated compared with severe infection or coagulation dysfunction. OBJECTIVE: This study was designed to investigate the alteration of complement system in patients with severe abdominal sepsis and evaluate the role of complement depletion in prognosis of such patients. The relationship between complement depletion and infection or coagulopathy was also explored. METHODS: Forty-five patients with severe abdominal sepsis were prospectively conducted among individuals referral to SICU. Currently recommended treatments, such as early goal-directed resuscitation, source control and antibiotics therapy, were performed. Acute physiology and chronic health evaluation II (APACHE II and sepsis related organ failure assessment (SOFA scores were employed to evaluate severity. Plasma levels of C3, C4, CRP, PCT, D-dimer and other parameters were detected within eight times of observation. The 28-day mortality, length of stay, and postoperative complications were compared between complement depletion and non-complement depletion groups. RESULTS: Within the study period, eight (17.8% patients died, five of them suffering from complement depletion. The overall incidence of complement depletion was 64.4%. At admission, mean complement C3 and C4 levels were 0.70 and 0.13 mg/mL, respectively. Using ROC analysis for mortality prediction, the area under the curve of C3 was 0.926 (95% CI, 0.845-0.998, P<0.001, with optimal cutpoint value of 0.578 mg/mL. Complement C3 depletion was shown to be no correlation to severity scores, however, strongly correlated with elevated D-dimer, PCT concentrations and increased postoperative complications. CONCLUSIONS: Complement C3 depletion was found to be connected to poor prognosis in severe abdominal sepsis. This depletion seems to be associated with coagulopathy and aggravated infection during sepsis, which should be paid close

  10. Spectrally selective UV bactericidal effect for curative treatment of post-surgical intra-abdominal abscesses and other infections

    Dudelzak, Alexander E.; Miller, Mark A.; Babichenko, Sergey M.


    Results of in-vitro studies of bactericidal effects of ultraviolet (UV) irradiation on strains causing drug-resistant endo-cavital infections (Enterococcus, Staphylococcus aureus, Pseudomonas aeruginosa, and others) are presented. An original technique to measure effects of UV-irradiation on bacterial growth at different wavelengths has been developed. Spectral dependences of the bactericidal effect have been observed, and spectral maxima of bactericidal efficiency have been found. Applications to curative treatments of wounds, post-surgical intra-abdominal abscesses and other diseases are discussed.

  11. Ceftazidime/avibactam: a novel cephalosporin/nonbeta-lactam beta-lactamase inhibitor for the treatment of complicated urinary tract infections and complicated intra-abdominal infections

    Hidalgo JA


    Full Text Available Jose A Hidalgo,1,2 Celeste M Vinluan,1–3 Nishaal Antony3 1UTEP/UT Austin Cooperative Pharmacy Program, College of Health Sciences, University of Texas at El Paso, El Paso, 2Department of Pharmacy, College of Pharmacy, The University of Texas at Austin, Austin, 3Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA Abstract: There has been greater interest in developing additional antimicrobial agents due to the increasing health care costs and resistance resulting from bacterial pathogens to currently available treatment options. Gram-negative organisms including Enterobacteriaceae and Pseudomonas aeruginosa are some of the most concerning threats due to their resistance mechanisms: extended-spectrum beta-lactamase production and Klebsiella pneumoniae carbapenemase enzymes. Ceftazidime is a third-generation broad-spectrum cephalosporin with activity against P. aeruginosa and avibactam is a novel nonbeta-lactam beta-lactamase inhibitor. Avycaz®, the trade name for this new combination antibiotic, restores the activity of ceftazidime against some of the previously resistant pathogens. Avycaz was approved in 2015 for the treatment of complicated urinary tract infections, including pyelonephritis, and complicated intra-abdominal infections with the addition of metronidazole in patients with little to no other treatment options. This review article assesses the clinical trials and data that led to the approval of this antibiotic, in addition to its spectrum of activity and limitations. Keywords: ceftazidime/avibactam, Avycaz, complicated urinary tract infections, complicated intra-abdominal infections

  12. Duration of antibiotic treatment in surgical infections of the abdomen. Blunt abdominal trauma.

    Melcher, G A; Rüedi, T P


    Blunt abdominal trauma is associated with a low risk of injury to the microorganism-containing hollow viscera. Therefore, routine pre-operative administration of antibiotics is not necessary. Antibiotics are given intraoperatively, if laparotomy discloses transmural injury of a hollow organ and peritoneal contamination. If intervention is early (injuries should be treated with antibiotics for a maximum of 5 days.

  13. Accuracy of ultrasonography and plain-film abdominal radiography in the diagnosis of urologic abnormalities in men with urinary tract infection: critically appraised topic

    Daunt, S.W. [Univ. of Western Ontario, Dept. of Family Medicine, London, Ontario (Canada)


    An adult male patient presented with dysuria and urinary frequency. A subsequent urine culture confirmed the presence of a urinary tract infection. How accurate is the combination of ultrasonography and plain-film abdominal radiography in the diagnosis of urologic abnormalities in men with confirmed urinary tract infection? (author)

  14. Tsukamurella: an unrecognized mimic of atypical mycobacterial keratitis? The first case report.

    Tam, Patrick M K; Young, Alvin L; Cheng, Lulu; Congdon, Nathan; Lam, Philip T H


    The purpose of this study was to report on Tsukamurella as a mimic of atypical mycobacterial infection. We report a patient who had received repeated corneal grafts with culture-proven Tsukamurella keratitis. A slow-progressing corneal abscess that initially developed adjacent to a corneal stitch responded poorly to empiric antibiotic treatment. A preliminary culture report revealed fast-growing mycobacterial species. Treatment adjustments successfully controlled the disease. A final diagnosis of Tsukamurella was subsequently made on the basis of cultures. Tsukamurella exhibits laboratory similarities to mycobacteria and should be considered in the differential of atypical infection of the ocular surface.

  15. In situ repair of a primary Brucella-infected abdominal aortic aneurysm: long-term follow-up.

    Goudard, Yvain; Pierret, Charles; de La Villéon, Bruno; Mlynski, Amélie; de Kerangal, Xavier


    Infected aortic aneurysms represent 0.85 to 1.3% of aortic aneurysms. Most often, the implicated bacteria species are Salmonella sp., Staphylococcus sp. and Streptococcus sp. Brucella-related infected aortic aneurysms are very rare. Most often, they result from endocarditis or from a local septic focus. Combined treatment by antibiotics and surgery is the standard for infectious aneurysms. In the absence of formal factual data, the surgical treatment is still discussed in the literature, especially since endovascular treatments have been in full expansion. We are reporting the case of a female patient presenting with a Brucella-related infra-renal abdominal aortic aneurysm, without primitive infectious source (area) or identified endocarditis. Surgical treatment with in situ prosthetic replacement and omentoplasty in association with adapted antibiotics allowed a favorable outcome with an excellent result after an 8-year follow up.

  16. Primary mucormycosis of abdominal wall: A rare fungal infection in a immunocompetent patient.

    Tapish, Sahu; Taha, Mustafa; Naresh, Garg; Neeraj, Dhamija; Malik Vinod, K


    Mucormycosis of the anterior abdominal wall is an uncommon disease and it is very rare to find this disease in immunocompetent, non-diabetic patients which usually affects patients with trauma, with contaminated wounds, patients with underlying malignancies or patients with immunocompromised state, e.g., diabetics. We herein report a case of primary cutaneous mucormycosis in an immunocompetent and non-diabetic patient. Our patient was a 48-year-old female, executive by profession. She was diagnosed to have cutaneous mucormycosis of the anterior abdominal wall, and was managed with multiple debridements of the wound and intravenous amphotericin B therapy. She was administered a total of 1500 mg of liposomal amphotericin B and when fully healed, split skin grafting was done. We would like to emphasize the importance of high index of suspicion and early start of therapy in a condition with high rate of mortality.

  17. Combined use of waist and hip circumference to identify abdominally obese HIV-infected patients at increased health risk.

    Trevor O'Neill

    Full Text Available OBJECTIVES: To determine whether for a given waist circumference (WC, a larger hip circumference (HC was associated with a reduced risk of insulin resistance, type 2 diabetes (T2D, hypertension and cardiovascular disease (CVD in HIV-infected patients. A second objective was to determine whether, for a given WC, the addition of HC improved upon estimates of abdominal adiposity, in particular visceral adipose tissue (VAT, compared to those obtained by WC alone. METHODS: HIV-infected men (N = 1481 and women (N = 841 were recruited between 2005 and 2009. WC and HC were obtained using standard techniques and abdominal adiposity was measured using computed tomography. RESULTS: After control for WC and covariates, HC was negatively associated with risk of insulin resistance (p<0.05 and T2D [Men: OR = 0.91 (95% CI: 0.86-0.96; Women: OR = 0.91 (95% CI: 0.84-0.98]. For a given WC, HC was also negatively associated with a lower risk of hypertension (p<0.05 and CVD [OR = 0.94 (95% CI: 0.88-0.99] in men, but not women. Although HC was negatively associated with VAT in men and women after control for WC (p<0.05, the addition of HC did not substantially improve upon the prediction of VAT compared to WC alone. CONCLUSIONS: The identification of HIV-infected individuals at increased health risk by WC alone is substantially improved by the addition of HC. Estimates of visceral adipose tissue by WC are not substantially improved by the addition of HC and thus variation in visceral adiposity may not be the conduit by which HC identifies increased health risk.


    Nermeen Galal


    Full Text Available Background: Tuberculosis remains a major health problem in developing countries especially with the emergence of multidrug resistant strains. Mendelian Susceptibility to Mycobacterial Disease (MSMD is a rare disorder with impaired immunity against mycobacterial pathogens. Reported MSMD etiologies highlight the crucial role of the Interferon gamma /Interleukin 12 (IFN-g/ IL-12 axis and the phagocyte respiratory burst axis. Purpose: Screen patients with possible presentations for MSMD. Methods: Patients with disseminated BCG infection following vaccination, atypical mycobacterial infections or recurrent tuberculosis infections were recruited from the Primary Immune Deficiency Clinic at Cairo University Specialized Pediatric Hospital, Egypt and immune and genetic laboratory investigations were conducted at Human Genetic of Infectious Diseases laboratory in Necker Medical School, France from 2005-2009. IFN-g level in patient’s plasma as well as mutations in the eight previously identified MSMD-causing genes were explored. Results: Nine cases from eight (unrelated kindreds were evaluated in detail. We detected a high level of IFN-g in plasma in one patient. Through Sanger sequencing, a homozygous mutation in the IFNGR1 gene at position 485 corresponding to an amino acid change from serine to phenylalanine (S485F, was detected in this patient. Conclusion: We report the first identified cases of MSMD among Egyptian patients, including in particular a new IFNGR1 mutation underlying IFN-gR1 deficiency. The eight remaining patients need to be explored further. These findings have implications regarding the compulsory Bacillus Calmette Guerin vaccination policy in Egypt, especially given the high consanguinity rate. Keywords: Interferon gamma axis, mycobacterium tuberculosis, BCG, consanguinity


    Nermeen Galal


    Full Text Available

    Background: Tuberculosis remains a major health problem in developing countries especially with the emergence of multidrug resistant strains. Mendelian Susceptibility to Mycobacterial Disease (MSMD is a rare disorder with impaired immunity against mycobacterial pathogens. Reported MSMD etiologies highlight the crucial role of the Interferon gamma /Interleukin 12 (IFN-g/ IL-12 axis and the phagocyte respiratory burst axis.

    Purpose: Screen patients with possible presentations for MSMD.

    Methods: Patients with disseminated BCG infection following vaccination, atypical mycobacterial infections or recurrent tuberculosis infections were recruited from the Primary Immune Deficiency Clinic at Cairo University Specialized Pediatric Hospital, Egypt and immune and genetic laboratory investigations were conducted at Human Genetic of Infectious Diseases laboratory in Necker Medical School, France from 2005-2009. IFN-g level in patient’s plasma as well as mutations in the eight previously identified MSMD-causing genes were explored.

    Results: Nine cases from eight (unrelated kindreds were evaluated in detail. We detected a high level of IFN-g in plasma in one patient. Through Sanger sequencing, a homozygous mutation in the IFNGR1 gene at position 485 corresponding to an amino acid change from serine to phenylalanine (S485F, was detected in this patient.

    Conclusion: We report the first identified cases of MSMD among Egyptian patients, including in particular a new IFNGR1 mutation underlying IFN-gR1 deficiency. The eight remaining patients need to be explored further. These findings have implications regarding the compulsory Bacillus Calmette Guerin vaccination policy in Egypt, especially given the high consanguinity rate.

    Keywords: Interferon gamma axis, mycobacterium tuberculosis, BCG, consanguinity

  20. Children with moderate-high infection with Entamoeba coli have higher percentage of body and abdominal fat than non-infected children.

    Zavala, G A; García, O P; Campos-Ponce, M; Ronquillo, D; Caamaño, M C; Doak, C M; Rosado, J L


    Intestinal parasites, virus and bacterial infections are positively associated with obesity and adiposity in vitro and in animal models, but conclusive evidence of this relationship in humans is lacking. The aim of this cross-sectional study was to determine differences in adiposity between infected and non-infected children, with a high prevalence of intestinal parasitic infection and obesity. A total of 296 school-aged children (8.0 ± 1.5 years) from a rural area in Querétaro, Mexico, participated in this study. Anthropometry (weight, height and waist circumference) and body fat (DXA) were measured in all children. A fresh stool sample was collected from each child and analysed for parasites. Questionnaires related to socioeconomic status and clinical history were completed by caretakers. Approximately 11% of the children were obese, and 19% were overweight. The overall prevalence of infection was 61%. Ascaris lumbricoides was the most prevalent soil transmitted helminth (16%) followed by hookworm. Entamoeba coli was the predominant protozoa (20%) followed by Endolimax nana, Balantidium coli, Entamoeba histolytica/dispar, Iodamoeba bütschlii and Giardia lamblia. Children with moderate-heavy infection of E. coli had significantly higher waist circumference, waist-to-height ratio, body and abdominal fat than children not infected or with light-intensity infection (p < 0.05). These findings raise the possibility that a moderate or heavy infection with E. coli may contribute to fat deposition and thereby have long-term consequences on human health. Further studies are needed to better understand if E. coli contributes directly to fat deposition and possible mechanisms. © 2015 World Obesity Federation.

  1. Regression analysis of the risk factors for postoperative nosocomial infection in patients with abdominal tumors: experience from a large cancer centre in China.

    Sun, Zhipeng; Zhu, Yubing; Xu, Guangzhong; Aminbuhe; Zhang, Nengwei


    Nosocomial infection is a common complication after abdominal oncology surgery. Aimed at finding its independent risk factors for prevention, all the patients who underwent abdominal oncology surgery were summarized from March 1(st), 2010 to March 1(st), 2013 from the oncology surgery department, Beijing Shijitan Hospital. The investigated variances were patients' information including admission number, sex, age, diabetes, diagnosis, length of stay, American society of anesthesiologists (ASA) grade, surgery time, number of drainage tubes. Comparisons were taken between the infected cases and non-infected cases for retrospective logistic regression analysis. 4 variances including diabetes, preoperative hospitalization time ≥ 6 days, surgery time ≥ 230 minutes, ASA grade ≥ III were found out to be related to nosocomial infection after surgery. The 4 variances mentioned above were risk factors for nosocomial infection after surgery.

  2. Tuberculosis abdominal Abdominal tuberculosis

    Rubio, T.; M. T. Gaztelu; Calvo, A.; M. Repiso; H. Sarasíbar; F. Jiménez Bermejo; A. Martínez Echeverría


    La tuberculosis abdominal cursa con un cuadro inespecífico, con difícil diagnóstico diferencial respecto a otras entidades de similar semiología. Presentamos el caso de un varón que ingresa por presentar dolor abdominal, pérdida progresiva y notoria de peso corporal y fiebre de dos meses de evolución. El cultivo de la biopsia de colon mostró presencia de bacilo de Koch.Abdominal tuberculosis develops according to a non-specific clinical picture, with a difficult differential diagnosis with re...

  3. New drugs for the treatment of complicated intra-abdominal infections in the era of increasing antimicrobial resistance.

    Syue, Ling-Shan; Chen, Yen-Hsu; Ko, Wen-Chien; Hsueh, Po-Ren


    The continuing increase in multidrug-resistant organisms (MDROs) worldwide has created new challenges in treating complicated intra-abdominal infections (cIAIs). A number of novel antimicrobial agents have been developed against resistant pathogens. To target extended-spectrum β-lactamase (ESBL)-producing pathogens, novel β-lactam antibiotics, such as ceftolozane/tazobactam, ceftazidime/avibactam, aztreonam/avibactam, imipenem/relebactam and S-649266, are antimicrobial alternatives for cIAIs. Two new drugs, eravacycline and plazomicin, have activity against Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae, carbapenem-resistant Acinetobacter baumannii and ESBL-producers. New lipoglycopeptides and oxazolidinones provide feasible options against resistant Gram-positive pathogens. These novel antimicrobials may play a role in improving the clinical outcomes of cIAIs caused by MDROs.

  4. Nontuberculous Mycobacterial Disease Is Not a Contraindication to Lung Transplantation in Patients With Cystic Fibrosis

    Qvist, Tavs; Pressler, Tanja; Thomsen, V O;


    Whether nontuberculous mycobacterial (NTM) disease is a contraindication to lung transplantation remains controversial. We conducted a nationwide study to evaluate the clinical importance of NTM infection among lung transplant patients with cystic fibrosis (CF) in Denmark and to determine if NTM...

  5. Evidence of low prevalence of mycobacterial lymphadenitis in wild boars (Sus scrofa) in Poland.

    Witkowski, Lucjan; Orłowska, Blanka; Rzewuska, Magdalena; Czopowicz, Michał; Welz, Mirosław; Anusz, Krzysztof; Kita, Jerzy


    Mycobacterium spp. and Rhodococcus equi are generally regarded as the main causes of lymphadenitis in pigs and wild boars. In Poland, mycobacterial submandibular lymphadenitis was first diagnosed in a wild boar in 2012 but Mycobacterium spp. infections are also present in the Polish population of European bison (Bison bonasus). The prevalence of lymphadenitis in Polish wild boars has been found to 8.4% (95% CI 6.2-11.3%) and it has been proved that R. equi is not an important cause of purulent lesions in these animals. The current study was carried out to assess the prevalence of mycobacterial lymphadenitis in the Polish wild boar population. Submandibular lymph nodes with purulent lesions collected from 38 wild boars in 2010/2011 and negative for R. equi were included. Calculations based on the hypergeometric approximation were used to determine the probability that at least one positive individual would be detected if the infection had been present at a prevalence greater than or equal to the design prevalence. All 38 samples were negative for Mycobacterium spp. [0% (95% CI 0, 9.2%)]. Epidemiological analysis showed that the true prevalence was 95% likely to be lower than 10%. In conclusion, mycobacterial lymphadenitis seems to occur rarely in wild boars in Poland. Due to the presence of Mycobacterium spp. infections in other wildlife, the surveillance of mycobacterial infections in wild animals in Poland remains an important issue.

  6. Incidence of ESBL producers amongst Gram-negative bacilli isolated from intra-abdominal infections across India (based on SMART study, 2007 data).

    Chaudhuri, B N; Rodrigues, C; Balaji, V; Iyer, R; Sekar, U; Wattal, Chand; Chitnis, D S; Dhole, T N; Joshi, Sangeeta


    This study was conducted in 9 centers spread over India from January 1 to December 31, 2007 to monitor in vitro susceptibility of Gram-negative bacilli to Group I carbapenem, ertapenem and other antimicrobials in intra-abdominal infections and to identify early changes in susceptibility pattern of community or hospital acquired organisms, with a focus on ESBL producers. Gram-negative bacilli isolated from intra-abdominal samples of patients with documented intra-abdominal infections were processed for identification by conventional/ automated methods and antimicrobial susceptibility by Micro-Scan (Siemens) MIC panel against 12 antimicrobials (3rd and 4th generation cephalosporins, Groups I and II carbapenems, amikacin, levofloxacin, amoxicillin-clavulanic acid and piperacillin-tazobactam). A total of 588 isolates were identified, of which 351 (60%) were E. coli and 114 (19%) were Klebsiella spp. 79% of E. coli and 70% of Klebsiella spp. were ESBL producers in general. 110 of E. coli and 35 of Klebsiella isolates were from community-acquired intra-abdominal infections. 80% of E. coli and 63% of Klebsiella isolates from community-acquired infections were ESBL producers, against 79% of E. coli and 73% of Klebsiella isolates from hospital-acquired infections. Amongst the ESBL-positive isolates of E. coli, 94% were susceptible in vitro to ertapenem, 96% to imipenem and 76% to piperacillin-tazobactam. For ESBL-positive isolates of Klebsiella spp., the corresponding figures were 80%, 94% and 59% respectively. The study showed a high incidence of ESBL-producers amongst Enterobacteriaceae isolates from intra-abdominal infections in both community-acquired and hospital-acquired settings across India. Ertapenem was comparable with imipenem against ESBL-positive E. coli isolates, while imipenem was more effective than ertapenem against ESBL-positive Klebsiella isolates.

  7. A Prospective Randomized Trial of Imipenem-Cilastatin Versus Clindamycin/Tobramycin in the Treatmentof Intra-Abdominal and Pelvic Infections

    Lionel A Mandell


    Full Text Available Objective: A Canadian multicentre clinical trial in the treatment of intra-abdominal and pelvic infections to compare the efficacy and safety of monotherapy using imipenem-cilastatin (imipenem (500 mg intravenously every 6 h versus combination therapy with clindamycin/tobramycin (clindamycin 600 mg intravenously every 6 h and tobramycin 1.7 mg/kg intravenously every 8 h.

  8. Antimicrobial Susceptibilities of Aerobic and Facultative Gram-Negative Bacilli from Intra-abdominal Infections in Patients from Seven Regions in China in 2012 and 2013

    Zhang, Hui; Yang, Qiwen; Liao, Kang; Ni, Yuxing; Yu, Yunsong; Hu, Bijie; Sun, Ziyong; Huang, Wenxiang; Wang,Yong; Wu, Anhua; Feng, Xianju; Luo, Yanping; Hu, Zhidong; Chu, Yunzhuo; Chen, Shulan


    To evaluate the antimicrobial susceptibility of Gram-negative bacilli that caused hospital-acquired and community-acquired intra-abdominal infections (IAIs) in China between 2012 and 2013, we determined the susceptibilities to 12 antimicrobials and the extended-spectrum β-lactamase (ESBL) statuses of 3,540 IAI isolates from seven geographic areas in China in a central laboratory using CLSI broth microdilution and interpretive standards. Most infections were caused by Escherichia coli (46.3%) ...


    BOUMA, J


    Surgical site-related infections occurred in 21% of 87 consecutive patients undergoing radical hysterectomy with pelvic lymphadenectomy (RHPL) without planned peri-operative prophylaxis. A prospective, randomized double-blind, placebo-controlled study was conducted in 68 consecutive RHPL patients.

  10. Long-term high-physiological-dose growth hormone reduces intra-abdominal fat in HIV-infected patients with a neutral effect on glucose metabolism

    Hansen, Birgitte Rønde; Haugaard, S B; Jensen, Frank Krieger;


    OBJECTIVES: The aim of the study was to investigate the effect of long-term high-physiological-dose recombinant human growth hormone (rhGH) therapy on fat distribution and glucose metabolism in HIV-infected patients. METHODS: Forty-six HIV-infected Caucasian men on highly active antiretroviral......, glucose tolerance, and total plasma cholesterol and triglycerides did not significantly change during intervention. CONCLUSIONS: Daily 0.7 mg rhGH treatment for 40 weeks reduced abdominal visceral fat and trunk fat mass in HIV-infected patients. This treatment appeared to be safe with respect to glucose...

  11. Rare Case of Non Tuberculous Mycobacterial: A Diagnostic dilemma

    Marathe, N


    Non-Tuberculous Mycobacterial (NTM) infections occur in HIV-negative patients with or without underlying lung disease. It is generally felt that these organisms are acquired from the environment. Unlike tuberculosis, there are no convincing data demonstrating human-to-human OR animal-to-human transmission of NTM. We report a case of NTM infection in a 38 year old patient with underlying emphysematous lung disease. The case highlights the diagnostic dilemma which occurs when persistent sputum Acid- Fast Bacilli (AFB) smears are positive, but Nucleic acid amplification test is negative. To aid the diagnosis and rule out Pulmonary Tuberculosis as the other differential diagnosis, we applied American Thoracic Society\\/Infectious Disease Society of America (ATS\\/IDSA) guidelines & recommendations1. The decision to treat was taken on basis of CT findings, clinical, microbiologic criteria and expert consultation with Microbiology department at Waterford.

  12. Length of stay and cost for surgical site infection after abdominal and cardiac surgery in Japanese hospitals: multi-center surveillance.

    Kusachi, Shinya; Kashimura, Nobuichi; Konishi, Toshiro; Shimizu, Junzo; Kusunoki, Masato; Oka, Masaaki; Wakatsuki, Toshiro; Kobayashi, Junjiro; Sawa, Yoshiki; Imoto, Hiroshi; Motomura, Noboru; Makuuchi, Haruo; Tanemoto, Kazuo; Sumiyama, Yoshinobu


    This study evaluated the influence of surgical site infections (SSIs) after abdominal or cardiac surgery on the post-operative duration of hospitalization and cost. A retrospective 1:1 matched case-control study of length of stay and healthcare expenditures for patients who were discharged from nine hospitals, between April 1, 2006 and March 31, 2008, after undergoing abdominal or cardiac surgery and who did and did not have a SSI. Information was obtained from 246 pairs of patients who had undergone abdominal surgery and 27 pairs of patients who had undergone cardiac surgery. Overall, the mean post-operative hospitalization was 20.7 days longer and the mean post-operative healthcare expenditure was $8,791 higher in the SSI group than for the SSI-free group. Among the patients who had undergone abdominal surgery, development of SSI extended the average hospitalization by 17.6 days and increased the average healthcare expenditure by $6,624. Among the patients who had undergone cardiac surgery, SSI extended the post-operative hospitalization by an average of 48.9 days and increased the post-operative healthcare expenditure by an average of $28,534. Under the current healthcare system in Japan, the development of SSI after abdominal surgery necessitates extension of hospitalization two-fold and increases the post-operative healthcare expenditure 2.5-fold. Development of SSI after cardiac surgery necessitates extension of hospitalization fourfold and increases the healthcare expenditure six-fold.

  13. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery

    Meyhoff, Christian S; Wetterslev, Jørn; Jorgensen, Lars N


    CONTEXT: Use of 80% oxygen during surgery has been suggested to reduce the risk of surgical wound infections, but this effect has not been consistently identified. The effect of 80% oxygen on pulmonary complications has not been well defined. OBJECTIVE: To assess whether use of 80% oxygen reduces...... Control and Prevention. Secondary outcomes included atelectasis, pneumonia, respiratory failure, and mortality. RESULTS: Surgical site infection occurred in 131 of 685 patients (19.1%) assigned to receive 80% oxygen vs 141 of 701 (20.1%) assigned to receive 30% oxygen (odds ratio [OR], 0.94; 95......% confidence interval [CI], 0.72-1.22; P = .64). Atelectasis occurred in 54 of 685 patients (7.9%) assigned to receive 80% oxygen vs 50 of 701 (7.1%) assigned to receive 30% oxygen (OR, 1.11; 95% CI, 0.75-1.66; P = .60), pneumonia in 41 (6.0%) vs 44 (6.3%) (OR, 0.95; 95% CI, 0.61-1.48; P = .82), respiratory...

  14. Simple sequence repeats in mycobacterial genomes

    Vattipally B Sreenu; Pankaj Kumar; Javaregowda Nagaraju; Hampapathalu A Nagarajaram


    Simple sequence repeats (SSRs) or microsatellites are the repetitive nucleotide sequences of motifs of length 1–6 bp. They are scattered throughout the genomes of all the known organisms ranging from viruses to eukaryotes. Microsatellites undergo mutations in the form of insertions and deletions (INDELS) of their repeat units with some bias towards insertions that lead to microsatellite tract expansion. Although prokaryotic genomes derive some plasticity due to microsatellite mutations they have in-built mechanisms to arrest undue expansions of microsatellites and one such mechanism is constituted by post-replicative DNA repair enzymes MutL, MutH and MutS. The mycobacterial genomes lack these enzymes and as a null hypothesis one could expect these genomes to harbour many long tracts. It is therefore interesting to analyse the mycobacterial genomes for distribution and abundance of microsatellites tracts and to look for potentially polymorphic microsatellites. Available mycobacterial genomes, Mycobacterium avium, M. leprae, M. bovis and the two strains of M. tuberculosis (CDC1551 and H37Rv) were analysed for frequencies and abundance of SSRs. Our analysis revealed that the SSRs are distributed throughout the mycobacterial genomes at an average of 220–230 SSR tracts per kb. All the mycobacterial genomes contain few regions that are conspicuously denser or poorer in microsatellites compared to their expected genome averages. The genomes distinctly show scarcity of long microsatellites despite the absence of a post-replicative DNA repair system. Such severe scarcity of long microsatellites could arise as a result of strong selection pressures operating against long and unstable sequences although influence of GC-content and role of point mutations in arresting microsatellite expansions can not be ruled out. Nonetheless, the long tracts occasionally found in coding as well as non-coding regions may account for limited genome plasticity in these genomes.

  15. [Abdominal-pelvic actinomycosis with urinary tract involvement, secondary to gynecologic infection caused by intrauterine device].

    Pérez García, M D; Rodríguez Alonso, A; Núñez López, A; Ojea Calvo, A; Alonso Rodrigo, A; Rodríguez Iglesias, B; Barros Rodríguez, M; Benavente Delgado, J; González-Carreró Fojón, J; Nogueira March, J L


    Abdomino-pelvic actinomycosis is a condition caused by Actinomyces israelii, a Gram-positive opportunistic bacteria that triggers and develops the infection only in previously injured tissues, and then slowly progresses and spreads until it extrinsically affects the urinary tract. Use of an intrauterine device is a known risk factor to suffer from this disease. Relative risk in IUD users is two- to four-fold higher compared to IUD non-users. Risk increased with prolonged IUD use. Treatment is by removal of the causative agent, surgical resection of necrotic tissues and administration of intravenous Penicillin G, 4 million units every 4 hours for 30 days, followed by Amoxicillin 500 mg every 8 hours for 12 months. This paper contributes two cases of abdomino-pelvic actinomycosis with urinary tract involvement in IUD users. Standard treatment was employed with good evolution.

  16. [General infection prevention in abdominal surgery with special reference to intestinal decontamination].

    Schardey, H M


    In surgery prophylaxis for infection is necessary, because patients are immunocompromised due to the underlying disease and the operation while at the same time being increasingly exposed to potentially pathogenic germs. Prophylaxis is based on the control of endogenous and exogenous microorganisms. For this purpose either systemic or locally active topical agents may be employed. Systemically active substances are applied with the aim to kill and eliminate invasive microorganisms in deep tissue levels, either by their own biological activity or by stimulating specific or unspecific host immune reactions. Local topical measures in contrast are to prevent the primary contact between microorganisms and host. The central pillar of systemic measures is the perioperative systemic antibiotic prophylaxis, immunonutrition is beginning to gain importance, and in the future possibly substances such as G-CSF, which directly stimulate the immune system, may be employed. Standard topical measures are sterilization and desinfection while decontamination of the digestive tract has until now not found a wide spread acceptance. For certain indications especially high risk surgical resections with anastomoses at the level of the oesophagus or the lower rectum it is possible to eliminate endogenous intestinal microorganisms effectively using topical decontamination in combination with systemic antibiotics and improve the surgical results, especially anastomotic healing.

  17. Mycobacterial panniculitis caused by Mycobacterium thermoresistibile in a cat

    Polina Vishkautsan


    Full Text Available Case summary A domestic shorthair cat was evaluated for chronic, bilateral, ulcerative dermatitis affecting the inguinal region and lateral aspects of both pelvic limbs. Histopathologic examination of skin biopsies collected throughout the course of disease revealed chronic pyogranulomatous ulcerative dermatitis. Aerobic bacterial skin cultures yielded growth of a methicillin-resistant Staphylococcus aureus and Corynebacterium amycolatum. Upon referral the clinical findings were suggestive of a non-tuberculous Mycobacterium species infection. Previously obtained skin cultures failed to yield growth of mycobacterial organisms. A deep skin biopsy was collected and submitted for mycobacterial culture. At 5 weeks of incubation Mycobacterium thermoresistibile was isolated. In previous reports, M thermoresistibile has been isolated after 2–4 days of incubation, suggesting that this strain may have been a slower growing variant, or other factors (such as prior antimicrobial therapy inhibited rapid growth of this isolate. The cat was hospitalized for intravenous antibiotic therapy, surgical debridement of wounds, vacuum-assisted wound closure therapy and reconstruction procedures. The wounds were ultimately primarily closed and the cat was discharged to the owner after 50 days of hospitalization. Seven months after hospitalization, the ulcerative skin lesions had healed. Relevance and novel information To our knowledge, only two cases of M thermoresistibile panniculitis have been reported in cats. In the only detailed report of feline M thermoresistibile panniculitis, treatment was not attempted. The second case only reported detection of M thermoresistibile by PCR without a clinical description of the case. In our case report, severe chronic skin infection with M thermoresistibile was addressed using prolonged specific antibiotic therapy, surgical debridement and reconstructions, and treatment of secondary bacterial infections.

  18. Gene chip array for differentiation of mycobacterial species and detection of drug resistance

    SHI Xiao-chun; LIU Xiao-qing; XIE Xiu-li; XU Ying-chun; ZHAO Zhi-xian


    Background Gene chip array can differentiate isolated mycobacterial strains using vadous mycobacterium specific probes simultaneously.Gene chip array can evaluate drug resistance to isoniazid and rifampin of tuberculosis strains by detecting drug resistance related gene mutation.This technique has great potential for clinical application.We performed a retrospective study to investigate the capability of gene chip array in the rapid differentiation of species and detection of drug resistance in mycobacterium,and to evaluate its clinical efficacy.Methods We selected 39 patients (54 clinical mycobacterium isolates),used gene chip array to identify the species of these isolates and detect drug resistance to isoniazid and rifampin in Mycobacterium tuberculosis isolates.Meanwhile,these patients' clinical data were analyzed retrospectively.Results Among these 39 patients whose mycopacterium culture were positive,32 patients' isolates were identified as Mycobacterium tubercu/osis, all of them were clinical infection. Seven patients' isolates were identified as non-tuberculosis mycobacterium.Analyzed with their clinical data,only two patients were considered as clinical infection,both of them were diagnosed as hematogenous disseminated Mycobacterium introcellulare infection.The other five patients' isolates were of no clinical significance; their clinical samples were all respiratory specimens.Clinical manifestations of tuberculosis and non-tuberculous mycobacterial infections were similar.Isoniazid resistance was detected in two tuberculosis patients,while rifampin resistance was detected in one tuberculosis patient; there was another patient whose Mycobacterium tuberculosis isolate was resistant to both isoniazid and rifampin (belongs to multidrug resistance tuberculosis).The fact that this patient did not respond to routine anti-tuberculosis chemotherapy also confirmed this result.Conclusions Gene chip array may be a simple,rapid,and reliable method for the

  19. Perioperative oxygen fraction - effect on surgical site infection and pulmonary complications after abdominal surgery: a randomized clinical trial. Rationale and design of the PROXI-Trial

    Meyhoff, Christian Sylvest; Wetterslev, Jørn; Jorgensen, Lars N;


    A high perioperative inspiratory oxygen fraction may reduce the risk of surgical site infections, as bacterial eradication by neutrophils depends on wound oxygen tension. Two trials have shown that a high perioperative inspiratory oxygen fraction (FiO(2) = 0.80) significantly reduced risk...... complications, such as atelectasis, pneumonia and respiratory failure. The aim of our trial is to assess the potential benefits and harms of a high perioperative oxygen fraction in patients undergoing abdominal surgery....

  20. Ganciclovir-Resistant Cytomegalovirus Infection in Abdominal Solid Organ Transplant Recipients: Case Series and Review of the Literature.

    Rolling, Katherine E; Jorgenson, Margaret R; Descourouez, Jillian L; Mandelbrot, Didier A; Redfield, Robert R; Smith, Jeannina A


    Ganciclovir-resistant cytomegalovirus (GR-CMV) is emerging as a significant infection in the abdominal transplant population. GR-CMV is difficult to manage, and treatment options are limited. We report a descriptive case series of 15 patients who had documented GR-CMV at our center and review the literature on treatment of GR-CMV. The first case in this series was detected in 2012; the majority of cases occurred after January 1, 2014, with approximately 50% occurring in 2015. UL97 and UL54 viral genome mutations were present in 100% and 40% of CMV-infected patients, respectively. GR-CMV infection occurred ≤ 1 year posttransplantation in 11 patients (73%). All patients experienced dose reduction of valganciclovir (the oral prodrug of ganciclovir) before the development of GR-CMV. Initial treatment for GR-CMV included a variety of regimens, all including reduction in maintenance immunosuppression. Of the 6 patients with detectable GR-CMV by polymerase chain reaction (PCR) who were discharged without GR-CMV treatment and had a length of stay (LOS) less than 14 days, 83% were subsequently readmitted for treatment of GR-CMV within 2 months (60% in < 20 days); none received leflunomide. Of six patients with a LOS ≥ 14 days, 80% had CMV PCR below quantification on hospital discharge, and only one patient was readmitted in less than 20 days; 83% received leflunomide. Following GR-CMV, there was a 50% rejection incidence, 27% graft loss, and 20% mortality. For patients with more than three admissions for GR-CMV treatment, 100% had a major complication: 60% rejection, 20% graft loss, and 40% mortality. Common clinical characteristics of patients with GR-CMV included high-risk serostatus, lymphocyte depletion, and history of valganciclovir dose reduction. Overall, outcomes were poor. It appears that hospital readmission rate was reduced when CMV was treated to negativity with an initial treatment regimen of reduced immunosuppression, foscarnet, intravenous immunoglobulins

  1. Analysis of nosocomial infections among patients undergoing abdominal operation%腹部手术后患者院内感染情况分析

    唐国文; 甘蔚明


    Objective To investigate the nosocomial infections among patients undergoing abdominal operation . Method Data in three hundred patients underwent abdominal operation in our department from January 2012 to December 2014 were reviewed. Results Seventeen cases developed nosocomial infection after operation, including 6 cases of respiratory system infection, accounting for 35.29%, 4 cases of urinary infection, accounting for 23.53%. The probability of nosocomial infection from the type Ⅲ operations was higher than that from the typeⅡ operations and that by emergency surgery was higher than that by non-emergency operations(P<0.05). Conclusions Respiratory and urinary infections are the major two types of the nosocomial infections in the abdominal operation. Sufficient preoperative preparation and postoperative nursing can reduce the incidence of nosocomial infections in abdominal surgery.%目的:探讨腹部手术后患者院内感染情况。方法2012年1月~2014年12月对300例行腹部手术患者进行调查,了解其腹部手术后院内感染发生情况及进行原因分析,结果300例腹部手术患者中17例发生术后院内感染,发生率为5.67%。主要为呼吸系统感染和泌尿系统感染,分别为35.29%(6/17)和23.53%(4/17)。三类切口较二类切口,急诊手术较非急诊手术患者院内感染发生率明显增高(均P<0.05)。结论腹部手术后院内感染主要为呼吸、泌尿系统感染,三类切口、急诊手术患者术后院内感染发生率较高。

  2. Abdominal and Pelvic CT

    Full Text Available ... to help diagnose the cause of abdominal or pelvic pain and diseases of the internal organs, small bowel and colon, such as: infections such as appendicitis , pyelonephritis or infected fluid collections, also known as abscesses. inflammatory bowel disease such as ulcerative colitis or Crohn's ...

  3. Influences of enteral nutrition combined with probiotics on gut microflora and barrier function of rats with abdominal infection

    Tong-Yi Shen; Huan-Long Qin; Zhi-Guang Gao; Xiao-Bing Fan; Xiao-Ming Hang; Yan-Qun Jiang


    AIM: To investigate the influences of enteral, parenteral nutrition and probiotics delivered by gut on intestinal microecology, epithelial tight junctions, immune and barrier function of rats with abdominal infection.METHODS: Rat abdominal infection models established with cecal ligation and perforation method, were divided into three groups: parenteral nutrition (PN group, n = 7), PN+enteral nutrition (EN group, n = 7) and PN EN + probiotics (probiotics group, n = 7) via the needle jejunostomy and neck vein for five days. The total nutritional supplement of the three groups was isonitrogenic and isocaloric. Probiotics was delivered by jejunostomy 10 mL/d (1 × 108 cfu/mL). The rats were killed on the sixth day. The feces in the cecum were cultured for anaerobic bacterial growth and analyzed with bacterial group DNA fingerprint profile with random amplified polymorphic DNA. The transmembrane binding proteins (occludin) and IgA level in plasma cells of intestine epithelium in colon and terminal ileum were measured by an immunohistochemistry method. The ultrastructure of intestinal epithelial tight junctions in colon and small intestine was observed by electronmicroscopy. Vena cava blood and the homogenated tissue of liver, lung and mesenteric lymph nodes were cultured to determine the bacterial translocations, and endotoxin in the blood from portal vein was detected.RESULTS: (1) The amount of bacteria of gut species in EN group and probiotic group was higher than that in PN group. The DNA-profiles in EN group and probiotic group were similar to that of normal rats. The number of DNAprofiles in probiotics group was much more than that in PN group and EN group. Moreover, there were strange stripes in PN group. (2) The expression of occludin and IgA in the small and large intestine in EN group (2.309± 0.336, 15.440 ± 2.383) and probiotic group (2.938 ±0.515, 16.230 ± 3.183) was improved as compared with PN group (1.207 ± 0.587, P < 0.05, 11.189 ± 2.108, P < 0

  4. Antimicrobial susceptibility of Gram-negative bacteria causing intra-abdominal infections in China: SMART China 2011.

    Zhang, Hui; Yang, Qiwen; Xiao, Meng; Chen, Minjun; Badal, Robert E; Xu, Yingchun


    The Study for Monitoring Antimicrobial Resistance Trends program monitors the activity of antibiotics against aerobic and facultative Gram-negative bacilli (GNBs) from intra-abdominal infections (IAIs) in patients worldwide. In 2011, 1 929 aerobic and facultative GNBs from 21 hospitals in 16 cities in China were collected. All isolates were tested using a panel of 12 antimicrobial agents, and susceptibility was determined following the Clinical Laboratory Standards Institute guidelines. Among the Gram-negative pathogens causing IAIs, Escherichia coli (47.3%) was the most commonly isolated, followed by Klebsiella pneumoniae (17.2%), Pseudomonas aeruginosa (10.1%), and Acinetobacter baumannii (8.3%). Enterobacteriaceae comprised 78.8% (1521/1929) of the total isolates. Among the antimicrobial agents tested, ertapenem and imipenem were the most active agents against Enterobacteriaceae, with susceptibility rates of 95.1% and 94.4%, followed by amikacin (93.9%) and piperacillin/tazobactam (87.7%). Susceptibility rates of ceftriaxone, cefotaxime, ceftazidime, and cefepime against Enterobacteriaceae were 38.3%, 38.3%, 61.1%, and 50.8%, respectively. The leastactive agent against Enterobacteriaceae was ampicillin/sulbactam (25.9%). The extended-spectrum β-lactamase (ESBL) rates among E. coli, K. pneumoniae, Klebsiella oxytoca, and Proteus mirabilis were 68.8%, 38.1%, 41.2%, and 57.7%, respectively. Enterobacteriaceae were the major pathogens causing IAIs, and the most active agents against the study isolates (including those producing ESBLs) were ertapenem, imipenem, and amikacin. Including the carbapenems, most agents exhibited reduced susceptibility against ESBL-positive and multidrug-resistant isolates.

  5. Antimicrobial susceptibility of Gram-negative bacteria causing intra-abdominal infections in China: SMART China 2011

    Zhang Hui; Yang Qiwen; Xiao Meng; Chen Minjun; Robert E.Badal; Xu Yingchun


    Background The Study for Monitoring Antimicrobial Resistance Trends program monitors the activity of antibiotics against aerobic and facultative Gram-negative bacilli (GNBs) from intra-abdominal infections (IAIs) in patients worldwide.Methods In 2011,1 929 aerobic and facultative GNBs from 21 hospitals in 16 cities in China were collected.All isolates were tested using a panel of 12 antimicrobial agents,and susceptibility was determined following the Clinical Laboratory Standards Institute guidelines.Results Among the Gram-negative pathogens causing IAIs,Escherichia coli (47.3%) was the most commonly isolated,followed by Klebsiella pneumoniae (17.2%),Pseudomonas aeruginosa (10.1%),and Acinetobacter baumannii (8.3%).Enterobacteriaceae comprised 78.8% (1521/1929) of the total isolates.Among the antimicrobial agents tested,ertapenem and imipenem were the most active agents against Enterobacteriaceae,with susceptibility rates of 95.1% and 94.4%,followed by amikacin (93.9%) and piperacillin/tazobactam (87.7%).Susceptibility rates of ceftriaxone,cefotaxime,ceftazidime,and cefepime against Enterobacteriaceae were 38.3%,38.3%,61.1%,and 50.8%,respectively.The leastactive agent against Enterobacteriaceae was ampicillin/sulbactam (25.9%).The extended-spectrum β-lactamase (ESBL) rates among E.coli,K.pneumoniae,Klebsiella oxytoca,and Proteus mirabilis were 68.8%,38.1%,41.2%,and 57.7%,respectively.Conclusions Enterobacteriaceae were the major pathogens causing IAIs,and the most active agents against the study isolates (including those producing ESBLs) were ertapenem,imipenem,and amikacin.Including the carbapenems,most agents exhibited reduced susceptibility against ESBL-positive and multidrug-resistant isolates.

  6. Congenital Abdominal Wall Defects

    Risby, Kirsten; Jakobsen, Marianne Skytte; Qvist, Niels


    complications were seen in five (15%) children: four had detachment of the mesh and one patient developed abdominal compartment syndrome. Mesh related clinical infection was observed in five children. In hospital mortality occurred in four cases (2 gastroschisis and 2 omphalocele) and was not procedure......OBJECTIVE: To evaluate the clinical utility of GORE® DUALMESH (GDM) in the staged closure of large congenital abdominal wall defects. MATERIALS AND METHODS: Data of patients with congenital abdominal wall defects managed with GDM was analyzed for outcome regarding complete fascial closure; mesh...

  7. 肝胆外科术后腹腔感染的综合护理%Integrated nursing for abdominal infections after hepatobiliary surgery

    程艳爽; 吕少诚; 徐明月; 高国强; 路辉; 张雯雯; 刘同友; 史宪杰


    OBJECTIVE To explore the integrated nursing of abdominal infection after hepatobiliary surgery. METHODS We retrospectively analyzed the clinical data of 51 patients with abdominal infections after hepatobiliary surgery between Jan 2009 and Dec 2011. All of the patients were treated by the method of the integrated nursing including unobstructed drainage, vacuum suction, and physiotherapy. RESULTS Of 51 patients with abdominal infections, were isolated, there were 35 case-times of single bacterial infectinos and 16 case-times of wixed infections and totally 61 strains of patnogens were isolated, among which the top three pathogens causing infections were 22 (32. 8%) strains of Enterococcus faecalis , 16 (23. 9%) strains of Escherichia coli, and 12 (17. 9%) strains of Enterococcus faecium ; After the integrated nursing for all the patients, forty-seven patients were cured with the effective rate of 92. 2 %, 4 cases were dead. CONCLUSION To adopt the integrated nursing for abdominal infections after hepatobiliary surgery can contribute to the control and treatment of the infections and decrease the mortality of the patients.%目的 探讨肝胆外科术后腹腔感染的综合护理方法.方法 回顾性分析2009年1月-2011年12月51例肝胆外科术后出现腹腔感染患者的临床资料,所有患者术后采用通畅引流、负压吸引、理疗等综合护理方法.结果 51例腹腔感染患者中送检标本培养阳性67例次,其中单一菌感染35例次,混合感染16例次;共检出病原菌67株,位居前3位的病原菌分别为粪肠球菌22株占32.8%、大肠埃希菌16株占23.9%、屎肠球菌12株占17.9%;所有患者经积极综合护理治疗后,47例治愈,治愈率为92.2%,4例死亡.结论 对肝胆外科术后腹腔感染的患者采用综合护理措施,有助于控制和治疗感染,降低患者的死亡率.

  8. Morphological characteristics of tissues of anterior abdominal wall of rats after implantation of alloplastic material, processed with collagen, in the initially infected wounds

    Svisenko O. V.


    Full Text Available A research purpose was to investigate the tissue reactions on implantation of polypropylene mesh, processed with collagen, after the plastic of experimental defect at rats at underaponevrotic localization of prosthesis in the initially infected wounds. Research was performed in two experimental groups. Group 1 – at 27 rats in the conditions of the infected wound the monofilamentous polypropylene mesh of size 1×1,5 sm was fixed under aponevrosis. Group 2 – at 27 rats at analogous conditions with the previously infected wound the underaponevrotic fixation of polypropylene mesh, processed with collagen, was performed. From the data of morphological analysis, use of polypropylene mesh, processed with collagen, after the plastic of experimental defect at rats at underaponevrotic localization of prosthesis in the initially infected wounds accompanied with the acceleration of reparative processes and improvement of restructuring of connective tissue, muscular and vascular components of anterior abdominal wall during 4 weeks after intervention.

  9. Case report of fatal Mycobacterium tilburgii infection.

    Akpinar, Timur; Bakkaloglu, Oguz K; Ince, Burak; Tufan, Fatih; Kose, Murat; Poda, Mehves; Tascioglu, Didem; Koksalan, O Kaya; Saka, Bulent; Erten, Nilgun; Buyukbabani, Nesimi; Kilicaslan, Zeki; Tascioglu, Cemil


    There are few reports concerning Mycobacterium tilburgii infection in humans because this bacterium is non-cultivatable. Herein, using new molecular techniques, we report the case of an immunocompromised patient with fatal disseminated lymphadenitis that was caused by M. tilburgii.26 years old Caucasian HIV negative female patient presented with abdominal pain. Her clinical assessment revealed disseminated lymphadenitis, that was acid fast bacilli positive. Further molecular evaluation showed the causative agent as M. tilburgii. Despite anti mycobacterial therapy and careful management of intervening complications patient died because of an intraabdominal sepsis. This is the first fatal M. tilburgii infection in the literature. This case points the importance of careful management of patient's immune status and intervening infections besides implementation of effective drug treatment.

  10. Jávea consensus guidelines for the treatment of Candida peritonitis and other intra-abdominal fungal infections in non-neutropenic critically ill adult patients.

    Pemán, Javier; Aguilar, Gerardo; Valía, Juan Carlos; Salavert, Miguel; Navarro, David; Zaragoza, Rafael

    Although the management of the invasive candidiasis has improved in the last decade, controversial issues yet remain, especially in the diagnostic and therapeutic approaches to Candida peritonitis and other forms of intra-abdominal fungal infections. We sought to identify core clinical knowledge about intra-abdominal fungal infections and to achieve high-agreement recommendations required to care for critically ill adult patients with Candida peritonitis and other forms of intra-abdominal fungal infection. A biregional Spanish survey, to elucidate the consensus about the already mentioned fungal infections by means of the Delphi technique, was conducted anonymously by e-mail with 29 multidisciplinary experts in invasive fungal infections from 14 hospitals in the Valencia and Murcia communities during 2014. Respondents included intensivists, anesthesiologists, microbiologists, pharmacologists, and infectious disease specialists, who answered 31 questions prepared by a coordination group after a strict review of the literature from the 5 previous years. The educational objectives spanned 6 categories: epidemiology, microbiological diagnosis, clinical diagnosis, antifungal treatment, de-escalation therapy, and special situations. The agreement required among the panelists for each item to be selected had to be higher than 70%. After extracting the recommendations from the selected items, a meeting at which the experts were asked to validate the previously selected recommendations in a second round of scoring took place. After the second round, 36 recommendations were validated according to the following distribution: epidemiology (5), microbiological diagnosis (4), clinical diagnosis (4), antifungal treatment (3), de-escalation therapy (4), and special situations (16). Treatment of Candida peritonitis and other forms of intra-abdominal fungal infections in ICU patients requires a broad range of knowledge application and skills that our recommendations address. Based

  11. Probiotics and synbiotics for the prevention of postoperative infections following abdominal surgery: a systematic review and meta-analysis of randomized controlled trials.

    Lytvyn, L; Quach, K; Banfield, L; Johnston, B C; Mertz, D


    Postoperative infections, particularly surgical site infections (SSIs), cause significant morbidity and mortality. Probiotics or synbiotics are a potential prevention strategy. To evaluate the efficacy of probiotics/synbiotics for reducing postoperative infection risk following abdominal surgery. We searched AMED, Central, CINAHL, Embase, Medline, and grey literature for randomized controlled trials of elective abdominal surgery patients administered probiotics or synbiotics compared to placebo or standard care. Primary outcome was SSIs. Secondary outcomes were adverse events, respiratory tract infections (RTIs), urinary tract infections (UTIs), combined infections, length of hospital stay, and mortality. Using random-effects meta-analyses, we estimated the relative risk (RR) or mean difference (MD) and 95% confidence interval (CI). Tests were performed for heterogeneity, subgroup and sensitivity analyses were conducted, and the overall evidence quality was graded. We identified 20 trials (N = 1374 participants) reporting postoperative infections. Probiotics/synbiotics reduced SSIs (RR: 0.63; 95% CI: 0.41-0.98; N = 15 studies), UTIs (RR: 0.29; 95% CI: 0.15-0.57; N = 11), and combined infections (RR: 0.49; 95% CI: 0.35-0.70; N = 18). There was no difference between groups for adverse events (RR: 0.89; 95% CI: 0.61-1.30; N = 6), RTIs (RR: 0.60; 95% CI: 0.36-1.00; N = 14), length of stay (MD: -1.19; 95% CI: -2.94 to 0.56; N = 12), or mortality (RR: 1.20; 95% CI: 0.58-2.48; N = 15). Our review suggests that probiotics/synbiotics reduce SSIs and UTIs from abdominal surgeries compared to placebo or standard of care, without evidence of safety risk. Overall study quality was low, owing mostly to imprecision (few patients and events, or wide CIs); thus larger multi-centered trials are needed to further assess the certainty in this estimate. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  12. Purification and characterization of the acyltransferase involved in biosynthesis of the major mycobacterial cell envelope glycolipid--monoacylated phosphatidylinositol dimannoside.

    Svetlíková, Zuzana; Baráth, Peter; Jackson, Mary; Korduláková, Jana; Mikušová, Katarína


    Phosphatidylinositol mannosides are essential structural components of the mycobacterial cell envelope. They are implicated in host-pathogen interactions during infection and serve as a basis for biosynthesis of other unique molecules with immunomodulatory properties - mycobacterial lipopolysaccharides lipoarabinomannan and lipomannan. Acyltransferase Rv2611 is involved in one of the initial steps in the assembly of these molecules in Mycobacterium tuberculosis - the attachment of an acyl group to position-6 of the 2-linked mannosyl residue of the phosphatidylinositol mannoside anchor. Although the function of this enzyme was annotated 10 years ago, it has never been completely biochemically characterized due to lack of the pure protein. We have successfully overexpressed and purified MSMEG_2934, the ortholog of Rv2611c from the non-pathogenic model organism Mycobacteriumsmegmatis mc(2)155 using mycobacterial pJAM2 expression system, which allowed confirmation of its in vitro acyltransferase activity, and establishment of its substrate specificity.

  13. Abdominal distention and constipation followed by herpes zoster infection in a 2-month-old female infant.

    Wang, Hongfeng; Fang, Fang


    Gastrointestinal symptoms of herpes zoster in infants are rarely reported. A 2-month-old female infant presented with herpes zoster and additional complication of abdominal distention and constipation. While rashes resolved, abdominal distention and constipation improved soon. To our knowledge, this is the first report of gastrointestinal complication of herpes zoster in infants. Physicians should be aware of the potential for motor involvement of herpes zoster in such infants. Herpes zoster should be considered during the diagnosis in the event of infants presenting with constipation.

  14. Synchronous infection of the aorta and the testis: emphysematous epididymo-orchitis, abdominal aortic mycotic aneurysm, and testicular artery pseudoaneurysm diagnosed by use of MDCT.

    Hegde, Rahul G; Balani, Ankit; Merchant, Suleman A; Joshi, Anagha R


    We report clinical details and imaging findings for a case of emphysematous epididymo-orchitis with co-existing mycotic abdominal aortic aneurysm and a testicular artery pseudoaneurysm in a diabetic 65-year-old male. We report imaging findings from ultrasonography (USG) and contrast-enhanced multidetector computed tomography (MDCT). Use of MDCT to identify, confirm, and define the extent of the disease, and its utility in understanding the pathogenesis of this rare condition are highlighted. For such lethal infections, early diagnosis and intervention can be lifesaving; imaging can be of crucial importance in this.

  15. Early Versus Delayed Source Control in Open Abdomen Management for Severe Intra-abdominal Infections: A Retrospective Analysis on 111 Cases.

    Rausei, Stefano; Pappalardo, Vincenzo; Ruspi, Laura; Colella, Antonio; Giudici, Simone; Ardita, Vincenzo; Frattini, Francesco; Rovera, Francesca; Boni, Luigi; Dionigi, Gianlorenzo


    Time to source control plays a determinant prognostic role in patients having severe intra-abdominal infections (IAIs). Open abdomen (OA) management became an effective treatment option for peritonitis. Aim of this study was to analyze the correlation between time to source control and outcome in patients presenting with abdominal sepsis and treated by OA. We retrospectively analyzed 111 patients affected by abdominal sepsis and treated with OA from May 2007 to May 2015. Patients were classified according to time interval from first patient evaluation to source control. The end points were intra-hospital mortality and primary fascial closure rate. The in-hospital mortality rate was 21.6% (24/111), and the primary fascial closure rate was 90.9% (101/111). A time to source control ≥6 h resulted significantly associated with a poor prognosis and a lower fascial closure rate (mortality 27.0 vs 9.0%, p = 0.04; primary fascial closure 86 vs 100%, p = 0.02). We observed a direct increase in mortality (and a reduction in closure rate) for each 6-h delay in surgery to source control. Early source control using OA management significantly improves outcome of patients with severe IAIs. This damage control approach well fits to the treatment of time-related conditions, particularly in case of critically ill patients.

  16. Immune defects in active mycobacterial diseases in patients with primary immunodeficiency diseases (PIDs).

    Lee, Wen-I; Huang, Jing-Long; Yeh, Kuo-Wei; Jaing, Tang-Her; Lin, Tzou-Yien; Huang, Yhu-Chering; Chiu, Cheng-Hsun


    Natural human immunity to the mycobacteria group, including Mycobacterium tuberculosis, Bacille Calmette-Guérin (BCG) or nontuberculous mycobacteria (NTM), and/or Salmonella species, relies on the functional IL-12/23-IFN-γ integrity of macrophages (monocyte/dendritic cell) connecting to T lymphocyte/NK cells. Patients with severe forms of primary immunodeficiency diseases (PIDs) have more profound immune defects involving this impaired circuit in patients with severe combined immunodeficiencies (SCID) including complete DiGeorge syndrome, X-linked hyper IgM syndrome (HIGM) (CD40L mutation), CD40 deficiency, immunodeficiency with or without anhidrotic ectodermal dysplasia (NEMO and IKBA mutations), chronic granulomatous disease (CGD) and hyper IgE recurrent infection syndromes (HIES). The patients with severe PIDs have broader diverse infections rather than mycobacterial infections. In contrast, patients with an isolated inborn error of the IL-12/23-IFN-γ pathway are exclusively prone to low-virulence mycobacterial infections and nontyphoid salmonella infections, known as Mendelian susceptibility to the mycobacterial disease (MSMD) phenotype. Restricted defective molecules in the circuit, including IFN-γR1, IFN-γR2, IL-12p40, IL-12R-β1, STAT-1, NEMO, IKBA and the recently discovered CYBB responsible for autophagocytic vacuole and proteolysis, and interferon regulatory factor 8 (IRF8) for dendritic cell immunodeficiency, have been identified in around 60% of patients with the MSMD phenotype. Among all of the patients with PIDs referred for investigation since 1985, we have identified four cases with the specific defect (IFNRG1 for three and IL12RB for one), presenting as both BCG-induced diseases and NTM infections, in addition to some patients with SCID, HIGM, CGD and HIES. Furthermore, manifestations in patients with autoantibodies to IFN-γ (autoAbs-IFN-γ), which is categorized as an anticytokine autoantibody syndrome, can resemble the relatively persistent

  17. Epidemiology of Nontuberculous Mycobacterial Lung Disease and Tuberculosis, Hawaii, USA

    Frankland, Timothy B.; Daida, Yihe G.; Honda, Jennifer R.; Olivier, Kenneth N.; Zelazny, Adrian; Honda, Stacey; Prevots, D. Rebecca


    Previous studies found Hawaiians and Asian-Americans/Pacific Islanders to be independently at increased risk for nontuberculous mycobacterial pulmonary disease (NTMPD) and tuberculosis (TB). To better understand NTM infection and TB risk patterns in Hawaii, USA, we evaluated data on a cohort of patients in Hawaii for 2005–2013. Period prevalence of NTMPD was highest among Japanese, Chinese, and Vietnamese patients (>300/100,000 persons) and lowest among Native Hawaiians and Other Pacific Islanders (50/100,000). Japanese patients were twice as likely as all other racial/ethnic groups to have Mycobacterium abscessus isolated (adjusted odds ratio 2.0, 95% CI 1.2–3.2) but were not at increased risk for infection with other mycobacteria species. In contrast, incidence of TB was stable and was lowest among Japanese patients (no cases) and highest among Filipino, Korean, and Vietnamese patients (>50/100,000). Substantial differences exist in the epidemiology of NTMPD by race/ethnicity, suggesting behavioral and biologic factors that affect disease susceptibility. PMID:28221128

  18. Playing hide-and-seek with host macrophages through the use of mycobacterial cell envelope phthiocerol dimycocerosates and phenolic glycolipids

    Ainhoa eARBUES


    Full Text Available Mycobacterial pathogens, including Mycobacterium tuberculosis, the etiological agent of tuberculosis (TB, have evolved a remarkable ability to evade the immune system in order to survive and to colonize the host. Among the most important evasion strategies is the capacity of these bacilli to parasitize host macrophages, since these are major effector cells against intracellular pathogens that can be used as long-term cellular reservoirs. Mycobacterial pathogens employ an array of virulence factors that manipulate macrophage function to survive and establish infection. Until recently, however, the role of mycobacterial cell envelope lipids as virulence factors in macrophage subversion has remained elusive. Here, we will address exclusively the proposed role for phthiocerol dimycocerosates (DIM in the modulation of the resident macrophage response and that of phenolic glycolipids (PGL in the regulation of the recruitment and phenotype of incoming macrophage precursors to the site of infection. We will provide a unique perspective of potential additional functions for these lipids, and highlight obstacles and opportunities to further understand their role in the pathogenesis of TB and other mycobacterial diseases.

  19. How should an infected perinephric haematoma be drained in a tetraplegic patient with baclofen pump implanted in the abdominal wall? – A case report

    Watt John WH


    Full Text Available Abstract Background We present a case to illustrate controversies in percutaneous drainage of infected, perinephric haematoma in a tetraplegic patient, who had implantation of baclofen pump in anterior abdominal wall on the same side as perinephric haematoma. Case presentation A 56-year-old male with C-4 tetraplegia had undergone implantation of programmable pump in the anterior abdominal wall for intrathecal infusion of baclofen to control spasticity. He developed perinephric haematoma while he was taking warfarin as prophylactic for deep vein thrombosis. Perinephric haematoma became infected with a resistant strain of Pseudomonas aeruginosa, and required percutaneous drainage. Positioning this patient on his abdomen without anaesthesia, for insertion of a catheter from behind, was not a realistic option. Administration of general anaesthesia in this patient in the radiology department would have been hazardous. Results and Conclusion Percutaneous drainage was carried out by anterior approach under propofol sedation. The site of entry of percutaneous catheter was close to cephalic end of baclofen pump. By carrying out drainage from anterior approach, and by keeping this catheter for ten weeks, we took a risk of causing infection of the baclofen pump site, and baclofen pump with a resistant strain of Pseudomonas aeruginosa. The alternative method would have been to anaesthetise the patient and position him prone for percutaneous drainage of perinephric collection from behind. This would have ensured that the drainage track was far away from the baclofen pump with minimal risk of infection of baclofen pump, but at the cost of incurring respiratory complications in a tetraplegic subject.


    Manju Singh


    Full Text Available BACKGROUND Dyspepsia is a common presenting complaint of various upper gastrointestinal disorders. The symptoms of causes of dyspepsia often overlap and this makes aetiological diagnosis difficult. Endoscopy is the ideal procedure for identifying organic diseases of the foregut and rapid urease test with endoscopy is a gold standard method for diagnosing the h.pylori infection. Helicobacter pylori infection is associated with various upper gastrointestinal pathologies. MATERIALS AND METHODS This hospital-based case-controlled study was carried out in a tertiary hospital, Dr. Bhim Rao Ambedkar Hospital, which is attached to Pt. J.N.M. Medical College, Raipur, and which provides open access service to endoscopy. Eighty two consecutive adult outpatients and admitted patients under Department of Surgery and Medicine with upper abdominal pain and dyspepsia were screened for eligibility and underwent upper gastrointestinal endoscopy using forward-viewing endoscopes from March 2015 to September 2016. Patients with dyspepsia who are over 18 years of age should undergoendoscopy (EGD for initial work up and divided in case having endoscopic findings and control having normal findings, then apply rapid urease test to all of these patients. RESULTS The most commonly identified endoscopic findings were gastritis (36%, Peptic Ulcer Disease (PUD (13.3%, oesophagitis (11%, duodenitis (7.3%. Gastric cancer was identified in 4.9% of patients and all of them were aged 18 years and above (p>0.05. H. pylori infection was detected in 51% (n=42 of patients. Gastritis andoesophagitis were statistically significantly associated with H. pylori (p0.05. Gastritis, GERD and PUD are the leading causes of dyspepsia. H. pylori infection is present in significant proportion of dyspeptic patients. CONCLUSION In present study, we are concluded that all upper abdominal pain is not due to acid peptic disease, but most of upper abdominal pain is due to acid peptic disease with H

  1. Antimicrobial Treatmdent of "Complicated" Intra-Abdominal Infections and The New IDSA Guidelines - A Commentary and an Alternative European Approach According to Clinical Definitions

    Eckmann C


    Full Text Available Abstract Recently, an update of the IDSA guidelines for the treatment of complicated intraabdominal infections has been published. No guideline can cater for all variations in ecology, antimicrobial resistance patterns, patient characteristics and presentation, health care and reimbursement systems in many different countries. In the short time the IDSA guidelines have been available, a number of practical clinical issues have been raised by physicians regarding interpretation of the guidelines. The main debatable issues of the new IDSA guidelines are described as follows: The authors of the IDSA guidelines present recommendations for the following subgroups of "complicated" IAI: community-acquired intra-abdominal infections of mild-to-moderate and high severity and health care-associated intra-abdominal infections (no general treatment recommendations, only information about antimicrobial therapy of specific resistant bacterial isolates. From a clinical point of view, "complicated" IAI are better differentiated into primary, secondary (community-acquired and postoperative and tertiary peritonitis. Those are the clinical presentations of IAI as seen in the emergency room, the general ward and on ICU. Future antibiotic treatment studies of IAI would be more clinically relevant if they included patients in studies for the efficacy and safety of antibiotics for the treatment of the above mentioned forms of IAI, rather than conducting studies based on the vague term "complicated" intra-abdominal infections. The new IDSA guidelines for the treatment of resistant bacteria fail to mention many of new available drugs, although clinical data for the treatment of "complicated IAI" with new substances exist. Further-more, treatment recommendations for cIAI caused by VRE are not included. This group of diseases comprises enough patients (i.e. the entire group of postoperative and tertiary peritonitis, recurrent interventions in bile duct surgery or

  2. The molecular biology of mycobacterial trehalose in the quest for advanced tuberculosis therapies.

    Nobre, Ana; Alarico, Susana; Maranha, Ana; Mendes, Vitor; Empadinhas, Nuno


    Trehalose is a natural glucose disaccharide identified in the 19th century in fungi and insect cocoons, and later across the three domains of life. In members of the genus Mycobacterium, which includes the tuberculosis (TB) pathogen and over 160 species of nontuberculous mycobacteria (NTM), many of which are opportunistic pathogens, trehalose has been an important focus of research over the last 60 years. It is a crucial player in the assembly and architecture of the remarkable mycobacterial cell envelope as an element of unique highly antigenic glycolipids, namely trehalose dimycolate ('cord factor'). Free trehalose has been detected in the mycobacterial cytoplasm and occasionally in oligosaccharides with unknown function. TB and NTM infection statistics and death toll, the decline in immune responses in the aging population, human immunodeficiency virus/AIDS or other debilitating conditions, and the proliferation of strains with different levels of resistance to the dated drugs in use, all merge into a serious public-health threat urging more effective vaccines, efficient diagnostic tools and new drugs. This review deals with the latest findings on mycobacterial trehalose biosynthesis, catabolism, processing and recycling, as well with the ongoing quest for novel trehalose-related mechanisms to be targeted by novel TB therapeutics. In this context, the drug-discovery pipeline has recently included new lead compounds directed toward trehalose-related targets highlighting the potential of these pathways to stem the tide of rising drug resistance.

  3. Ubiquitination as a Mechanism To Transport Soluble Mycobacterial and Eukaryotic Proteins to Exosomes.

    Smith, Victoria L; Jackson, Liam; Schorey, Jeffrey S


    Exosomes are extracellular vesicles of endocytic origin that function in intercellular communication. Our previous studies indicate that exosomes released from Mycobacterium tuberculosis-infected macrophages contain soluble mycobacterial proteins. However, it was unclear how these secreted proteins were targeted to exosomes. In this study, we determined that exosome production by the murine macrophage cell line RAW264.7 requires the endosomal sorting complexes required for transport and that trafficking of mycobacterial proteins from phagocytosed bacilli to exosomes was dependent on protein ubiquitination. Moreover, soluble mycobacterial proteins, when added exogenously to RAW264.7 or human HEK293 cells, were endocytosed, ubiquitinated, and released via exosomes. This suggested that endocytosed proteins could be recycled from cells through exosomes. This hypothesis was supported using the tumor-associated protein He4, which, when endocytosed by RAW264.7 or HEK293 cells, was transported to exosomes in a ubiquitin-dependent manner. Our data suggest that ubiquitination is a modification sufficient for trafficking soluble proteins within the phagocytic/endocytic network to exosomes.

  4. Mycofactocin-associated mycobacterial dehydrogenases with non-exchangeable NAD cofactors

    Haft, Daniel H.; Pierce, Phillip G.; Mayclin, Stephen J.; Sullivan, Amy; Gardberg, Anna S.; Abendroth, Jan; Begley, Darren W.; Phan, Isabelle Q.; Staker, Bart L.; Myler, Peter J.; Marathias, Vasilios M.; Lorimer, Donald D.; Edwards, Thomas E.


    During human infection, Mycobacterium tuberculosis (Mtb) survives the normally bacteriocidal phagosome of macrophages. Mtb and related species may be able to combat this harsh acidic environment which contains reactive oxygen species due to the mycobacterial genomes encoding a large number of dehydrogenases. Typically, dehydrogenase cofactor binding sites are open to solvent, which allows NAD/NADH exchange to support multiple turnover. Interestingly, mycobacterial short chain dehydrogenases/reductases (SDRs) within family TIGR03971 contain an insertion at the NAD binding site. Here we present crystal structures of 9 mycobacterial SDRs in which the insertion buries the NAD cofactor except for a small portion of the nicotinamide ring. Line broadening and STD-NMR experiments did not show NAD or NADH exchange on the NMR timescale. STD-NMR demonstrated binding of the potential substrate carveol, the potential product carvone, the inhibitor tricyclazol, and an external redox partner 2,6-dichloroindophenol (DCIP). Therefore, these SDRs appear to contain a non-exchangeable NAD cofactor and may rely on an external redox partner, rather than cofactor exchange, for multiple turnover. Incidentally, these genes always appear in conjunction with the mftA gene, which encodes the short peptide MftA, and with other genes proposed to convert MftA into the external redox partner mycofactocin. PMID:28120876

  5. Abdominal pain

    Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is does not always reflect the seriousness ...

  6. IFN-γ Acts Directly on Activated CD4+ T Cells during Mycobacterial Infection to Promote Apoptosis by Inducing Components of the Intracellular Apoptosis Machinery and by Inducing Extracellular Proapoptotic Signals1

    Li, Xujian; McKinstry, K. Kai; Swain, Susan L.; Dalton, Dyana K.


    Despite many studies, the regulation of CD4+ T cell apoptosis during the shutdown of immune responses is not fully understood. We have investigated the molecular mechanisms of IFN-γ in regulating apoptosis of CD4+ T cells during bacillus Calmette-Guérin (BCG) infection of mice. Our data provide new insight into the regulation of CD4+ T cell apoptosis by IFN-γ. As CD4+ T cells responded to BCG infection, there was a coordinated increase in IFN-γ production by effector CD4+ T cells and a coordi...

  7. Hyperplasia of gastric mucosa in donor rats orally infected with Taenia taeniaeformis eggs and in recipient rats surgically implanted with the larvae in the abdominal cavity.

    Konno, K; Oku, Y; Nonaka, N; Kamiya, M


    Rats heavily infected with Taenia taeniaeformis larvae in the liver show a remarkable increase in their stomach weight, hyperplasia, and hypergastrinemia. However, it is unknown what causes these phenomena. Hence, as a preliminary study to investigate the importance of larval parasitism in the liver, two experiments were done. In the first experiment, 14 donor rats were orally inoculated with 3,000 T. taeniaeformis eggs. In the second experiment, 136-300 of the larvae obtained from the rats were surgically implanted into the abdominal cavity of 7 recipient rats. Gastrin levels and histopathological changes in the gastric mucosa were investigated. In all, 11 donor rats showed hypergastrinemia and hyperplasia, 5 recipient rats showed gastric mucosal hyperplasia accompanied by excessive mucous cell proliferation, and 2 recipient rats showed hypergastrinemia. These results suggest that parasitism of the liver by the larvae is not essential for the development of hyperplasia and that factors from the larvae might cause these phenomena.

  8. Mesenteric lymphadenopathy in patient with Yersinia enterocolitica infection. A differential diagnosis to abdominal lymphoma; Mesenteriale Lymphadenopathie bei Infektion mit Yersinia enterocolitica. Eine Differentialdiagnose zum abdominalen Lymphom

    Trommer, G.; Koesling, S. [Leipzig Univ. (Germany). Klinik und Poliklinik fuer Diagnostische Radiologie; Bewer, A. [Leipzig Univ. (Germany). Klinik fuer Allgemein-, Thorax- und onkologische Chirurgie


    We report a case of previously undiagnosed Yersinia enterocolitica infection in a 46-year old woman. She consulted her physician because of continual weight loss and physical lassitude. A leucocytosis was found. Sonography revealed an excessive enlargement of abdominal lymph nodes. A malignant lymphoma was suspected and the patient underwent a staging by CT. There the disease was limited on mesenteric and retroperitoneal lymph nodes. Bone marrow biopsy and CT-guided lymph node biopsy did not confirm a systemic lymphatic disease. The patient did not undergo a special therapy. After six months, CT showed a clear regression of enlarged lymph nodes. Finally, a previous Yersinia enterocolitica infection of immunotype 03 could be proved serologically. At this time, the patient had no complaints. Diagnostic and differential diagnosis of benign abdominal lymph node enlargement are discussed based on literature. (orig.) [Deutsch] Berichtet wird der Fall einer klinisch inapperenten Yersinia-enterocolitica-Infektion bei einer 46jaehrigen Patientin, die aufgrund stetigen Gewichtsverlustes und koerperlicher Abgeschlagenheit den Hausarzt konsultierte. Dieser diagnostizierte eine Leukozytose. Die daraufhin durchgefuehrte Sonographie ergab eine massive abdominale Lymphknotenvergroesserung. Unter dem Verdacht eines malignen Lymphoms erfolgte eine computertomographische Ausbreitungsdiagnostik, die die Erkrankung auf mesenteriale und retroperitoneale Lymphknoten beschraenkt zeigte. Knochenmarkbiopsie und CT-gestuetzte Lymphknotenpunktion ergaben keinen Hinweis auf eine lymphatische Systemerkrankung. Ohne Therapie zeigte eine CT-Kontrolle nach 6 Monaten eine deutliche Regredienz der Lymphknotenschwellung. Bei der Erregersuche konnte serologisch eine zurueckliegende Infektion mit Yersinia enterocolitica, Serotyp 03, nachgewiesen werden. Zu diesem Zeitpunkt war die Patientin beschwerdefrei. Anhand der Literatur werden Diagnostik und Differentialdiagnose benigner abdominaler

  9. Resistance among Gram-negative ESKAPE pathogens isolated from hospitalized patients with intra-abdominal and urinary tract infections in Latin American countries: SMART 2013-2015

    James A. Karlowsky

    Full Text Available ABSTRACT Gram-negative ESKAPE pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species are important etiologic agents of nosocomial infection that are frequently resistant to broad-spectrum antimicrobial agents. Gram-negative ESKAPE pathogens were collected from hospitalized patients in 11 Latin American countries from 2013 to 2015 as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART global surveillance program. In total, 2113 isolates from intra-abdominal infections (IAI and 970 isolates from urinary tract infections (UTI were tested against antimicrobial agents using standardized CLSI broth microdilution methodology. Of the agents tested, amikacin demonstrated the highest rates of susceptibility (% for K. pneumoniae (92.2, 92.3, Enterobacter spp. (97.5, 92.1, and P. aeruginosa (85.3, 75.2 isolates from both IAI and UTI, respectively. Ertapenem (68.5, 62.6 and imipenem (79.2, 75.9 showed substantially higher rates of susceptibility (% than other β-lactams, including piperacillin-tazobactam (35.9, 37.4 against ESBL-positive isolates of K. pneumoniae from IAI and UTI, respectively. Rates of susceptibility to all agents tested against A. baumannii were ≤30.9%. Gram-negative ESKAPE pathogens isolated from Latin America demonstrated compromised in vitro susceptibility to commonly prescribed broad-spectrum, parenteral antimicrobial agents. Continued surveillance is warranted. New antimicrobial agents with potent activity against Gram-negative ESKAPE pathogens are urgently needed.

  10. Clinical and economic consequences of failure of initial antibiotic therapy for patients with community-onset complicated intra-abdominal infections.

    Yong Pil Chong

    Full Text Available Complicated intra-abdominal infection (cIAI is infection that extends beyond the hollow viscus of origin into the peritoneal space, and is associated with either abscess formation or peritonitis. There are few studies that have assessed the actual costs and outcomes associated with failure of initial antibiotic therapy for cIAI. The aims of this study were to evaluate risk factors and impact on costs and outcomes of failure of initial antibiotic therapy for community-onset cIAI.A retrospective study was performed at eleven tertiary-care hospitals. Hospitalized adults with community-onset cIAI who underwent an appropriate source control procedure between August 2008 and September 2011 were included. Failure of initial antibiotic therapy was defined as a change of antibiotics due to a lack of improvement of the clinical symptoms and signs associated with cIAI in the first week.A total of 514 patients hospitalized for community-onset cIAI were included in the analysis. The mean age of the patients was 53.3 ± 17.6 years, 72 patients (14% had health care-associated infection, and 48 (9% experienced failure of initial antibiotic therapy. Failure of initial antibiotic therapy was associated with increased costs and morbidity. After adjustment for covariates, patients with unsuccessful initial therapy received an additional 2.9 days of parenteral antibiotic therapy, were hospitalized for an additional 5.3 days, and incurred $3,287 in additional inpatient charges. Independent risk factors for failure of initial antibiotic therapy were health care-associated infection, solid cancer, and APACHE II ≥13.To improve outcomes and costs in patients with community-onset cIAI, rapid assessment of health care-associated risk factors and severity of disease, selection of an appropriate antibiotic regimen accordingly, and early infection source control should be performed.

  11. Construction of genomic libraries of mycobacterial origin: identification of recombinants encoding mycobacterial-specific proteins.

    Khandekar, P S; Munshi, A; Sinha, S; Sharma, G; Kapoor, A; Gaur, A; Talwar, G P


    A complete genomic library from Mycobacterium vaccae (2785 recombinants) and a partial genomic library of M. leprae and BCG (300 and 1750 clones, respectively) were constructed in the plasmid pBR322. Bam HI was selected as the restriction endonuclease for obtaining DNA cleavage products. Evidence was obtained for limited expression of the cloned mycobacterial DNA inserts in Escherichia coli. A recombinant has been identified which codes for antigen immunoreactive with rabbit anti-M. leprae antibody but not with anti-H37Rv antibody.

  12. Comparative pharmacoeconomics and efficacy analysis of a new antibiotic adjuvant entity and piperacillin-tazobactam for the management of intra-abdominal infections: A retrospective study

    Sandip Jadhav


    Full Text Available Objective: To analyze the comparative efficacy of piperacillin-tazobactam (PIP-TAZ and ceftriaxone-sulbactam with adjuvant (CSA in the treatment of intra-abdominal infections (IAIs and to assess the costs associated with respective therapies. Methods: The present study analyzed the data collected from 94 IAI patients treated at a tertiary-care hospital. Patient characteristics, infection types, surgical procedures, antibiotic therapies, treatment durations were recorded and overall cost involved in the infections management was estimated in Indian rupee. Results: In total, 46 patients received PIP-TAZ and 48 patients received CSA. The clinical cure was seen in 39.13% patients of PIP-TAZ group and 62.50% patients of CSA group. The patients diagnosed with mixed culture (Gram-positive and negative infections, needed additional cover of clindamycin to achieve clinical success. The failure patients from PIP-TAZ group were shifted to meropenem therapy. For the patients where meropenem and CSA therapy failed, colistin was given as an additional cover. Comparative cost expenditure analysis of the two drug treatment groups revealed that, the overall treatment cost for patients cured with empirical PIP-TAZ group was 51.79% more than that of CSA therapy. The strongest predictor of the increase in treatment costs was clinical failure. Similar trends were maintained for the patients cured with clindamycin additional therapy and change of therapy, with PIP-TAZ group accounting 36.11% and 39.99% more expenditure than CSA group. Conclusions: This study demonstrates that CSA has comparatively higher efficacy as compared to PIP-TAZ when used along with metronidazole in patients with different types of IAIs. Pharmacoeconomic analysis clearly shows that starting appropriate empirical antibiotic therapy has a large impact on the cost of treatment in management of IAIs and selection of CSA, can significantly reduce the cost involved in the treatment.


    Josephine Pudumai Selvi


    Full Text Available BACKGROUND Surgical site infection (SSI is an immense burden on healthcare resources even in the modern era of immaculate sterilization approaches and highly effective antibiotics. An estimated 234 million various surgical procedures, involving skin incisions requiring various types of wound closure techniques, are performed in the world, with the majority resulting in a wound healing by primary intention. Triclosan (5-chloro-2-(2, 4-dichlorophenoxy phenol is a broad-spectrum bactericidal agent that has been used for more than 40 years in various products, such as toothpaste and soaps. Higher concentrations of Triclosan work as a bactericide by attacking different structures in the bacterial cytoplasm and cell membrane. Use of Triclosan-coated sutures should theoretically result in the reduction of SSI. The aim of the study is to assess the abdominal closure with antibacterial coated suture materials and its relation to the incidence of post-operative superficial surgical site infection rates. MATERIALS AND METHODS The data will be collected from hospital records of surgery performed, post-operative daily progress notes and outpatient folders and telephonic conversations with patients after discharge. All patients undergoing laparotomy procedure for any cause. 100 patients divided as 50 in each group. RESULTS The positive outcome of infection (21.5% in patients using ordinary sutures was significantly differed with the positive outcome of infection (11.4% of Triclosan coated sutures. CONCLUSION In conclusion since there was a definite advantage inferred to the patients by using Triclosan coated polyglactin 910, it is the opinion of the researcher that Triclosan coated sutures has a role to play in reducing SSI in clean wounds and its use should be confined to areas where its application has proven benefits. However more studies should be done to clearly define its role and indications in surgery.

  14. Immune Imbalance of Rats with Severe Abdominal Infection%腹腔感染大鼠机体免疫状态变化

    喻文立; 崔乃强; 傅强; 李东华


    Objective To investigate the cellular immune function changes during sever abdominal infection, the mechanism of cellular immune imbalance and the effect of Qingrejiedu (清热解毒) decoction on the immune balance.Methods The rat model of severe abdominal infection was established by intra-abdominal E.coli administration.One hundred and 20 rats were divided into 3 groups randomly, including the control group,the model group and the treatment group.At the time of 12 h, 24, 48 h after the operation, blood sample in the abdominal aorta were collected.Th1/Th2 ratio and Regulatory T cells (Treg) percentage of CD4+ T cell was determined by means of flow cytometry respectively.Results The level of Th1/Th2 ratio increased in the early period of sepsis (12 h) but decreased in the late period of sepsis (from 24 to 72 h) in the model group; while the percentages of Treg in CD4+ T cells were significantly decreased at 12 h and 24 h and increased at 48 h and 72 h in the model group compared with those in the control group.The trends of these parameters were similar in the treatment group, but the magnitudes were smaller.There were negative correlations between the ration of Th1/Th2 and the percentage of Treg both in the model group and in the treatment group.Conclusion There is a dissonance in immunological function in rats with abdominal infection, including a depression in T cell immunological function, whereas Treg may participate in sepsis-induced immunoparalysis.Qingrejiedu( 清热解毒) herbal decoction can obviously ameliorate the immunological disturbance in rats with severe abdominal infection.%目的:观察腹腔感染大鼠的机体免疫状态变化,研究清热解毒方剂对机体细胞免疫失衡的影响.方法:采用人工胃液联合大肠杆菌腹腔内注射的方法建立大鼠腹腔感染模型,取Wistar大鼠120只随机分为对照组、模型组、清热解毒方剂组,造模后12 h、24 h、48 h、72 h经腹主动脉取血,采用流式细胞仪

  15. Susceptibility trends and molecular characterization of Gram-negative bacilli associated with urinary tract and intra-abdominal infections in Jordan and Lebanon: SMART 2011-2013.

    Hayajneh, Wail A; Hajj, Aline; Hulliel, Fawzi; Sarkis, Dolla Karam; Irani-Hakimeh, Noha; Kazan, Lama; Badal, Robert E


    To investigate phenotypic and genotypic patterns of antimicrobial resistance among Gram-negative bacilli associated with urinary tract infection (UTI) and intra-abdominal infection (IAI) in medical centres of Jordan and Lebanon. Gram-negative bacilli from the SMART study, collected between the years 2011 and 2013, were first identified at local laboratories. These isolates were shipped to a central laboratory where re-identification, susceptibility testing, and molecular characterization were performed using standard methods. Among the 523 UTI-associated isolates, Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis were the most frequent (70%, 14%, and 5%, respectively). E. coli, K. pneumoniae, and Pseudomonas aeruginosa were the most frequent species among the 527 IAI-associated isolates (46%, 14%, and 12%, respectively). Incidence rates of extended-spectrum beta-lactamase (ESBL) producers among UTI-associated E. coli, K. pneumoniae, and P. mirabilis were 43%, 54%, and 4%, respectively. Corresponding rates among IAI-associated isolates were 49%, 56%, and 12%, respectively. Acinetobacter baumannii and P. aeruginosa isolates showed very disturbing low susceptibility patterns. CTX-M-15 was the most prevalent ESBL produced. Seventeen isolates were non-susceptible to carbapenems (estimated prevalence of 1.6%). The alarmingly high rates of ESBL production and emergence of carbapenemases emphasize the urgent need to develop antimicrobial stewardship initiatives and to maintain antimicrobial resistance surveillance systems. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  16. Correlation between carbapenem consumption and resistance to carbapenems among Enterobacteriaceae isolates collected from patients with intra-abdominal infections at five medical centers in Taiwan, 2006-2010.

    Ho, Cheng-Mao; Ho, Mao-Wang; Liu, Yung-Ching; Toh, Han-Siong; Lee, Yu-Lin; Liu, Yuag-Meng; Huang, Chi-Chang; Lu, Po-Liang; Liu, Chun-Eng; Chen, Yen-Hsu; Ko, Wen-Chien; Tang, Hung-Jen; Yu, Kwok-Woon; Chen, Yao-Shen; Chuang, Yin-Ching; Wang, Jen-Hsien; Hsueh, Po-Ren


    We investigated the trend in resistance to carbapenems among isolates of Enterobacteriaceae that had been collected from patients with intra-abdominal infections at five medical centers in Taiwan from 2006 to 2010 and evaluated the correlation between resistance to carbapenems and consumption of said agents as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART). During the study period, the usage of ertapenem and that of total carbapenems (ertapenem, imipenem, and meropenem) increased significantly from 6.13 to 13.38 defined daily doses per 1000 patient-days for ertapenem and from 20.43 to 34.25 defined daily doses per 1000 patient-days for total carbapenems. The most common species were Escherichia coli (n = 1095), Klebsiella spp. (n = 663), and Enterobacter spp. (n = 202). The susceptibility of all isolates to ertapenem and to imipenem varied during the study period. For ertapenem, the rates of nonsusceptibility ranged from 3.5% to 10.3% and those for imipenem ranged from 3.5% to 10.7%. Although the use of carbapenems increased during the study period, there was no marked increase in resistance to carbapenems. Continuous monitoring of resistance trends is necessary so that antimicrobial prescription policies can be adjusted and infection control intervention programs can be implemented.

  17. Antimicrobial Susceptibilities of Aerobic and Facultative Gram-Negative Bacilli from Intra-abdominal Infections in Patients from Seven Regions in China in 2012 and 2013.

    Zhang, Hui; Yang, Qiwen; Liao, Kang; Ni, Yuxing; Yu, Yunsong; Hu, Bijie; Sun, Ziyong; Huang, Wenxiang; Wang, Yong; Wu, Anhua; Feng, Xianju; Luo, Yanping; Hu, Zhidong; Chu, Yunzhuo; Chen, Shulan; Cao, Bin; Su, Jianrong; Gui, Bingdong; Duan, Qiong; Zhang, Shufang; Shao, Haifeng; Kong, Haishen; Badal, Robert E; Xu, Yingchun


    To evaluate the antimicrobial susceptibility of Gram-negative bacilli that caused hospital-acquired and community-acquired intra-abdominal infections (IAIs) in China between 2012 and 2013, we determined the susceptibilities to 12 antimicrobials and the extended-spectrum β-lactamase (ESBL) statuses of 3,540 IAI isolates from seven geographic areas in China in a central laboratory using CLSI broth microdilution and interpretive standards. Most infections were caused by Escherichia coli (46.3%) and Klebsiella pneumoniae (19.7%). Rates of ESBL-producing E. coli (P = 0.031), K. pneumoniae (P = 0.017), and Proteus mirabilis (P = 0.004) were higher in hospital-acquired IAIs than in community-acquired IAIs. Susceptibilities of enterobacteriaceae to ertapenem, amikacin, piperacillin-tazobactam, and imipenem were 71.3% to 100%, 81.3% to 100%, 64.7% to 100%, and 83.1% to 100%, respectively, but imipenem was ineffective against P. mirabilis (Zhe) area where the rates of carbapenem resistance were also highest. Ertapenem, amikacin, piperacillin-tazobactam, and imipenem are the most efficacious antibiotics for treating IAIs in China, especially those caused by E. coli or K. pneumoniae. Resistance to cephalosporins and carbapenems is more common in the Jiang-Zhe area than in other regions in China.

  18. An unusual outbreak of nontuberculous mycobacteria in hospital respiratory wards: Association with nontuberculous mycobacterial colonization of hospital water supply network.

    D'Antonio, Salvatore; Rogliani, Paola; Paone, Gregorino; Altieri, Alfonso; Alma, Mario Giuseppe; Cazzola, Mario; Puxeddu, Ermanno


    The incidence and prevalence of pulmonary nontuberculous mycobacterial (NTM) infection is increasing worldwide arousing concerns that NTM infection may become a serious health challenge. We recently observed a significant increase of NTM-positive sputa samples from patients referred to respiratory disease wards of a large tertiary hospital in Rome. A survey to identify possible NTM contamination revealed a massive presence of NTM in the hospital water supply network. After decontamination procedures, NTM presence dropped both in water pipelines and sputa samples. We believe that this observation should encourage water network surveys for NTM contamination and prompt decontamination procedures should be considered to reduce this potential source of infection.

  19. Abdominal Aortic Aneurysm (AAA)

    ... News Physician Resources Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis ... an abdominal aortic aneurysm treated? What is an abdominal aortic aneurysm? The aorta, the largest artery in the body, ...

  20. Anti-Mycobacterial Peptides: From Human to Phage

    Tieshan Teng


    Full Text Available Mycobacterium tuberculosis is the major pathogen of tuberculosis (TB. With the growing problem of M. tuberculosis resistant to conventional antibiotics, especially multi-drug resistant tuberculosis (MDR-TB and extensively-drug resistant tuberculosis (XDR-TB, the need for new TB drugs is now more prominent than ever. Among the promising candidates for anti-TB drugs, anti-mycobacterial peptides have a few advantages, such as low immunogenicity, selective affinity to prokaryotic negatively charged cell envelopes, and diverse modes of action. In this review, we summarize the recent progress in the anti-mycobacterial peptides, highlighting the sources, effectiveness and bactericidal mechanisms of these antimicrobial peptides. Most of the current anti-mycobacterial peptides are derived either from host immune cells, bacterial extraction, or mycobacteriophages. Besides trans-membrane pore formation, which is considered to be the common bactericidal mechanism, many of the anti-mycobacterial peptides have the second non-membrane targets within mycobacteria. Additionally, some antimicrobial peptides play critical roles in innate immunity. However, a few obstacles, such as short half-life in vivo and resistance to antimicrobial peptides, need overcoming before clinical applications. Nevertheless, the multiple functions of anti-mycobacterial peptides, especially direct killing of pathogens and immune-modulators in infectious and inflammatory conditions, indicate that they are promising candidates for future drug development.

  1. Interventional management of abdominal sepsis : when and how

    van Goor, H


    Background: To decide "how and when to treat intra-abdominal infection" is one of the most important challenges for surgeons interested in abdominal sepsis. The minimally invasive approach to intra-abdominal infection, both diagnostic and therapeutic, has gained great popularity in recent years: the

  2. Impacto da automação no diagnóstico de infecções por micobactérias Impact of automation in the diagnosis of mycobacterial infection

    Carmen Paz Oplustil


    oferecer maior segurança para os técnicos durante a realização destes procedimentos.Tuberculosis is a disease of worldwide importance and several years ago in many countries the disease was almost eradicated. With the advent of Aids infection, new cases of the disease started to emerge with the appearance of multiple drug resistant strains. Together with the increase in tuberculosis cases, diagnostic methodologies showed an advance and nowadays there are several manual and automated methodologies for the diagnosis of these infections. The Bactec 460 (Becton Dickinson Diagnostic Systems, Sparks, MD system is used for the direct detection of mycobacteria in clinical specimens, for susceptibility testing against tuberculostatic drugs and differentiation of Mycobacterium tuberculosis complex from other species not of the complex, shortening the process in several days. In this study we evaluated the impact of the introduction of an automated system. In the period of January to June 1995, 326 specimens were processed using the traditional methodology of culture in Lowenstein-Jensen (LJ. Thirty-nine (12% were positive being 77% of these identified as M. tuberculosis. Of the total of 39 positive cultures for M. tuberculosis, 29 (74.3% showed a time for detection greater than 30 days. In the same period in the year of 1997 with the introduction of the semiautomated system, 340 specimens were processed of which 50 (14.7% were positive being 46% of these M. tuberculosis. The mean time for detection of positive cultures for M. tuberculosis was 12 days. The use of the automated system for culture of mycobacteria showed an increase in the number of different species isolated from different specimens, decreasing the time for detection and allowing a better and safe condition for technicians while executing theses procedures.

  3. Pseudomonas aeruginosa necrotizing infection of the abdominal flap in a post-bariatric patient undergoing body contouring surgery.

    Araco, Antonino; Araco, Francesco; Abdullah, Parveen; Overton, John; Gravante, Gianpiero


    Pseudomonas aeruginosa infections may involve any organ or body district and may give serious clinical sequelae. We report the case of an infection of the abdominoplasty flap that compromised wound closure and jeopardized the aesthetic outcome. To the best of our knowledge, this is the first such case reported in the literature for this group of patients. We have presented this case in order to alert plastic and general surgeons who may encounter this complication in future, such that they may be aware of the need to adopt an aggressive approach to manage these patients. This consisted of the accurate monitoring of the patient's clinical condition, prescribing appropriate antibiotics, and performing serial debridement of necrotic tissue.

  4. Novel targeting of PEGylated liposomes for codelivery of TGF-β1 siRNA and four antitubercular drugs to human macrophages for the treatment of mycobacterial infection: a quantitative proteomic study

    Niu NK


    Full Text Available Ning-Kui Niu,1–3 Juan-Juan Yin,3 Yin-Xue Yang,4 Zi-Li Wang,1 Zhi-Wei Zhou,3 Zhi-Xu He,5 Xiao-Wu Chen,6 Xueji Zhang,7 Wei Duan,8 Tianxin Yang,9 Shu-Feng Zhou3 1Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin, 2Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China; 3Department of Pharmaceutical Sciences, College of Pharmacy, University of South Florida, Tampa, FL, USA; 4Department of Colorectal Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 5Guizhou Provincial Key Laboratory for Regenerative Medicine, Stem Cell and Tissue Engineering Research Center and Sino-US Joint Laboratory for Medical Sciences, Guizhou Medical University, Guiyang, Guizhou, 6Department of General Surgery, The First People’s Hospital of Shunde Affiliated to Southern Medical University, Shunde, Foshan, Guangdong, 7Research Center for Bioengineering and Sensing Technology, University of Science and Technology Beijing, Beijing, People’s Republic of China; 8School of Medicine, Deakin University, Waurn Ponds, VIC, Australia; 9Department of Internal Medicine, University of Utah and Salt Lake Veterans Affairs Medical Center, Salt Lake City, UT, USA Abstract: Tuberculosis (TB is still a major public health issue in developing countries, and its chemotherapy is compromised by poor drug compliance and severe side effects. This study aimed to synthesize and characterize new multimodal PEGylated liposomes encapsulated with clinically commonly used anti-TB drugs with linkage to small interfering RNA (siRNA against transforming growth factor-β1 (TGF-β1. The novel NP-siRNA liposomes could target THP-1-derived human macrophages that were the host cells of mycobacterium infection. The biological effects of the NP-siRNA liposomes were evaluated on cell cycle distribution, apoptosis, autophagy, and the gene silencing efficiency of TGF-β1 siRNA in human

  5. [Diagnostic value of IgG antibody levels against 38 kDa mycobacterial antigen].

    Demkow, U; Zielonka, T M; Strzałkowski, J; Michałowska-Mitczuk, D; Augustynowicz-Kopeć, E; Białas-Chromiec, B; Kuś, J; Skopińska-Rózewska, E; Zwolska, Z


    Tuberculosis diagnosis bases on clinical and radiological symptoms and identification of mycobacteria. Accuracy of both methods is limited. Therefore reliable serological test would have considerable advantage. The present study was aimed at evaluating IgG-mediated immune response against specific mycobacterial antigens 38 kDa in group of 200 patients and control subjects. Our material consisted of 104 tuberculosis patients, 25 with sarcoidosis, 24 with lung cancer, 13 with bacterial or fungal pulmonary infection, 8 with mycobacterial infections other than tuberculosis and 26 healthy persons. We used commercially available ELISA based kits (Pathozyme TB-complex). Specificity of 100% and sensitivity of 49% was achieved. Sensitivity increased to 59% in chronic cases and to 52% in culture positive cases. Sensitivity decreased to only 14% in group of new culture negative cases. Measurement of IgG serum level against 38 kDa can be helpful in tuberculosis diagnosis. As the test lacks falsely positive results it indicates its high positive predictive value.

  6. [Antimicrobial susceptibility of Gram-negative bacilli of community acquired intra-abdominal infections in a hospital at Buenos Aires, Argentina].

    Morganti, L; Córdova, E; Cassini, E; Gómez, N; López Moral, L; Badía, M; Rodríguez, C


    Community acquired complicated intra-abdominal infections (cIAI) are a common condition. Few data are available about the level of antimicrobial resistance of Gram-negative bacteria isolated from community acquired cIAIs in Argentina. Retrospective-prospective observational study (March 2010 to February 2012). Gram-negative bacteria antimicrobial susceptibility of isolates from community acquired cIAIs were evaluated. During this period, a total of 85 patients were included and 138 pathogens were collected. Male sex: 58%. Median age: 33. Monomicrobial cultures were obtained in 49% of the cases. Ninety (65%) corresponded to Gram-negative organisms, and 48 (38%) to Gram-positive cocci. Gram-negative organisms most frequently observed were: Escherichia coli 76%, Klebsiella pneumoniae 8%, Pseudomonas aeruginosa 7% and Enterobacter spp. 6%. E. coli and K. pneumoniae showed a high percentage of strains resistance to ciprofloxacin of 37% and 29%, respectively. Similarly, resistance to ampicillin/sulbactam was observed in a 16% of the E. coli isolates. The prevalence of multiresistant Gram-negative organisms was 38%. A high level of resistance to antimicrobials was observed in community acquired cIAIs, mainly to ciprofloxacin and ampicillin/sulbactam two of the most used antimicrobial for empirically treatment of cIAIs in our country. In addition a significant proportion of multiresistant Gram-negative organisms were identified.

  7. Anaphylaxis, Intra-Abdominal Infections, Skin Lacerations, and Behavioral Emergencies: A Literature Review of Austere Analogs for a near Earth Asteroid Mission

    Chough, Natacha G.; Watkins, Sharmi; Menon, Anil S.


    As space exploration is directed towards destinations beyond low-Earth orbit, the consequent new set of medical risks will drive requirements for new capabilities and more resources to ensure crew health. The Space Medicine Exploration Medical Conditions List (SMEMCL), developed by the Exploration Medical Capability element of the Human Research Program, addresses the risk of "unacceptable health and mission outcomes due to limitations of in-flight medical capabilities". It itemizes 85 evidence-based clinical requirements for eight different mission profiles and identifies conditions warranting further research and technology development. Each condition is given a clinical priority for each mission profile. Four conditions -- intra-abdominal infections, skin lacerations, anaphylaxis, and behavioral emergencies -- were selected as a starting point for analysis. A systematic literature review was performed to understand how these conditions are treated in austere, limited-resource, space-analog environments (i.e., high-altitude and mountain environments, submarines, military deployments, Antarctica, isolated wilderness environments, in-flight environments, and remote, resource-poor, rural environments). These environments serve as analogs to spaceflight because of their shared characteristics (limited medical resources, delay in communication, confined living quarters, difficulty with resupply, variable time to evacuation). Treatment of these four medical conditions in austere environments provides insight into medical equipment and training requirements for exploration-class missions.


    Nevein Mohammed Mohammed Gharib


    Full Text Available Background: Obesity is a medical condition that may adversely affect wellbeing and leading to increased incidence of many health problems. Abdominal obesity tends to be associated with weight gain and obesity and it is significantly connected with different disorders like coronary heart disease and type II diabetes mellitus.This study was conducted to investigate the efficacy of vacuum therapy as compared to abdominal exercises on abdominal obesity in overweight and obese women. Methods: Thirtyoverweight and obese women participated in this study with body mass index > 25 kg/m2andwaist circumference ≥ 85 cm. Their ages ranged from 28 - 40 years old.The subjects were excluded if they have diabetes, abdominal infection diseases or any physical limitation restricting exercise ability. They were randomly allocated into two equal groups; group I and group II. Group I received vacuum therapy sessions (by the use of LPG device in addition to aerobic exercise training. Group II received abdominal exercises in addition to the same aerobic exercisesgiven to group I. This study was extended for successive 8 weeks (3 sessions/ week. All subjects were assessed for thickness ofnthe abdominal skin fold, waist circumference and body mass index. Results: The results of this study showeda significant difference between group I and group II post-interventionas regarding to the mean values of waist circumference and abdominal skin fold thickness (p<0.05. Conclusion: It can be concluded that aerobic exercises combined with vacuum therapy (for three sessions/week for successive 8 weeks have a positive effect on women with abdominal obesity in terms of reducing waist circumference and abdominal skin fold thickness.

  9. Intra-abdominal tuberculous peritonitis

    Schneider, G.; Ahlhelm, F.; Altmeyer, K.; Kramann, B. [Dept. of Diagnostic Radiology, University Hospital, Homburg (Germany); Hennes, P. [Dept. of Pediatrics, University Hospital, Homburg (Germany); Pueschel, W. [Dept. of Pathology, University Hospital, Homburg (Germany); Karadiakos, N. [Dept. of Pediatric Surgery, University Hospital, Homburg (Germany)


    We report the case of a 15-year-old boy suffering from progressive dyspnea on exertion and painful abdominal protrusion. Final diagnosis of intra-abdominal tuberculosis (TB), including lymphadenopathy and abdominal abscess formation, was made following elective laparotomy. This type of disease is a rare manifestation of extrapulmonary tuberculosis. The imaging findings in unenhanced and contrast-enhanced MRI and laparoscopic images are presented. Differential diagnosis of abdominal abscess formation and other fungal or bacteriological infections, as well as the imaging findings of this type of lesion, are discussed. This case demonstrates that atypical manifestation of TB may remain unrecognized; thus, awareness of this kind of manifestation of tuberculosis may prevent patients from being subjected to inappropriate therapies. (orig.)

  10. Cutaneous Mycobacterium abscessus Infection Associated with Mesotherapy Injection

    Pranee Wongkitisophon


    Full Text Available Non-tuberculous mycobacterial skin infections have an increasing incidence. In immunocompetent patients, they usually follow local trauma. We present a case of cutaneous Mycobacterium abscessus infection following mesotherapy. The lesions were successfully treated with a combination of clarithromycin, ciprofloxacin, and doxycycline. Atypical mycobacterial infection should be suspected in patients who develop late-onset skin and soft tissue infection after cutaneous injury, injection, and surgical intervention, particularly if they do not respond to conventional antibiotic treatment.

  11. Evaluation of the effects of ozone therapy in the treatment of intra-abdominal infection in rats

    Yglesio Moyses de Souza


    Full Text Available INTRODUCTION: The antibacterial effect of ozone (O3 has been described in the extant literature, but the role of O3 therapy in the treatment of certain types of infection remains controversial. OBJECTIVES: To evaluate the effect of intraperitoneal (i.p. O3 application in a cecal ligation/puncture rat model on interleukins (IL-6, IL-10 and cytokine-induced neutrophil chemoattractant (CINC-1 serum levels, acute lung injury and survival rates. METHODS: Four animal groups were used for the study: a the SHAM group underwent laparotomy; b the cecal ligation/puncture group underwent cecal ligation/puncture procedures; and c the CLP+O2 and CLP+O3 groups underwent CLP+ corresponding gas mixture infusions (i.p. throughout the observation period. IL-6, CINC-1 and IL-10 concentrations were determined by enzyme-linked immunosorbent assay (ELISA. Acute lung injury was evaluated with the Evans blue dye lung leakage method and by lung histology. P<0.05 was considered significant. RESULTS: CINC-1 was at the lowest level in the SHAM group and was lower for the CLP+O3 group vs. the CLP+O2 group and the cecal ligation/puncture group. IL-10 was lower for the SHAM group vs. the other three groups, which were similar compared to each other. IL-6 was lower for the SHAM group vs. all other groups, was lower for the CLP+O3 or CLP+O2 group vs. the cecal ligation/puncture group, and was similar for the CLP+O3 group vs. the CLP+O2 group. The lung histology score was lower for the SHAM group vs. the other groups. The Evans blue dye result was lower for the CLP+O3 group vs. the CLP+O2 group and the cecal ligation/puncture group but similar to that of the SHAM group. The survival rate for the CLP+O3 group was lower than for the SHAM group and similar to that for the other 2 groups (CLP and CLP+O2. CONCLUSION: Ozone therapy modulated the inflammatory response and acute lung injury in the cecal ligation/puncture infection model in rats, although there was no improvement on

  12. Musculoskeletal infections: ultrasound appearances

    Chau, C.L.F. [Department of Radiology, North District Hospital, NTEC, Fanling, NT, Hong Kong (China)]. E-mail:; Griffith, J.F. [Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, NTEC, Shatin, NT, Hong Kong (China)


    Musculoskeletal infections are commonly encountered in clinical practice. This review will discuss the ultrasound appearances of a variety of musculoskeletal infections such as cellulitis, infective tenosynovitis, pyomyositis, soft-tissue abscesses, septic arthritis, acute and chronic osteomyelitis, and post-operative infection. The peculiar sonographic features of less common musculoskeletal infections, such as necrotizing fasciitis, and rice body formation in atypical mycobacterial tenosynovitis, and bursitis will also be presented.

  13. Use of vacuum-assisted closure device in a disastrous form of abdominal sepsis and stoma site infection: systematic review and report of a case.

    Popović, Milos; Barisić, Goran; Marković, Velimir; Petrović, Jelena; Krivokapić, Zoran


    Use of Vacuum-Assisted Closure (VAC) for treatment of open abdomen has been established predominantly in cases of severe abdominal trauma, resulting with high percentage of primary fascial closure. The role of VAC technique in cases of severe diffuse peritonitis is not definitely incorrigible. However, in cases of severe complicated abdominal sepsis VAC come up as a last resort.

  14. Development of a murine mycobacterial growth inhibition assay for evaluating vaccines against Mycobacterium tuberculosis.

    Parra, Marcela; Yang, Amy L; Lim, JaeHyun; Kolibab, Kristopher; Derrick, Steven; Cadieux, Nathalie; Perera, Liyanage P; Jacobs, William R; Brennan, Michael; Morris, Sheldon L


    The development and characterization of new tuberculosis (TB) vaccines has been impeded by the lack of reproducible and reliable in vitro assays for measuring vaccine activity. In this study, we developed a murine in vitro mycobacterial growth inhibition assay for evaluating TB vaccines that directly assesses the capacity of immune splenocytes to control the growth of Mycobacterium tuberculosis within infected macrophages. Using this in vitro assay, protective immune responses induced by immunization with five different types of TB vaccine preparations (Mycobacterium bovis BCG, an attenuated M. tuberculosis mutant strain, a DNA vaccine, a modified vaccinia virus strain Ankara [MVA] construct expressing four TB antigens, and a TB fusion protein formulated in adjuvant) can be detected. Importantly, the levels of vaccine-induced mycobacterial growth-inhibitory responses seen in vitro after 1 week of coculture correlated with the protective immune responses detected in vivo at 28 days postchallenge in a mouse model of pulmonary tuberculosis. In addition, similar patterns of cytokine expression were evoked at day 7 of the in vitro culture by immune splenocytes taken from animals immunized with the different TB vaccines. Among the consistently upregulated cytokines detected in the immune cocultures are gamma interferon, growth differentiation factor 15, interleukin-21 (IL-21), IL-27, and tumor necrosis factor alpha. Overall, we have developed an in vitro functional assay that may be useful for screening and comparing new TB vaccine preparations, investigating vaccine-induced protective mechanisms, and assessing manufacturing issues, including product potency and stability.

  15. Mycobacterial cell-wall skeleton as a universal vaccine vehicle for antigen conjugation.

    Paik, Tae-Hyun; Lee, Ji-Sook; Kim, Ki-Hye; Yang, Chul-Su; Jo, Eun-Kyeong; Song, Chang-Hwa


    Mycobacterial cell-wall skeleton (CWS) is an immunoactive and biodegradable particulate adjuvant and has been used for immunotherapy in patients with cancer. The CWS of Mycobacterium bovis bacillus Calmette-Guérin (BCG-CWS) was studied as a universal vaccine vehicle for antigen conjugation, to develop potentially effective and safe vaccines. Here, we describe experiments in which protein antigens, such as keyhole limpet haemocyanin (KLH), ovalbumin (OVA) and bovine serum albumin (BSA) were highly efficiently coupled to 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide and N-hydroxysuccinimide (EDC/NHS)-activated carboxyl groups of BCG-CWS, and tested the immunogenicity of OVA-conjugated BCG-CWS vaccine. We found that a strong immune response was induced in mice immunised with OVA-conjugated BCG-CWS, which was similar to the enhancement of the immune responses in mice immunised with OVA and complete Freund's adjuvant. Covalent conjugation of OVA to BCG-CWS was essential for Th1-skewed immune responses, with prominent expression of IFN-γ. Furthermore, antigen-conjugated BCG-CWS vaccine is simple to manufacture, safe, and easy to use. Our results suggest that mycobacterial CWS as a universal vaccine vehicle for conjugation of a wide variety of antigens constitutes a breakthrough for development of the most promising vaccines for infections, allergic diseases, and cancer.

  16. Anti-mycobacterial activity of root and leaf extracts of Anthocleista djalonensis (Loganiaceae and Diospyros mespiliformis (Ebenaceae

    Esimone Charles


    Full Text Available We screened the aqueous and methanol leaf and root extracts of Anthocleista djalonensis, Diospyros mespiliformis, and their combinations for possible anti-mycobacterial activities using Mycobacterium smegmatis as a surrogate screen. These plants are reputed among folk practices as potent remedy in the management of tuberculosis and leprosy cases. In the sensitivity screening study, only the methanol extracts of A. djalonensis and D. mespiliformis showed anti-mycobacterial activity, while the aqueous extracts exhibited no inhibitory activity on M. smegmatis. The minimum inhibitory concentration (MIC of the methanol leaf and root extract of A. djalonensis against M. smegmatis were 125 μg/ml. The MIC of the methanol leaf and root extracts of D. mespiliformis is 167 and 250 μg/ml, respectively. In the interaction studies, four out of nine decimal combinations of the two medicinal plant extracts exhibited synergism with fractional inhibitory concentration indices < 1 and a negative activity index values. The 8:2 ratio of D. mespiliformis and A. djalonensis exhibited the greatest degree of antimycobacterial synergy against M. smegmatis. The result of this study supports the claims of efficacy reported in the folk use of these plants in mycobacterial infection and the plants could therefore be investigated further and harnessed as potent antimycobacterial agents.

  17. Diagnosis and treatment of biliary fistula complicated with abdominal infection after liver or biliary surgery%肝脏及胆管术后胆瘘合并腹腔感染的诊疗分析

    吕少诚; 史宪杰; 梁雨荣; 何蕾; 纪文斌; 芦芳; 罗英; 徐明月


    Objective To study the methods of diagnosis and treatment of biliary fistula complicated with abdominal infection. Methods We analyzed the clinical data of 387 patients,among whom 31 cases were diagnosed of biliary fistula and 14 cases were diagnosed of biliary fistula complicated with abdominal infection. The patients who were afraid of biliary fistula complicated with abdominal infection was diagnosed by examining funga in blood,fluid,and image examination (such as abdominal CT scan). Those who were diagnosed with biliary fistula complicated with abdominal infection would be treated by puncture drainage and antibiotics. Results Nineteen pathogenic strains were isolated from 14 patients. Enterococcus faecalis infection was diagnosed in 8 strains (42.1%), Escherichia coli infection was diagnosed in 7 strains (36.8%) ,Shewanella putrefaciens infection was diagnosed in 2 strains (10.5 %),Citrobacter freundii infection was diagnosed in 1 strains(5.3%) ,and Candida tropicalis infection was diagnosed in 1 strains (5.3%). Thirteen patients were cured,and one patient died. Conclusions Image examination and funga examination were the most important methods in the diagnosis of biliary fistula complicated with abdominal infection. The best therapy is puncture drainage.%目的 探讨肝脏及胆管术后胆瘘合并腹腔感染患者的诊断与治疗方法.方法 387例肝胆外科手术的患者,其中胆瘘31例,胆瘘合并腹腔感染14例.对临床上怀疑胆瘘合并腹腔感染的患者行血液及引流液培养、腹部CT等检查,一经确诊,即给予穿刺引流、抗生素等综合治疗措施.结果 14例胆瘘合并腹腔感染的患者中,共培养出阳性菌19例次,其中粪肠球菌感染8例次(42.1%),大肠埃希菌感染7例次(36.8%),腐败希瓦菌感染2例次(10.5%),弗氏柠檬酸杆菌感染1例次(5.3%),热带念珠菌感染1例次(5.3%),患者经治疗后好转13例,死亡1例.结论 对胆瘘合并腹腔感染患者,影像学检查

  18. Complex abdominal wall reconstruction in the setting of active infection and contamination: a systematic review of hernia and fistula recurrence rates.

    Hodgkinson, J D; Maeda, Y; Leo, C A; Warusavitarne, J; Vaizey, C J


    Minimal evidence exists to guide surgeons on the risk of complications when performing abdominal wall reconstruction (AWR) in the presence of active infection, contamination or enterocutaneous fistula. This study aims to establish the outcomes of contaminated complex AWR. Analysis was conducted according to PRISMA guidelines. Systematic search of the MEDLINE, EMBASE and Pubmed databases was performed. Studies reporting exclusively on single-staged repair of contaminated complex AWR were included. Pooled data were analysed to establish rates of complications. Sixteen studies were included, consisting of 601 contaminated complex AWRs, of which 233 included concurrent enterocutaneous fistula repair. The average follow-up period was 26.7 months. There were 146 (24.3%) reported hernia recurrences. When stratified by repair method, suture repair alone had the lowest rate of recurrence (14.2%), followed by nonabsorbable synthetic mesh reinforcement (21.2%), biological mesh (25.8%) and absorbable synthetic mesh (53.1%). Hernia recurrence was higher when fascial closure was not achieved. Of the 233 enterocutaneous fistula repairs, fistula recurrence was seen in 24 patients (10.3%). Suture repair alone had the lowest rate of recurrence (1.6%), followed by nonbiological mesh (10.3%) and biological mesh reinforcement (12%). Forty-six per cent of patients were reported as having a wound-related complication and the mortality rate was 2.5%. It is feasible to perform simultaneous enterocutaneous fistula repair and AWR as rates of recurrent fistula are comparable with series describing enterocutaneous fistula repair alone. Hernias recurred in nearly a quarter of cases. This analysis is limited by a lack of comparative data and variability of outcome reporting. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

  19. Recombinant human growth hormone and rosiglitazone for abdominal fat accumulation in HIV-infected patients with insulin resistance: a randomized, double-blind, placebo-controlled, factorial trial.

    Marshall J Glesby

    Full Text Available BACKGROUND: Recombinant human growth hormone (rhGH reduces visceral adipose tissue (VAT volume in HIV-infected patients but can worsen glucose homeostasis and lipoatrophy. We aimed to determine if adding rosiglitazone to rhGH would abrogate the adverse effects of rhGH on insulin sensitivity (SI and subcutaneous adipose tissue (SAT volume. METHODOLOGY/PRINCIPAL FINDINGS: Randomized, double-blind, placebo-controlled, multicenter trial using a 2×2 factorial design in which HIV-infected subjects with abdominal obesity and insulin resistance were randomized to rhGH 3 mg daily, rosiglitazone 4 mg twice daily, combination rhGH + rosiglitazone, or double placebo (control for 12 weeks. The primary endpoint was change in SI by frequently sampled intravenous glucose tolerance test from entry to week 12. Body composition was assessed by whole body magnetic resonance imaging (MRI and dual Xray absorptiometry (DEXA. Seventy-seven subjects were randomized of whom 72 initiated study drugs. Change in SI from entry to week 12 differed across the 4 arms by 1-way ANCOVA (P = 0.02; by pair-wise comparisons, only rhGH (decreasing SI; P = 0.03 differed significantly from control. Changes from entry to week 12 in fasting glucose and glucose area under the curve on 2-hour oral glucose tolerance test differed across arms (1-way ANCOVA P = 0.004, increasing in the rhGH arm relative to control. VAT decreased significantly in the rhGH arms (-17.5% in rhGH/rosiglitazone and -22.7% in rhGH but not in the rosiglitazone alone (-2.5% or control arms (-1.9%. SAT did not change significantly in any arm. DEXA results were consistent with the MRI data. There was no significant rhGH x rosiglitazone interaction for any body composition parameter. CONCLUSIONS/SIGNIFICANCE: The addition of rosiglitazone abrogated the adverse effects of rhGH on insulin sensitivity and glucose tolerance while not significantly modifying the lowering effect of rhGH on VAT. TRIAL REGISTRATION

  20. Molecular characteristics of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae causing intra-abdominal infections from 9 tertiary hospitals in China.

    Liao, Kang; Chen, Yili; Wang, Menghe; Guo, Penghao; Yang, Qiwen; Ni, Yuxing; Yu, Yunsong; Hu, Bijie; Sun, Ziyong; Huang, Wenxiang; Wang, Yong; Wu, Anhua; Feng, Xianju; Luo, Yanping; Hu, Zhidong; Chu, Yunzhuo; Chen, Shulan; Cao, Bin; Su, Jianrong; Gui, Bingdong; Duan, Qiong; Zhang, Shufang; Shao, Haifeng; Kong, Haishen; Xu, Yingchun


    Recently, the emergence of multidrug-resistant organisms such as extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae has raised considerable concern regarding the appropriate treatment of intra-abdominal infections (IAIs). In this study, we investigated the molecular characteristics of ESBL among clinical isolates of Escherichia coli and Klebsiella pneumoniae causing IAIs and their pattern of antimicrobial resistance, which can provide useful information about the epidemiology and risk factors associated with these infections. One hundred sixty-seven E.coli and 47 K. pneumoniae ESBL-producing strains causing IAIs were collected from 9 hospitals in China, during 2012 and 2013. The antimicrobial susceptibility profile of these strains was determined. Polymerase chain reaction and sequencing were performed to identify genes for β-lactamase (blaTEM, blaSHV, blaOXA-1-like, and blaCTX-M). The isolates were also analyzed by pulsed-field gel electrophoresis (PFGE). In 167 ESBL-producing E. coli strains, 104 strains (62.3%) were positive for CTX-M, and 9 strains (5.39%) were positive for SHV. Among the 47 K. pneumoniae strains, 35 strains (74.5%) were positive for SHV-2a, 12 strains (25.5%) were positive for CTX-M. No TEM-type and OXA-1-like strain was detected among all the ESBL-producing strains. Regarding the CTX-M-positive E. coli and K. pneumoniae strains, CTX-M-15 was the most common genotype in E. coli and K. pneumoniae strains, accounting for 28.7% and 17.0%, respectively, followed by CTX-M-55 accounting for 16.2% and 2.13%, respectively; the remaining genotypes included CTX-M-123 and CTX-M-82. PFGE showed that E.coli and K. pneumoniae ESBL-producing strains causing IAIs were diverse and that emerging resistance may not be due to the dissemination of national clones. The present study revealed that in ESBL-producing strains causing IAIs in China, the most common genotype for E.coli was CTX-M-15 and for K. pneumoniae was SHV-2a. However, there was a

  1. Mycobacterial secretion systems ESX-1 and ESX-5 play distinct roles in host cell death and inflammasome activation

    Abdallah, Abdallah


    During infection of humans and animals, pathogenic mycobacteria manipulate the host cell causing severe diseases such as tuberculosis and leprosy. To understand the basis of mycobacterial pathogenicity, it is crucial to identify the molecular virulence mechanisms. In this study, we address the contribution of ESX-1 and ESX-5 - two homologous type VII secretion systems of mycobacteria that secrete distinct sets of immune modulators - during the macrophage infection cycle. Using wild-type, ESX-1- and ESX-5-deficient mycobacterial strains, we demonstrate that these secretion systems differentially affect subcellular localization and macrophage cell responses. We show that in contrast to ESX-1, the effector proteins secreted by ESX-5 are not required for the translocation of Mycobacterium tuberculosis or Mycobacterium marinum to the cytosol of host cells. However, the M. marinum ESX-5 mutant does not induce inflammasome activation and IL-1b activation. The ESX-5 system also induces a caspase-independent cell death after translocation has taken place. Importantly, by means of inhibitory agents and small interfering RNA experiments, we reveal that cathepsin B is involved in both the induction of cell death and inflammasome activation upon infection with wild-type mycobacteria. These results reveal distinct roles for two different type VII secretion systems during infection and shed light on how virulent mycobacteria manipulate the host cell in various ways to replicate and spread. Copyright © 2011 by The American Association of Immunologists, Inc.

  2. The Epidemiology of Intra-Abdominal Flora in Critically III Patients with Secondary and Tertiary Abdominal Sepsis

    de Ruiter, J.; Weel, J.; Manusama, E.; Kingma, W. P.; van der Voort, P. H. J.


    Background: Different micro-organisms can be cultured from abdominal fluid obtained from patients with intra-abdominal infection resulting from a perforated digestive tract. We evaluated a cohort of patients with abdominal sepsis admitted to the intensive care with the aim of obtaining more insight

  3. The Epidemiology of Intra-Abdominal Flora in Critically III Patients with Secondary and Tertiary Abdominal Sepsis

    de Ruiter, J.; Weel, J.; Manusama, E.; Kingma, W. P.; van der Voort, P. H. J.


    Background: Different micro-organisms can be cultured from abdominal fluid obtained from patients with intra-abdominal infection resulting from a perforated digestive tract. We evaluated a cohort of patients with abdominal sepsis admitted to the intensive care with the aim of obtaining more insight

  4. Mycobacterial toxin induces analgesia in buruli ulcer by targeting the angiotensin pathways.

    Marion, Estelle; Song, Ok-Ryul; Christophe, Thierry; Babonneau, Jérémie; Fenistein, Denis; Eyer, Joël; Letournel, Frank; Henrion, Daniel; Clere, Nicolas; Paille, Vincent; Guérineau, Nathalie C; Saint André, Jean-Paul; Gersbach, Philipp; Altmann, Karl-Heinz; Stinear, Timothy Paul; Comoglio, Yannick; Sandoz, Guillaume; Preisser, Laurence; Delneste, Yves; Yeramian, Edouard; Marsollier, Laurent; Brodin, Priscille


    Mycobacterium ulcerans, the etiological agent of Buruli ulcer, causes extensive skin lesions, which despite their severity are not accompanied by pain. It was previously thought that this remarkable analgesia is ensured by direct nerve cell destruction. We demonstrate here that M. ulcerans-induced hypoesthesia is instead achieved through a specific neurological pathway triggered by the secreted mycobacterial polyketide mycolactone. We decipher this pathway at the molecular level, showing that mycolactone elicits signaling through type 2 angiotensin II receptors (AT2Rs), leading to potassium-dependent hyperpolarization of neurons. We further validate the physiological relevance of this mechanism with in vivo studies of pain sensitivity in mice infected with M. ulcerans, following the disruption of the identified pathway. Our findings shed new light on molecular mechanisms evolved by natural systems for the induction of very effective analgesia, opening up the prospect of new families of analgesics derived from such systems.

  5. Detection of mycobacterial siderophores and implications for diagnostics

    McBride, Nicholas S.


    Mycobacterium tuberculosis (Mtb) is a pervasive human pathogen that continues to kill 1.8 million people every year. Acquisition of iron within the host is vital to the pathogenicity of Mtb and to accomplish this it produces siderophores called mycobactins and carboxymycobactins. This dissertation has sought to build a simple assay for detection and quantification of mycobacterial siderophores that has potential applications in tuberculosis (TB) diagnosis. This assay has been tested a...

  6. Mendelian Susceptibility to Mycobacterial Disease due to IL-12Rβ1 Deficiency in Three Iranian Children

    Shokouh azam SARRAFZADEH


    Full Text Available Mendelian susceptibility to mycobacterial diseases (MSMD is a rare inheritance syndrome, characterized by a disseminated infection with mycobacterium in children following BCG vaccination at birth. Regarding the vaccination program in Iran, it may consider as a public health problem. The pathogenesis of MSMD is dependent on either insufficient production of IFN-gamma (γ or inadequate response to it. Here, we want to introduce three cases including two siblings and one girl from two unrelated families with severe mycobacterial infections referred to Immunology, Asthma and Allergy Research Institute (IAARI, from 2013 to 2015; their MSMD was confirmed by both cytokine assessment and genetic analysis. Regarding the clinical features of the patients, cell proliferation against a mitogen and BCG antigen was ordered in a lymphocyte transformation test (LTT setting. ELISA was performed for the measurement of IL-12p70 and IFN- γ in whole blood samples activated by BCG + recombinant human IFN-γ and BCG + recombinant human IL-12, respectively. In contrast to mitogen, the antigen-dependent proliferation activity of the patients’ leukocytes was significantly lower than that in normal range. We identified a homozygous mutation in IL12RB1 gene for two kindred who had a homozygous mutation affecting an essential splice site. For the third patient, a novel frameshift deletion in IL12RB1 gene was found. The genetic study results confirmed the impaired function of stimulated lymphocytes to release IFN-γ following stimulation with BCG+IL-12 while the response to rhIFN-γ for IL-12p70 production was relatively intact. Our findings show that cellular and molecular assessments are needed for precise identification of immunodeficiency disorders especially those without clear-cut diagnostic criteria. Keywords: Mendelian, IL-12Rβ1 Deficiency, Interfron-gamma, Interleukin 12, Mycobacterium

  7. Mechanism of inducible nitric oxide synthase exclusion from mycobacterial phagosomes.

    Alexander S Davis


    Full Text Available Mycobacterium tuberculosis is sensitive to nitric oxide generated by inducible nitric oxide synthase (iNOS. Consequently, to ensure its survival in macrophages, M. tuberculosis inhibits iNOS recruitment to its phagosome by an unknown mechanism. Here we report the mechanism underlying this process, whereby mycobacteria affect the scaffolding protein EBP50, which normally binds to iNOS and links it to the actin cytoskeleton. Phagosomes harboring live mycobacteria showed reduced capacity to retain EBP50, consistent with lower iNOS recruitment. EBP50 was found on purified phagosomes, and its expression increased upon macrophage activation, paralleling expression changes seen with iNOS. Overexpression of EBP50 increased while EBP50 knockdown decreased iNOS recruitment to phagosomes. Knockdown of EBP50 enhanced mycobacterial survival in activated macrophages. We tested another actin organizer, coronin-1, implicated in mycobacterium-macrophage interaction for contribution to iNOS exclusion. A knockdown of coronin-1 resulted in increased iNOS recruitment to model latex bead phagosomes but did not increase iNOS recruitment to phagosomes with live mycobacteria and did not affect mycobacterial survival. Our findings are consistent with a model for the block in iNOS association with mycobacterial phagosomes as a mechanism dependent primarily on reduced EBP50 recruitment.

  8. Anaerobic Infections

    ... on the face and neck, sometimes after a dental infection or procedure such as a tooth extraction or ... adults of all ages. The most common are dental infections, inflammation of the abdominal lining (peritonitis), and abscesses ...

  9. Investigation on the Influence Factors of Helicobacter Pylori Infection of Children with Recurrent Abdominal Pain%反复腹痛患儿幽门螺杆菌感染影响因素调查分析

    吴凌根; 陈景亮; 孙义娟


    Objective:To analyze and study the influence factors of helicobacter pylori infection of chil-dren with recurrent abdominal pain.Methods:175 children with recurrent abdominal pain who were diag-nosed and treated in our hospital from Feb.2011 to Apr.2013 were selected as research object,and the heli-cobacter pylori infection rate of all the children was analyzed , then the helicobacter pylori infection rate of children with different ages,gender,feeding way,family history of stomach,peptic ulcer and education degree of mother were compared ,and the correction between those factors and helicobacter pylori infection was ana-lyzed.Results:74 cases of 175 children with recurrent abdominal pain were with helicobacter pylori infec-tion,the infection rate was 42.29%,and the infection rate of children with higher age,male,chewing feed-ing,family history of stomach,peptic ulcer and lower education degree of mother were higher than those of others,those factors were all the high risk factors of helicobacter pylori infection by the analysis of logistic,all P<0.05,there were all significant differences.Conclusion:The helicobacter pylori infection rate of children with recurrent abdominal pain is higher,and the age,gender,feeding way,family history of stomach,peptic ulcer and education degree of mother are all the influence factors of helicobacter pylori infection of children with recurrent abdominal pain.%目的:分析研究反复腹痛患儿幽门螺杆菌感染的影响因素。方法:选取2011年2月至2013年4月于本院进行诊治的175例反复腹痛患儿为研究对象,将其中幽门螺杆菌感染率进行统计,并将其中不同年龄、性别、喂食方式、胃病家族史、消化性溃疡及母亲文化程度者的幽门螺杆菌感染率进行比较,并分析上述因素与幽门螺杆菌感染的相关性。结果:175例反复腹痛患儿中74例为幽门螺杆菌感染,感染率为42.29%,其中年龄越高、男性、咀嚼喂食者

  10. Determining the mode of action of anti-mycobacterial C17 diyne natural products using expression profiling: evidence for fatty acid biosynthesis inhibition

    Li, Haoxin; Cowie, Andrew; JOHNSON, JOHN A.; Webster, Duncan; Martyniuk, Christopher J.; Gray, Christopher A.


    Background The treatment of microbial infections is becoming increasingly challenging because of limited therapeutic options and the growing number of pathogenic strains that are resistant to current antibiotics. There is an urgent need to identify molecules with novel modes of action to facilitate the development of new and more effective therapeutic agents. The anti-mycobacterial activity of the C17 diyne natural products falcarinol and panaxydol has been described previously; however, thei...

  11. Polyphenolic acetates : A newer anti-Mycobacterial therapeutic option



    Full Text Available The objective of our research project was screening of various highly specific substrates of Acetoxy Drug: Protein Transacytylase (M.TAase for antimycobacterial activity. Mycobacterial culture was done in Middlebrook’s 7H9 media. Protein purification (Mycobacterial Tranacetylase, M.TAase was done by ion exchange chromatography and its demonstration was done on SDS- polyacrylamide gel electrophoresis (SDS-PAGE and western blot. Middlebrook’s 7H9 broth was procured from Becton Dickinson. CM-Sepharose, DEAE-Sepharose and Q-Sephharose were purchased from Amersham Pharmacia. Anti acetyl lysine polyclonal antibody was purchased from Cell Signaling. The Middlebrook 7H9 medium was used for M. smegmatis culture. The media was prepared according to the manufacturer’s instructions. The various Polyphenol acetate compounds were tested for their antimycobacterial activities. Minimal inhibitory concentrations (MIC were calculated by Alamar blue dye assay method. The GST protein was used as a receptor protein and purified Mycobacterial Glutamine Synthetase (GS as TAase for acetylation by DAMC. To demonstrate the TAase catalyzed acetylation of GST by DAMC, purified M.TAase (GS was preincubated with GST and DAMC followed by western blot using anti acetyl lysine antibody, which avidly react with the acetylated proteins. The growth pattern of M. smegmatis was diminished under the influence of various polyphenolic acetates (PA tested for their anti-mycobacterial activity. DAMC and DAMC-5-carboxylic acid was found to have MIC of 40μg/ml whereas DAMC-6-carboxylic acid was reported to have MIC value of 35μg/ml and for ellagic acid tetra acetate (EATA it was 60μg/ml. Previous work in our lab has led to discovery of a novel enzyme acetoxy drug: protein transacetylase (TAase, catalyzing transfer of acetyl group from various polyphenolic peracetate (PA to certain receptor proteins such as cytochromes P-450, NADPH cytochrome reductase, nitric oxide synthase (NOS

  12. Nitric oxide production inhibition and anti-mycobacterial activity of extracts and halogenated sesquiterpenes from the Brazilian red alga laurencia dendroidea J. Agardh

    Thatiana Lopes Biá Ventura


    Full Text Available Background: Red algae of the genus Laurencia J. V. Lamouroux are a rich source of secondary metabolites with important pharmacological activities such as anti-tumoral, anti-inflammatory, anti-fungal, anti-viral, anti-leishmanial, anti-helminthic, anti-malarial, anti-trypanosomal, anti-microbial as well as anti-bacterial against Mycobacterium tuberculosis. Objective: In the present study, we evaluated the inhibition of nitric oxide (NO and tumor necrosis factor-a production and the anti-mycobacterial activity of crude extracts from the red Alga Laurencia dendroidea (from the South-Eastern coast of Brazil. Halogenated sesquiterpenes elatol (1, obtusol (2 and cartilagineol (3, previously isolated from this Alga by our group, were also studied. Materials and Methods: The lipopolysaccharide-activated macrophage cells (RAW 264.7 were used as inflammation model. Cytotoxic effect was determined using a commercial  lactate dehydrogenase (LDH kit and 3-(4,5-dimethylthiazol-2-yl-2,5-diphenyltetrazolium bromide assay. The growing Mycobacterium inhibition was verified against Mycobacterium bovis Bacillus Calmette-Guιrin and M. tuberculosis H 37 Rv strains. Results: The crude extract from Alga collected at Angra dos Reis, RJ, Brazil, was the most active inhibitor of both mycobacterial growth (half maximal inhibitory concentration [IC 50 ] 8.7 ± 1.4 mg/mL and NO production by activated macrophages (IC 50 5.3 ± 1.3 mg/mL. The assays with isolated compounds revealed the anti-mycobacterial activity of obtusol (2, whereas (--elatol (1 inhibited the release of inflammatory mediators, especially NO. To our knowledge, this is the first report describing an anti-mycobacterial effect of L. dendroidea extract and demonstrating the association of this activity with obtusol (2. Conclusion: The described effects of active compounds from L. dendroidea are promising for the control of inflammation in infectious diseases and specifically, against mycobacterial

  13. Oral antimicrobial rinse to reduce mycobacterial culture contamination among tuberculosis suspects in Uganda: a prospective study.

    Nelson Kalema

    Full Text Available Contamination by bacterial or fungal organisms reduces the effectiveness of mycobacterial culture for diagnosis of pulmonary tuberculosis (TB. We evaluated the effect of an anti-microbial and an anti-fungal oral rinse prior to expectoration on culture-contamination rates.We enrolled a consecutive random sample of adults with cough for ≥ 2 weeks and suspected TB admitted to Mulago Hospital (Kampala, Uganda between October 2008 and June 2009. We randomly assigned patients to oral rinse (60 seconds with chlorhexidine followed by 60 seconds with nystatin vs. no oral rinse prior to initial sputum collection. Uganda National Tuberculosis Reference Laboratory technicians blinded to the method of sputum collection (with or without oral rinse processed all sputum specimens for smear microscopy (direct Ziehl-Neelsen and mycobacterial culture (Lowenstein-Jensen media.Of 220 patients enrolled, 177 (80% were HIV-seropositive (median CD4-count 37 cells/uL, IQR 13-171 cells/uL. Baseline characteristics were similar between patients in the oral-rinse (N = 110 and no oral-rinse (N = 110 groups. The proportion of contaminated cultures was significantly lower in the oral-rinse group compared to the no oral-rinse group (4% vs. 15%, risk difference -11%, 95% CI -18 to -3%, p = 0.005. Oral rinse significantly reduced the proportion of contaminated cultures among HIV-infected patients (3% vs. 18%, risk difference -14%, 95% CI -23 to -6%, p = 0.002 but not HIV-uninfected (6% vs. 4%, risk difference 2%, 95% CI -12 to +15%, p = 0.81 patients. However, the proportion of smear-positive specimens (25% vs. 35%, p = 0.10 and culture-positive specimens (48% vs. 56%, p = 0.24 were lower in the oral-rinse compared to the no oral-rinse group, although the differences were not statistically significant.Oral rinse prior to sputum expectoration is a promising strategy to reduce mycobacterial culture contamination in areas with high HIV prevalence, if strategies can be devised to

  14. Cryptococcus sp abdominal infection in a patient with acquired immunodeficiency under secondary prophylaxis with fluconazole; Infeccao abdominal por Cryptococcus sp em paciente com imunodeficiencia adquirida em uso de profilaxia secundaria com fluconazol

    Coutinho, Rosane Luiza; Zarehdinne, Monica [Infectologia do Hospital Eduardo de Menezes Belo Horizonte, MG (Brazil); Peixoto, Arley; Tardieu Junior, Jose [Medicina da Faculdade de Saude e Ecologia Humana - FASEH, Vespasiano, MG (Brazil); Pedroso, Enio Roberto Pietra [Departamento de Clinica Medica da Faculdade de Medicina da Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, MG (Brazil)


    This paper reports on a Cryptococcus sp infection relapse in a patient with acquired immunodeficiency three years after the first episode, when her T CD4+ lymphocyte count was high and she was making regular use of antiretroviral drugs. (author)

  15. Characterization of bovine gamma delta T cells phenotype during post-natal development and following Mycobacterium bovis vaccination or virulent infection

    Bovine tuberculosis caused by Mycobacterium bovis is a globally significant veterinary health problem. Gamma delta T cells are known to participate in the immune control of mycobacterial infections. Data in human and non-human primates suggest that mycobacterial infection regulates memory/effector p...




    Background and Methods. This study was undertaken to find out whether translocation of bacteria to the abdominal cavity and endotoxemia in rats with sterile peritonitis could be prevented by selective decontamination of the digestive tract. Sterile peritonitis was caused by the intraperitoneal




    Background and Methods. This study was undertaken to find out whether translocation of bacteria to the abdominal cavity and endotoxemia in rats with sterile peritonitis could be prevented by selective decontamination of the digestive tract. Sterile peritonitis was caused by the intraperitoneal injec

  18. Mycobacterium ulcerans infection

    van der Werf, TS; van der Graaf, WTA; Tappero, JW; Asiedu, K


    After tuberculosis and leprosy, Buruli-ulcer disease (caused by infection with Mycobacterium ulcerans) is the third most common mycobacterial disease in immunocompetent people. Countries in which the disease is endemic have been identified, predominantly in areas of tropical rain forest; the emergen

  19. Mycobacterium ulcerans infection

    van der Werf, TS; van der Graaf, WTA; Tappero, JW; Asiedu, K


    After tuberculosis and leprosy, Buruli-ulcer disease (caused by infection with Mycobacterium ulcerans) is the third most common mycobacterial disease in immunocompetent people. Countries in which the disease is endemic have been identified, predominantly in areas of tropical rain forest; the

  20. Standard abdominal wound edge protection with surgical dressings vs coverage with a sterile circular polyethylene drape for prevention of surgical site infections (BaFO: study protocol for a randomized controlled trial

    Mihaljevic André L


    Full Text Available Abstract Background Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality and remain one of the most frequent surgical complications. Approximately 14% to 30% of all patients undergoing elective open abdominal surgery are affected and methods to reduce surgical site infection rates warrant further investigation and evaluation in randomized controlled trials. Methods/design To investigate whether the application of a circular plastic wound protector reduces the rate of surgical site infections in general and visceral surgical patients that undergo midline or transverse laparotomy by 50%. BaFO is a randomized, controlled, patient-blinded and observer-blinded multicenter clinical trial with two parallel surgical groups. The primary outcome measure will be the rate of surgical site infections within 45 days postoperative assessed according to the definition of the Center for Disease Control. Statistical analysis of the primary endpoint will be based on the intention-to-treat population. The global level of significance is set at 5% (2 sided and sample size (n = 258 per group is determined to assure a power of 80% with a planned interim analysis for the primary endpoint after the inclusion of 340 patients. Discussion The BaFO trial will explore if the rate of surgical site infections can be reduced by a single, simple, inexpensive intervention in patients undergoing open elective abdominal surgery. Its pragmatic design guarantees high external validity and clinical relevance. Trial registration NCT01181206. Date of registration: 11 August 2010; date of first patient randomized: 8 September 2010

  1. Lung and Nodal Involvement in Nontuberculous Mycobacterial Disease: PET/CT Role

    Ginevra Del Giudice


    Full Text Available Introduction. Systematic use of 18F-FDG PET/CT has the potential to simultaneously assess both pulmonary and lymph node involvement in nontuberculous mycobacterial (NTM lung infection. Objective. The aim of the study was to evaluate the role of 18F-FDG PET/CT in the assessment of both mediastinal lymph nodes and lung involvement in NTM patients compared with active tuberculosis (TB patients. Methods. 26 patients with pulmonary NTM disease were selected; six consecutive patients had undergone 18F-FDG PET/CT and data was compared with 6 active TB patients. Results. NTM exhibited different radiological lung patterns with an average SUV max value at PET/CT scan of 3,59 ± 2,32 (range 1,14 to 9,01 on pulmonary lesions and a mean value of SUV max 1,21 ± 0,29 (range 0,90 to 1,70 on mediastinal lymph nodes. Pulmonary lesions in TB showed an average SUV max value of 10,07 ± 6,45 (range 1,20 to 22,75 whilst involved mediastinal lymph nodes exhibited a mean SUV max value of 7,23 ± 3,03 (range 1,78 to 15,72. Conclusions. The differences in PET uptake in a broad range of lung lesions and lymph nodes between NTM and M. tuberculosis patients suggest a potential role for PET/CT scan in the diagnosis and management of pulmonary mycobacterial disease.

  2. Antibiotic prophylaxis for abdominal hysterectomy.

    Mele, G; Loizzi, P; Greco, P; Gargano, G; Varcaccio Garofalo, G; Belsanti, A


    Three different regimens of antibiotic treatment have been employed in order to evaluate their efficacy as a profilaxis for abdominal hysterectomy. Two short term administrations (Cephtriaxone and Cephamandole plus Tobramycine) and a conventional full dose treatment (Cephazoline) have been compared over a group of homogeneous patients. No significant differences, except a reduction in postoperative time spent in hospital, have been found among the groups. A reduction in urinary tract infection has also been reported with a single-dose antibiotic prophylaxis.

  3. 儿童反复腹痛与幽门螺杆菌感染的关联性探讨%Discussion of children's repeated abdominal pain and helicobacter pylori infection



    Objective:To study the correlation between children's repeated abdominal pain and helicobacter pylori infection. Methods:100 children with repeated abdominal pain were selected.They were given gastroscope detection and Hp test.Results:38 cases were helicobacter pylori positive,and the positive rate was 38.0%.The infection rate of Hp positive children's family member was 65.8% .Two had statistical difference(P=0.001).Through the gastroscope detection,the overall detection rate of upper gastrointestinal symptoms was as high as 96%,and the detection rate of superficial gastritis was the highest and as high as 55.2%. Conclusion:Children's repeated abdominal pain and helicobacter pylori infection have a certain correlation and a family gathering at the same time.Repeated abdominal pain is usually associated with organic diseases,and the superficial gastritis is one most critical nosogenesis.%目的:研究儿童反复腹痛和幽门螺杆菌(Hp)感染之间的关联性。方法:收治反复腹痛儿童100例,给予胃镜检测和 Hp 测试。结果:Hp 阳性38例,阳性率38.0%,Hp 阳性儿童家属的感染率65.8%,二者差异具有统计学意义(P=0.001)。通过胃镜检测,上消化道病症整体检出率高达96.0%,浅表性胃炎检出率最高,高达55.2%。结论:儿童反复腹痛和幽门螺杆菌感染存在着一定的关联性,同时存在着家庭聚集的情况。反复腹痛一般伴随着器质性的病症,其中浅表性胃炎是最为关键的致病原因。

  4. Mycobacterial species as case-study of comparative genome analysis.

    Zakham, F; Belayachi, L; Ussery, D; Akrim, M; Benjouad, A; El Aouad, R; Ennaji, M M


    The genus Mycobacterium represents more than 120 species including important pathogens of human and cause major public health problems and illnesses. Further, with more than 100 genome sequences from this genus, comparative genome analysis can provide new insights for better understanding the evolutionary events of these species and improving drugs, vaccines, and diagnostics tools for controlling Mycobacterial diseases. In this present study we aim to outline a comparative genome analysis of fourteen Mycobacterial genomes: M. avium subsp. paratuberculosis K—10, M. bovis AF2122/97, M. bovis BCG str. Pasteur 1173P2, M. leprae Br4923, M. marinum M, M. sp. KMS, M. sp. MCS, M. tuberculosis CDC1551, M. tuberculosis F11, M. tuberculosis H37Ra, M. tuberculosis H37Rv, M. tuberculosis KZN 1435 , M. ulcerans Agy99,and M. vanbaalenii PYR—1, For this purpose a comparison has been done based on their length of genomes, GC content, number of genes in different data bases (Genbank, Refseq, and Prodigal). The BLAST matrix of these genomes has been figured to give a lot of information about the similarity between species in a simple scheme. As a result of multiple genome analysis, the pan and core genome have been defined for twelve Mycobacterial species. We have also introduced the genome atlas of the reference strain M. tuberculosis H37Rv which can give a good overview of this genome. And for examining the phylogenetic relationships among these bacteria, a phylogenic tree has been constructed from 16S rRNA gene for tuberculosis and non tuberculosis Mycobacteria to understand the evolutionary events of these species.

  5. Abdominal radiation - discharge

    Radiation - abdomen - discharge; Cancer - abdominal radiation; Lymphoma - abdominal radiation ... When you have radiation treatment for cancer, your body goes through changes. About 2 weeks after radiation treatment starts, you might notice changes ...

  6. Abdominal and Pelvic CT

    Full Text Available ... accurate. In emergency cases, it can reveal internal injuries and bleeding quickly enough to help save lives. ... kidney and bladder stones. abdominal aortic aneurysms (AAA), injuries to abdominal organs such as the spleen, liver, ...

  7. Abdominal and Pelvic CT

    Full Text Available ... accurate. In emergency cases, it can reveal internal injuries and bleeding quickly enough to help save lives. ... kidney and bladder stones. abdominal aortic aneurysms (AAA), injuries to abdominal organs such as the spleen, liver, ...

  8. Abdominal aortic aneurysm

    ... this page: // Abdominal aortic aneurysm To use the sharing features on this page, ... blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes ...

  9. Abdominal neoplasia with sarcomatoid features as the presenting illness of a patient with a newly diagnosed HIV infection and no AIDS-related disorders. Case report, clinical and diagnostic features, and literature discussion

    Roberto Manfredi


    Full Text Available We aim to describe a patient with an already advanced HIV infection disclosed for the first time during a complex diagnostic workup, which detected a gross abdominal mass attributable to a poorly differentiated mesenchymal cancer with sarcomatoid features which rapidly led our patient to death, in absence of other potential HIV-associated opportunistic diseases. Although extremely rare and rapidly lethal, our case report underscores the need of all caregivers who follow HIV-infected patients also in the cART era to maintain an elevated attention toward infrequent, unexpected, and clinically atypical solid tumors, in order to ensure a timely diagnosis and management when possible.

  10. Traumatic abdominal hernia complicated by necrotizing fasciitis.

    Martínez-Pérez, Aleix; Garrigós-Ortega, Gonzalo; Gómez-Abril, Segundo Ángel; Martí-Martínez, Eva; Torres-Sánchez, Teresa


    Necrotizing fasciitis is a critical illness involving skin and soft tissues, which may develop after blunt abdominal trauma causing abdominal wall hernia and representing a great challenge for physicians. A 52-year-old man was brought to the emergency department after a road accident, presenting blunt abdominal trauma with a large non-reducible mass in the lower-right abdomen. A first, CT showed abdominal hernia without signs of complication. Three hours after ICU admission, he developed hemodynamic instability. Therefore, a new CT scan was requested, showing signs of hernia complication. He was moved to the operating room where a complete transversal section of an ileal loop was identified. Five hours after surgery, he presented a new episode of hemodynamic instability with signs of skin and soft tissue infection. Due to the high clinical suspicion of necrotizing fasciitis development, wide debridement was performed. Following traumatic abdominal wall hernia (TAWH), patients can present unsuspected injuries in abdominal organs. Helical CT can be falsely negative in the early moments, leading to misdiagnosis. Necrotizing fasciitis is a potentially fatal infection and, consequently, resuscitation measures, wide-spectrum antibiotics, and early surgical debridement are required. This type of fasciitis can develop after blunt abdominal trauma following wall hernia without skin disruption.

  11. Elevated serum CA 19-9 levels in patients with pulmonary nontuberculous mycobacterial disease

    Ji Young Hong


    Full Text Available Abstract Increased serum CA 19-9 levels in patients with nonmalignant diseases have been investigated in previous reports. This study evaluates the clinical significance of serum CA 19-9 elevation in pulmonary nontuberculous mycobacterial disease and pulmonary tuberculosis. The median CA 19-9 level was higher in patients with pulmonary nontuberculous mycobacterial disease than in patients with pulmonary tuberculosis (pulmonary nontuberculous mycobacterial disease: 13.80, tuberculosis: 5.85, p < 0.001. A multivariate logistic regression analysis performed in this study showed that Mycobacterium abscessus (OR 9.97, 95% CI: 1.58, 62.80; p = 0.014 and active phase of pulmonary nontuberculous mycobacterial disease (OR 12.18, 95% CI: 1.07, 138.36, p = 0.044 were found to be risk factors for serum CA 19-9 elevation in pulmonary nontuberculous mycobacterial disease. The serum CA 19-9 levels showed a tendency to decrease during successful treatment of pulmonary nontuberculous mycobacterial disease but not in pulmonary tuberculosis. These findings suggest that CA 19-9 may be a useful marker for monitoring therapeutic responses in pulmonary nontuberculous mycobacterial disease, although it is not pulmonary nontuberculous mycobacterial disease-specific marker.

  12. Post trauma abdominal cocoon.

    Kaur, Supreet; Doley, Rudra Prasad; Chabbhra, Mohinish; Kapoor, Rajeev; Wig, Jaidev


    Abdominal cocoon or sclerosing peritonitis refers to a rare cause of intestinal obstruction due to formation of a membrane encasing the bowel. We report a case of abdominal cocoon post blunt trauma abdomen. The patient presented with a history of subacute intestinal obstruction and a mobile abdomen lump. Abdominal cocoon was diagnosed on computed tomography. He underwent adhesiolysis with excision of membrane.

  13. The LIPPSMAck POP (Lung Infection Prevention Post Surgery - Major Abdominal - with Pre-Operative Physiotherapy) trial: study protocol for a multi-centre randomised controlled trial

    Boden, Ianthe; Browning, Laura; Elizabeth H Skinner; Reeve, Julie; El-Ansary, Doa; Robertson, Iain K.; Denehy, Linda


    Background Post-operative pulmonary complications are a significant problem following open upper abdominal surgery. Preliminary evidence suggests that a single pre-operative physiotherapy education and preparatory lung expansion training session alone may prevent respiratory complications more effectively than supervised post-operative breathing and coughing exercises. However, the evidence is inconclusive due to methodological limitations. No well-designed, adequately powered, randomised con...

  14. Abdominal wall fat pad biopsy

    Amyloidosis - abdominal wall fat pad biopsy; Abdominal wall biopsy; Biopsy - abdominal wall fat pad ... method of taking an abdominal wall fat pad biopsy . The health care provider cleans the skin on ...

  15. Clinical characteristics of tumor patients with complicated intra-abdominal infections%肿瘤患者腹腔复杂感染的临床特点分析

    章宝云; 赵擎宇; 方翼; 徐大志; 顾葆春; 王慧


    目的 分析肿瘤患者腹腔复杂感染的特点 ,为医院感染预防控制提供参考依据.方法 回顾性分析2009年1月-2014年12月144例肿瘤患者腹腔感染的临床资料 ,用SPSS19 .0统计软件进行数据录入和分析.结果 144例腹腔复杂感染肿瘤患者中有114例行手术治疗 ,其余30例为化疗或放疗等非手术治疗 ;共有102例患者发展为脓毒症 ,发生率为70 .8% ,20例发展为严重脓毒症 ,发生率为13 .9% ,22例发展为脓毒症休克 ,发生率为15 .3% ,死亡25例病死率为17 .4% ;所有患者感染标本共检出病原菌253株 ,检出革兰阴性菌最高占46 .1% ,其次革兰阳性菌占29 .5% 、真菌占24 .4% .结论 肿瘤患者腹腔复杂感染以术后吻合口瘘导致的感染常见 ,且易发展为严重的腹腔感染 ,预后较差 ;感染多由肠道混合菌群感染所致 ,其耐药率较高.%OBJECTIVE To investigate the characteristics of the tumor patients with complicated intra-abdominal in-fections so as to provide guidance for control and prevention of the nosocomial infections .METHODS The clinical data of 144 tumor patients with intra-abdominal infections who were treated from Jan 2009 to Dec 2014 were retro-spectively analyzed , and the statistical analysis of data was performed with the use of SPSS 19 .0 software . RESULTS Of the 144 tumor patients with complicated intra-abdominal infections ,114 received the postoperarive treatment and the rest of 30 cases received the non-surgical procedures such as chemotherapy and radiotherapy ;102 cases developed to sepsis ,with the incidence rate of 70 .8% ;20 cases developed to severe sepsis ,with the in-cidence rate of 13 .9% ;22 cases developed to septic shock ,with the incidence rate of 15 .3% ,and 25 cases died , with the mortality rate of 17 .4% .A total of 253 strains of pathogens were isolated from all of the specimens ,of which 46 .1% were gram-negative bacteria , 29 .5% were gram-positive bacteria , and 24 .4% were

  16. Clinical management of abdominal trauma

    FANG Guo-en; LUO Tian-hang; DU Cheng-hui; BI Jian-wei; XUE Xu-chao; WEI Guo; WENG Zhao-zhang; MA Li-ye; HUA Ji-de


    Objective: To improve the prognosis of patients with abdominal trauma. Methods: Between January 1993 and December 2005, 415 patients were enrolled in this research. The patients consisted of 347 males and 68 females with mean age of 36 years ranging from 3-82 years. All abdominal traumas consisted of closed traumas 360 cases, 86.7% and open traumas 55 cases, 13.3%. Results: Atotal of 407 cases 98.1% were fully recovered from trauma and the other 8 cases 1.9% died of multiple injuries. The mean injury severity score ISS of all patients was 22 while the mean ISS of the patients who died in hospital was 42. Postoperative complications were seen in 9 patients such as infection of incisional wounds 6 cases, pancreatic fistula 2 cases and intestinal fistula 1 case. All these postoperative complications were cured by the conservative treatment. Conclusion: Careful case history inquisition and physical examination are the basic methods to diagnose abdomi- nal trauma. Focused abdominal ultrasonography is always the initial imaging examination because it is non-invasive and can be performed repeatedly with high accuracy. The doctors should consider the severity of local injuries and the general status of patients during the assessment of abdominal trauma. The principle of treatment is to save lives at first, then to cure the injuries. Unnecessary laparotomy should be avoided to reduce additional surgical trauma.

  17. The role of the mycobacterial DNA-binding protein 1 (MDP1 from Mycobacterium bovis BCG in host cell interaction

    Kunisch Ralph


    Full Text Available Abstract Background Mycobacterium tuberculosis differs from most pathogens in its ability to multiply inside monocytes and to persist during long periods of time within granuloma in a status of latency. A class of proteins called mycobacterial histone-like proteins has been associated with regulation of replication and latency, but their precise role in the infection process has yet to be uncovered. Our study aimed at defining the impact of the histone-like protein MDP1 from M. bovis BCG (mycobacterial DNA-binding protein 1, corresponding to Rv2986c from M. tuberculosis on early steps of infection. Results Previously, a BCG (Bacillus Calmette Guérin strain had been generated by antisense-technique exhibiting reduced MDP1 expression. This strain was now used to analyse the impact of reduced amount of MDP1 on the interaction with human blood monocytes, macrophage lines and PBMC (peripheral blood mononuclear cells. MDP1 was revealed to be required for growth at acidic pH and for intracellular replication in human blood monocytes. Down-regulation of MDP1 resulted in reduced secretion of the cytokine IL-1β by infected human PBMC. In addition, a reduction of MDP1 expression had a major impact on the formation of fused multi-nucleated macrophages. In monocyte preparations from human blood as well as in human and mouse macrophage cell lines, both the percentage of multi-nucleated cells and the number of nuclei per cell were much enhanced when the monocytes were infected with BCG expressing less MDP1. Conclusion MDP1 from M. bovis BCG affects the growth at acidic pH and the intracellular replication in human monocytes. It furthermore affects cytokine secretion by host cells, and the formation of fused multi-nucleated macrophages. Our results suggest an important role of MDP1 in persistent infection.

  18. Real-Time PCR Assay Using Fine-Needle Aspirates and Tissue Biopsy Specimens for Rapid Diagnosis of Mycobacterial Lymphadenitis in Children

    van Coppenraet, E. S. Bruijnesteijn; Lindeboom, J. A.; Prins, J. M.; Peeters, M. F.; Claas, E. C. J.; Kuijper, E. J.


    A real-time PCR assay was developed to diagnose and identify the causative agents of suspected mycobacterial lymphadenitis. Primers and probes for the real-time PCR were designed on the basis of the internal transcribed spacer sequence, enabling the recognition of the genus Mycobacterium and the species Mycobacterium avium and M. tuberculosis. The detection limit for the assay was established at 1,100 CFU/ml of pus, and the specificity tests showed no false-positive reaction with other mycobacterial species and other pathogens causing lymphadenitis. From 67 children with suspected mycobacterial lymphadenitis based on a positive mycobacterial skin test, 102 samples (58 fine-needle aspirates [FNA] and 44 tissue specimens) were obtained. The real-time PCR assay detected a mycobacterial infection in 48 patients (71.6%), whereas auramine staining and culturing were positive for 31 (46.3%) and 28 (41.8%) of the patients. The addition of the real-time PCR assay to conventional diagnostic tests resulted in the recognition of 13 more patients with mycobacterial disease. These results indicate that the real-time PCR is more sensitive than conventional staining and culturing techniques (P = 0.006). The M. avium-specific real-time PCR was positive for 38 patients, and the M. tuberculosis-specific real-time PCR was positive for 1 patient. Analysis of 27 patients from whom FNA and tissue biopsy specimens were collected revealed significantly more positive real-time PCR results for FNA than for tissue biopsy specimens (P = 0.003). Samples from an age-matched control group of 50 patients with PCR-proven cat scratch disease were all found to be negative by the real-time PCR. We conclude that this real-time PCR assay with a sensitivity of 72% for patients with lymphadenitis and a specificity of 100% for the detection of atypical mycobacteria can provide excellent support for clinical decision making in children with lymphadenitis. PMID:15184446

  19. Application of enterostomy in treatment of bowel perforation complicated with abdominal cavity infections%肠穿孔腹腔感染肠造口术的应用研究

    乔小平; 张桂华; 陈名林


    OBJECTIVE To analyze the application value of enterostomy in treating bowel perforation complicated with abdominal cavity infections so as to reduce the infection rate .METHODS Totally 80 patients with intestinal perforation complicated by abdominal cavity infections between Jan .2012 and Jan .2014 in our hospital were select‐ed and divided into the treatment group (50 cases ,enterostomy) and the control group (30 cases ,open abdominal cavity therapy) .Two groups of patients were compared for serum C‐reactive protein (CRP) and serum calcitonin (PCT) ,white blood cell count (WBC) levels and APACHE Ⅱ grading preoperatively and at 10 d postoperatively . Meanwhile ,two groups of patients were compared for mortality ,length of hospital stay ,operation time and post‐operative first farting time .RESULTS CRP and PCT and WBC levels were lower in the treatment group than in the control group at postoperative 10 d and the APACHE Ⅱ grade at 4 d was lower in the treatment group than in the control group .The mortality was 0 in the treatment group and 3 .3% in the control group .Mortality ,length of hospital stay and operation time were significently lower in the treatment group than in the control group (P<0 .05) .There was no significant difference in the postoperative first farting time between the two groups . CONCLUSION Enterostomy is simple to operation ,economical ,safe and fast to recover which can cut off abdomi‐nal cavity infections from sources and is worthy promoting in the treatment of bowel perforation complicated with abdominal cavity infections .%目的:探讨肠造口术在肠穿孔并发腹腔感染中的应用价值,以降低临床肠穿孔并发腹腔感染的发生率。方法选取2012年1月-2014年1月医院收治的80例肠穿孔腹腔感染患者,将其分为治疗组50例行肠造口术,对照组30例行腹腔开放疗法,对比两组患者术前及术后10 d血清C‐反应蛋白(CRP)、血清降钙素原(PCT )、白

  20. Elevated serum CA 19-9 levels in patients with pulmonary nontuberculous mycobacterial disease.

    Hong, Ji Young; Jang, Sun Hee; Kim, Song Yee; Chung, Kyung Soo; Song, Joo Han; Park, Moo Suk; Kim, Young Sam; Kim, Se Kyu; Chang, Joon; Kang, Young Ae


    Increased serum CA 19-9 levels in patients with nonmalignant diseases have been investigated in previous reports. This study evaluates the clinical significance of serum CA 19-9 elevation in pulmonary nontuberculous mycobacterial disease and pulmonary tuberculosis. The median CA 19-9 level was higher in patients with pulmonary nontuberculous mycobacterial disease than in patients with pulmonary tuberculosis (pulmonary nontuberculous mycobacterial disease: 13.80, tuberculosis: 5.85, pdisease (OR 12.18, 95% CI: 1.07, 138.36, p=0.044) were found to be risk factors for serum CA 19-9 elevation in pulmonary nontuberculous mycobacterial disease. The serum CA 19-9 levels showed a tendency to decrease during successful treatment of pulmonary nontuberculous mycobacterial disease but not in pulmonary tuberculosis. These findings suggest that CA 19-9 may be a useful marker for monitoring therapeutic responses in pulmonary nontuberculous mycobacterial disease, although it is not pulmonary nontuberculous mycobacterial disease-specific marker.

  1. Abdominal epilepsy in chronic recurrent abdominal pain

    V Y Kshirsagar


    Full Text Available Background: Abdominal epilepsy (AE is an uncommon cause for chronic recurrent abdominal pain in children and adults. It is characterized by paroxysmal episode of abdominal pain, diverse abdominal complaints, definite electroencephalogram (EEG abnormalities and favorable response to the introduction of anti-epileptic drugs (AED. We studied 150 children with chronic recurrent abdominal pain and after exclusion of more common etiologies for the presenting complaints; workup proceeded with an EEG. We found 111 (74% children with an abnormal EEG and 39 (26% children with normal EEG. All children were subjected to AED (Oxcarbazepine and 139 (92% children responded to AED out of which 111 (74% children had an abnormal EEG and 27 (18% had a normal EEG. On further follow-up the patients were symptom free, which helped us to confirm the clinical diagnosis. Context: Recurrent chronic abdominal pain is a common problem encountered by pediatricians. Variety of investigations are done to come to a diagnosis but a cause is rarely found. In such children diagnosis of AE should be considered and an EEG will confirm the diagnosis and treated with AED. Aims: To find the incidence of AE in children presenting with chronic recurrent abdominal pain and to correlate EEG findings and their clinical response to empirical AEDs in both cases and control. Settings and Design: Krishna Institute of Medical Sciences University, Karad, Maharashtra, India. Prospective analytical study. Materials and Methods: A total of 150 children with chronic recurrent abdominal pain were studied by investigations to rule out common causes of abdominal pain and an EEG. All children were then started with AED oxycarbamezepine and their response to the treatment was noted. Results: 111 (74% of the total 150 children showed a positive EEG change suggestive of epileptogenic activity and of which 75 (67.56% were females and 36 (32.43% were male, majority of children were in the age of group of 9

  2. Multisite Infection with Mycobacterium abscessus after Replacement of Breast Implants and Gluteal Lipofilling.

    Rüegg, Eva; Cheretakis, Alexandre; Modarressi, Ali; Harbarth, Stephan; Pittet-Cuénod, Brigitte


    Introduction. Medical tourism for aesthetic surgery is popular. Nontuberculous mycobacteria (NTM) occasionally cause surgical-site infections. As NTM grow in biofilms, implantations of foreign bodies are at risk. Due to late manifestation, infections occur when patients are back home, where they must be managed properly. Case Report. A 39-year-old healthy female was referred for acute infection of the right gluteal area. Five months before, she had breast implants replacement, abdominal liposuction, and gluteal lipofilling in Mexico. Three months postoperatively, implants were removed for NTM-infection in Switzerland. Adequate antibiotic treatment was stopped after seven days for drug-related hepatitis. At entrance, gluteal puncture for bacterial analysis was performed. MRI showed large subcutaneous collection. Debridement under general anaesthesia was followed by open wound management. Total antibiotic treatment was 20 weeks. Methods. Bacterial analysis of periprosthetic and gluteal liquids included Gram-stain plus acid-fast stain, and aerobic, anaerobic and mycobacterial cultures.  Results. In periprosthetic fluid, Mycobacterium abscessus, Propionibacterium, and Staphylococcus epidermidis were identified. The same M. abscessus strain was found gluteally. The gluteal wound healed within six weeks. At ten months' follow-up, gluteal asymmetry persists for deep scarring. Conclusion. This case presents major complications of multisite aesthetic surgery. Surgical-site infections in context of medical tourism need appropriate bacteriological investigations, considering potential NTM-infections.

  3. Multisite Infection with Mycobacterium abscessus after Replacement of Breast Implants and Gluteal Lipofilling

    Eva Rüegg


    Full Text Available Introduction. Medical tourism for aesthetic surgery is popular. Nontuberculous mycobacteria (NTM occasionally cause surgical-site infections. As NTM grow in biofilms, implantations of foreign bodies are at risk. Due to late manifestation, infections occur when patients are back home, where they must be managed properly. Case Report. A 39-year-old healthy female was referred for acute infection of the right gluteal area. Five months before, she had breast implants replacement, abdominal liposuction, and gluteal lipofilling in Mexico. Three months postoperatively, implants were removed for NTM-infection in Switzerland. Adequate antibiotic treatment was stopped after seven days for drug-related hepatitis. At entrance, gluteal puncture for bacterial analysis was performed. MRI showed large subcutaneous collection. Debridement under general anaesthesia was followed by open wound management. Total antibiotic treatment was 20 weeks. Methods. Bacterial analysis of periprosthetic and gluteal liquids included Gram-stain plus acid-fast stain, and aerobic, anaerobic and mycobacterial cultures.  Results. In periprosthetic fluid, Mycobacterium abscessus, Propionibacterium, and Staphylococcus epidermidis were identified. The same M. abscessus strain was found gluteally. The gluteal wound healed within six weeks. At ten months’ follow-up, gluteal asymmetry persists for deep scarring. Conclusion. This case presents major complications of multisite aesthetic surgery. Surgical-site infections in context of medical tourism need appropriate bacteriological investigations, considering potential NTM-infections.

  4. Abdominal Decompression in Children

    J. Chiaka Ejike


    Full Text Available Abdominal compartment syndrome (ACS increases the risk for mortality in critically ill children. It occurs in association with a wide variety of medical and surgical diagnoses. Management of ACS involves recognizing the development of intra-abdominal hypertension (IAH by intra-abdominal pressure (IAP monitoring, treating the underlying cause, and preventing progression to ACS by lowering IAP. When ACS is already present, supporting dysfunctional organs and decreasing IAP to prevent new organ involvement become an additional focus of therapy. Medical management strategies to achieve these goals should be employed but when medical management fails, timely abdominal decompression is essential to reduce the risk of mortality. A literature review was performed to understand the role and outcomes of abdominal decompression among children with ACS. Abdominal decompression appears to have a positive effect on patient survival. However, prospective randomized studies are needed to fully understand the indications and impact of these therapies on survival in children.

  5. Growth detection failures by the nonradiometric Bactec MGIT 960 mycobacterial culture system.

    Peña, Jeremy A; Ferraro, Mary Jane; Hoffman, Colleen G; Branda, John A


    Mycobacterial growth in liquid culture can go undetected by automated, nonradiometric growth detection systems. In our laboratory, instrument-negative tubes from the Bactec MGIT 960 system are inspected visually for clumps suggestive of mycobacterial growth, which (if present) are examined by acid-fast smear analysis. A 3-year review demonstrated that ∼1% of instrument-negative MGIT cultures contained mycobacterial growth and that 10% of all cultures yielding mycobacteria were instrument negative. Isolates from instrument-negative MGIT cultures included both tuberculous and nontuberculous mycobacteria.

  6. Identification of novel sRNAs in mycobacterial species.

    Chen-Hsun Tsai

    Full Text Available Bacterial small RNAs (sRNAs are short transcripts that typically do not encode proteins and often act as regulators of gene expression through a variety of mechanisms. Regulatory sRNAs have been identified in many species, including Mycobacterium tuberculosis, the causative agent of tuberculosis. Here, we use a computational algorithm to predict sRNA candidates in the mycobacterial species M. smegmatis and M. bovis BCG and confirmed the expression of many sRNAs using Northern blotting. Thus, we have identified 17 and 23 novel sRNAs in M. smegmatis and M. bovis BCG, respectively. We have also applied a high-throughput technique (Deep-RACE to map the 5' and 3' ends of many of these sRNAs and identified potential regulators of sRNAs by analysis of existing ChIP-seq datasets. The sRNAs identified in this work likely contribute to the unique biology of mycobacteria.

  7. Total synthesis of mycobacterial arabinogalactan containing 92 monosaccharide units

    Wu, Yong; Xiong, De-Cai; Chen, Si-Cong; Wang, Yong-Shi; Ye, Xin-Shan


    Carbohydrates are diverse bio-macromolecules with highly complex structures that are involved in numerous biological processes. Well-defined carbohydrates obtained by chemical synthesis are essential to the understanding of their functions. However, synthesis of carbohydrates is greatly hampered by its insufficient efficiency. So far, assembly of long carbohydrate chains remains one of the most challenging tasks for synthetic chemists. Here we describe a highly efficient assembly of a 92-mer polysaccharide by the preactivation-based one-pot glycosylation protocol. Several linear and branched oligosaccharide/polysaccharide fragments ranging from 5-mer to 31-mer in length have been rapidly constructed in one-pot manner, which enables the first total synthesis of a biologically important mycobacterial arabinogalactan through a highly convergent [31+31+30] coupling reaction. Our results show that the preactivation-based one-pot glycosylation protocol may provide access to the construction of long and complicated carbohydrate chains.

  8. Abdominal Compartment Syndrome

    Ovchinnikov V.А.; Sokolov V.А.


    We considered one of the most complicated problems of surgery and intensive care — abdominal compartment syndrome. It is a severe, and in some cases lethal complication developing in major injuries and pathology of abdominal cavity and retroperitoneal space, as well as in extra-abdominal pathology. In addition, compartment syndrome can be the complication of a number of surgical procedures accompanied primarily by laparotomy wound closure with tissue tension. We demonstrated the classificatio...

  9. Post trauma abdominal cocoon

    Supreet Kaur


    Full Text Available Abdominal cocoon or sclerosing peritonitis refers to a rare cause of intestinal obstruction due to formation of a membrane encasing the bowel. We report a case of abdominal cocoon post blunt trauma abdomen. The patient presented with a history of subacute intestinal obstruction and a mobile abdomen lump. Abdominal cocoon was diagnosed on computed tomography. He underwent adhesiolysis with excision of membrane.

  10. Abdominal Compartment Syndrome

    Pınar Zeyneloğlu


    Full Text Available Intraabdominal hypertension and Abdominal compartment syndrome are causes of morbidity and mortality in critical care patients. Timely diagnosis and treatment may improve organ functions. Intra-abdominal pressure monitoring is vital during evaluation of the patients and in the management algorithms. The incidence, definition and risk factors, clinical presentation, diagnosis and management of intraabdominal hypertension and Abdominal compartment syndrome were reviewed here.

  11. In Vitro Activity of Ceftazidime-Avibactam against Isolates in a Phase 3 Open-Label Clinical Trial for Complicated Intra-Abdominal and Urinary Tract Infections Caused by Ceftazidime-Nonsusceptible Gram-Negative Pathogens.

    Stone, Gregory G; Bradford, Patricia A; Newell, Paul; Wardman, Angela


    The in vitro activity of ceftazidime-avibactam was evaluated against 341 Gram-negative isolates from 333 patients in a randomized, phase 3 clinical trial of patients with complicated urinary tract or intra-abdominal infections caused by ceftazidime-nonsusceptible pathogens (NCT01644643). Ceftazidime-avibactam MIC90 values against Enterobacteriaceae and Pseudomonas aeruginosa (including several class B or D enzyme producers that avibactam does not inhibit) were 1 and 64 μg/ml, respectively. Overall, the ceftazidime-avibactam activity against ceftazidime-nonsusceptible isolates was comparable to the activity of ceftazidime-avibactam previously reported against ceftazidime-susceptible isolates. (This study has been registered at under identifier NCT01644643.).

  12. Variation in immune state of mesenteric lymph node induced by intra-abdominal infection in sepsis rats%脓毒症大鼠肠系膜淋巴结细胞免疫功能的变化

    喻文立; 崔乃强; 杜洪印; 傅强; 刘洪斌; 李东华


    Objective To investigate the variation in the immune state of mesenteric lymph node (MLN) during intra-abdominal infection in sepsis rats. Methods Ninety-six male Wistar rats weighing 200-250 g were randomly divided into 2 groups (n = 48 each): sham operation group and intra-abdominal infection group. Intra-abdominal infection was induced by cecum ligation and puncture (CLP). Eight rats in each group were killed after collection of blood and MLN samples at 0 (T_0), 6 (T_1), 12 (T_2), 24 (T_3),48 (T_4) and 72 h (T_5) after CLP. Plasma concentrations of endotoxin were detected. The ratio of T helper cells 1/T helper cells 2 (Th1/Th2) and the percentage of regulatory T cells (Treg) in CD4~+ T cells in MLN were determined by flow cytometry. Results The levels of endotoxin were significantly higher at T_2, T_3, T_4 and T_5 in group CLP than in sham operation group. The ratios of Th1/Th2 were significantly higher at T_1 and lower at T_2,T_3,T_4 and T_5 in group CLP than in sham operation group, while the percentage of Treg in CD4~+ T cells was significantly lower at T_1 and higher at T_2, T_3, T_4 and T_5 in group CLP than in sham operation group. There was a negative correlation between the ratio of Th1/Th2 and the percentage of Treg (r=-0.87, P<0.05). Conclusion Cellular immune function of MLN is suppressed during intra-abdominal infection by increasing the percentage of Treg in MLN.%目的 探讨脓毒症大鼠肠系膜淋巴结细胞免疫功能的变化.方法 雄性Wistar大鼠96只,体重200~250 g,随机分为假手术组(S组)和盲肠结扎穿孔致脓毒症组(CLP组),每组48只.分别于CLP后即刻、6、12、24、48、72 h(T_(1~5))时随机取8只大鼠抽取腹主动脉血,采用鲎试剂偶氮显色法测定血浆内毒素水平;取肠系膜淋巴结组织,流式细胞仪测定肠系膜淋巴结组织Th1/Th2比值和调节性T淋巴细胞(Treg)占CD4~+细胞的比例(Treg比例).结果 与S组比较,CLP组T_(2~5)时血浆内毒素水平升高,T_1

  13. Platensimycin activity against mycobacterial beta-ketoacyl-ACP synthases.

    Alistair K Brown

    Full Text Available BACKGROUND: There is an urgent need for the discovery and development of new drugs against Mycobacterium tuberculosis, the causative agent of tuberculosis, especially due to the recent emergence of multi-drug and extensively-drug resistant strains. Herein, we have examined the susceptibility of mycobacteria to the natural product platensimycin. METHODS AND FINDINGS: We have demonstrated that platensimycin has bacteriostatic activity against the fast growing Mycobacterium smegmatis (MIC = 14 microg/ml and against Mycobacterium tuberculosis (MIC = 12 microg/ml. Growth in the presence of paltensimycin specifically inhibited the biosynthesis of mycolic acids suggesting that the antibiotic targeted the components of the mycolate biosynthesis complex. Given the inhibitory activity of platensimycin against beta-ketoacyl-ACP synthases from Staphylococcus aureus, M. tuberculosis KasA, KasB or FabH were overexpressed in M. smegmatis to establish whether these mycobacterial KAS enzymes were targets of platensimycin. In M. smegmatis overexpression of kasA or kasB increased the MIC of the strains from 14 microg/ml, to 30 and 124 microg/ml respectively. However, overexpression of fabH on did not affect the MIC. Additionally, consistent with the overexpression data, in vitro assays using purified proteins demonstrated that platensimycin inhibited Mt-KasA and Mt-KasB, but not Mt-FabH. SIGNIFICANCE: Our results have shown that platensimycin is active against mycobacterial KasA and KasB and is thus an exciting lead compound against M. tuberculosis and the development of new synthetic analogues.

  14. Mycobacterium chelonae infection under adalimumab therapy for spondylarthritis.

    Kluger, N; Cohen, P; Fallet-Bianco, C; Guillevin, L


    Tumour necrosis factor (TNF)-alpha antagonists have been prescribed increasingly over the past few years to manage various inflammatory diseases. This widespread use was quickly followed by the heightened frequency of opportunistic mycobacterial infections including environmental non-tuberculous mycobacterial infections (ENTM). We describe a 66-year-old man taking adalimumab for spondyloarthropathy who developed an inflammatory infiltration in his right index finger. A non-necrotising granuloma with epitheloid and giant cells in the dermis and eosinophilic acid-fast bacilli, identified by using Ziehl-Neelsen staining suggested a mycobacterial infection. Cultures for mycobacteria grew positive on Loewenstein-Jensen medium and molecular identification confirmed M. chelonae infection. The outcome was favourable after five months of clarythromycin. In this context of more frequent ENTM infections, chronic non-specific cutaneous lesions of the extremities should evoke systematically cutaneous ENTM infections. Skin biopsy with histological examination and oriented microbiological cultures and molecular identification are mandatory to confirm the diagnosis.

  15. Post liposuction Mycobacterium abscessus surgical site infection in a returned medical tourist complicated by a paradoxical reaction during treatment

    Siong H. Hui


    Full Text Available Rapidly growing mycobacterial skin and soft tissue infections are known to complicate cosmetic surgical procedures. Treatment consists of more surgery and prolonged antibiotic therapy guided by drug susceptibility testing. Paradoxical reactions occurring during antibiotic therapy can further complicate treatment of non-tuberculous mycobacterial infections. We report a case of post liposuction Mycobacterium abscessus surgical site infection in a returned medical tourist and occurrence of paradox during treatment.

  16. Post Liposuction Mycobacterium Abscessus Surgical Site Infection in a Returned Medical tourist Complicated by a Paradoxical Reaction During Treatment.

    Hui, Siong H; Noonan, Lisa; Chavada, Ruchir


    Rapidly growing mycobacterial skin and soft tissue infections are known to complicate cosmetic surgical procedures. Treatment consists of more surgery and prolonged antibiotic therapy guided by drug susceptibility testing. Paradoxical reactions occurring during antibiotic therapy can further complicate treatment of non-tuberculous mycobacterial infections. We report a case of post liposuction Mycobacterium abscessus surgical site infection in a returned medical tourist and occurrence of paradox during treatment.

  17. Alteration of human macrophages microRNA expression profile upon infection with Mycobacterium tuberculosis

    Lucinda Furci


    Conclusions: This study signifies the miRNA host response upon intracellular mycobacterial infection in macrophages, providing new aspects of regulation in host-pathogen interactions, at post-transcriptional levels.

  18. Enterotomy risk in abdominal wall repair: a prospective study.

    Broek, R.P. Ten; Schreinemacher, M.H.; Jilesen, A.P.; Bouvy, N.; Bleichrodt, R.P.; Goor, H. van


    OBJECTIVES: To establish the incidence and predictive factors of enterotomy made during adhesiolysis in abdominal wall repair and to assess the impact of enterotomies and long-lasting adhesiolysis on postoperative morbidity such as sepsis, wound infection, abdominal complications and pneumonia, and

  19. Intra-Abdominal Hypertension and Abdominal Compartment Syndrome after Abdominal Wall Reconstruction: Quaternary Syndromes?

    Kirkpatrick, A W; Nickerson, D; Roberts, D J; Rosen, M J; McBeth, P B; Petro, C C; Berrevoet, Frederik; Sugrue, M; Xiao, Jimmy; Ball, C G


    Reconstruction with reconstitution of the container function of the abdominal compartment is increasingly being performed in patients with massive ventral hernia previously deemed inoperable. This situation places patients at great risk of severe intra-abdominal hypertension and abdominal compartment syndrome if organ failure ensues. Intra-abdominal hypertension and especially abdominal compartment syndrome may be devastating systemic complications with systematic and progressive organ failure and death. We thus reviewed the pathophysiology and reported clinical experiences with abnormalities of intra-abdominal pressure in the context of abdominal wall reconstruction. Bibliographic databases (1950-2015), websites, textbooks, and the bibliographies of previously recovered articles for reports or data relating to intra-abdominal pressure, intra-abdominal hypertension, and the abdominal compartment syndrome in relation to ventral, incisional, or abdominal hernia repair or abdominal wall reconstruction. Surgeons should thus consider and carefully measure intra-abdominal pressure and its resultant effects on respiratory parameters and function during abdominal wall reconstruction. The intra-abdominal pressure post-operatively will be a result of the new intra-peritoneal volume and the abdominal wall compliance. Strategies surgeons may utilize to ameliorate intra-abdominal pressure rise after abdominal wall reconstruction including temporizing paralysis of the musculature either temporarily or semi-permanently, pre-operative progressive pneumoperitoneum, permanently removing visceral contents, or surgically releasing the musculature to increase the abdominal container volume. In patients without complicating shock and inflammation, and in whom the abdominal wall anatomy has been so functionally adapted to maximize compliance, intra-abdominal hypertension may be transient and tolerable. Intra-abdominal hypertension/abdominal compartment syndrome in the specific setting of

  20. Analysis of pathogen spectra and their drug resistance in patients with enterocutaneous fistula complicated with abdominal infection%肠外瘘并发腹腔感染的致病菌谱与耐药性分析

    周郑; 任建安; 王革非; 王新波; 范朝刚; 黎介寿


    Objective To study the pathogen spectra in patients with enterocutaneous fistula complicated with abdominal infection and their resistance to antibiotics. Methods The abdominal pus was collected from 226 patients with enterocutaneous fistula complicated with abdominal infection for bacterial culture and antibiotic susceptibility test. Results A total of 520 bacterial strains were harvested, including 333 strains of gram-negative bacteria, I 80 strains of gram-positive bacteria and 7 strains of fungi. The top 10 bacteria cultured were Escherichia coli (131 strains), Staphylococcus aureus (62 strains), Enterococcus (59 strains), Pseudomonas aeruginosa (50 strains), Klebsiella pneumoniae (23 strains), Acinetobacter baumannii (18 strains), Enterobacter cloacae (17 strains), Proteus mirabilis (15 strains), Morganella morganii (15 strains) and Enterococcus faecalis (12 strains). The extended spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae were 102 and 17 strains, respectively. Methicillin-resistant Staphylococcus aureus were 60 strains. Conclusions Gram-negative bacteria were the main pathogens in patients with enterocutaneous fistula complicated with abdominal infection. The positive rate of the extended spectrum beta-lactamase is high. Most of the Staphylococcus aureus were resistant to Methicillin.%目的 研究肠外瘘并发腹腔感染的主要致病菌谱及致病菌对常用抗生素的耐药特点.方法 取226例肠外瘘并发腹腔感染患者的腹腔脓液进行细菌培养和抗生素药物敏感试验.结果 获取菌株520株,其中革兰阴性菌333株,革兰阳性菌180株,真菌7株.前10位的为大肠埃希菌131株,金黄色葡萄球菌62株,肠球菌59株,铜绿假单胞菌50株,肺炎克雷伯杆菌23株,鲍曼不动杆菌18株,阴沟肠杆菌17株,奇异变形杆菌15株,摩氏摩根菌15株,粪肠球菌12株.大肠埃希菌和肺炎克雷伯杆菌中表达超广谱13内酰胺酶阳性菌株分别为102株和17株.

  1. Recurrent Abdominal Pain

    Banez, Gerard A.; Gallagher, Heather M.


    The purpose of this article is to provide an empirically informed but clinically oriented overview of behavioral treatment of recurrent abdominal pain. The epidemiology and scope of recurrent abdominal pain are presented. Referral process and procedures are discussed, and standardized approaches to assessment are summarized. Treatment protocols…

  2. [Abdominal pregnancy, institutional experience].

    Bonfante Ramírez, E; Bolaños Ancona, R; Simón Pereyra, L; Juárez García, L; García-Benitez, C Q


    Abdominal pregnancy is a rare entity, which has been classified as primary or secondary by Studiford criteria. A retrospective study, between January 1989 and December 1994, realized at Instituto Nacional de Perinatología, found 35,080 pregnancies, from which 149 happened to be ectopic, and 6 of them were abdominal. All patients belonged to a low income society class, age between 24 and 35 years, and average of gestations in 2.6. Gestational age varied from 15 weeks to 32.2 weeks having only one delivery at term with satisfactory postnatal evolution. One patient had a recurrent abdominal pregnancy, with genital Tb as a conditional factor. Time of hospitalization varied from 4 to 5 days, and no further patient complications were reported. Fetal loss was estimated in 83.4%. Abdominal pregnancy is often the sequence of a tubarian ectopic pregnancy an when present, it has a very high maternal mortality reported in world literature, not found in this study. The stated frequency of abdominal pregnancy is from 1 of each 3372, up to 1 in every 10,200 deliveries, reporting in the study 1 abdominal pregnancy in 5846 deliveries. The study had two characteristic entities one, the recurrence and two, the delivery at term of one newborn. Abdominal pregnancy accounts for 4% of all ectopic pregnancies. Clinical findings in abdominal pregnancies are pain, transvaginal bleeding and amenorrea, being the cardinal signs of ectopic pregnancy.

  3. Urgent Abdominal Re-Explorations

    Peskersoy Mustafa


    Full Text Available Abstract Background Treatment of a number of complications that occur after abdominal surgeries may require that Urgent Abdominal Re-explorations (UARs, the life-saving and obligatory operations, are performed. The objectives of this study were to evaluate the reasons for performing UARs, outcomes of relaparotomies (RLs and factors that affect mortality. Methods Demographic characteristics; initial diagnoses; information from and complications of the first surgery received; durations and outcomes of UAR(s performed in patients who received early RLs because of complicated abdominal surgeries in our clinic between 01.01.2000 and 31.12.2004 were investigated retrospectively. Statistical analyses were done using the chi-square and Fisher exact tests. Results Early UAR was performed in 81 out of 4410 cases (1.8%. Average patient age was 50.46 (13–81 years with a male-to-female ratio of 60/21. Fifty one (62.96% patients had infection, 41 (50.61% of them had an accompanying serious disease, 24 (29.62% of them had various tumors and 57 (70.37% patients were operated under emergency conditions during first operation. Causes of urgent abdominal re-explorations were as follows: leakage from intestinal repair site or from anostomosis (n:34; 41.97%; hemorrhage (n:15; 18.51%; intestinal perforation (n:8; 9.87%; intraabdominal infection or abscess (n:8; 9.87%; progressive intestinal necrosis (n:7; 8.64%; stomal complications (n:5; 6.17%; and postoperative ileus (n:4; 4.93%. Two or more UARs were performed in 18 (22.22% cases, and overall mortality was 34.97% (n:30. Interval between the first laparotomy and UAR averaged as 6.95 (1–20 days, and average hospitalization period was 27.1 (3–78 days. Mortality rate was found to be higher among the patients who received multiple UARs. The most common (55.5% cause of mortality was sepsis/multiple organ failure (MOF. The rates for common mortality and sepsis/MOF-dependent mortality that occured following UAR were

  4. Abdominal hernias: Radiological features

    Lassandro, Francesco; Iasiello, Francesca; Pizza, Nunzia Luisa; Valente, Tullio; Stefano, Maria Luisa Mangoni di Santo; Grassi, Roberto; Muto, Roberto


    Abdominal wall hernias are common diseases of the abdomen with a global incidence approximately 4%-5%. They are distinguished in external, diaphragmatic and internal hernias on the basis of their localisation. Groin hernias are the most common with a prevalence of 75%, followed by femoral (15%) and umbilical (8%). There is a higher prevalence in males (M:F, 8:1). Diagnosis is usually made on physical examination. However, clinical diagnosis may be difficult, especially in patients with obesity, pain or abdominal wall scarring. In these cases, abdominal imaging may be the first clue to the correct diagnosis and to confirm suspected complications. Different imaging modalities are used: conventional radiographs or barium studies, ultrasonography and Computed Tomography. Imaging modalities can aid in the differential diagnosis of palpable abdominal wall masses and can help to define hernial contents such as fatty tissue, bowel, other organs or fluid. This work focuses on the main radiological findings of abdominal herniations. PMID:21860678

  5. Postoperative pleural effusion following upper abdominal surgery

    Nielsen, P H; Jepsen, S B; Olsen, A D


    Of 128 patients who underwent upper abdominal surgery, examined by standard preoperative and postoperative chest roentgenograms for the formation of postoperative pleural effusions, 89 had postoperative pleural effusions. Their presence was not related to the type of operation, infection, serum a...

  6. Postoperative pleural effusion following upper abdominal surgery

    Nielsen, P H; Jepsen, S B; Olsen, A D


    Of 128 patients who underwent upper abdominal surgery, examined by standard preoperative and postoperative chest roentgenograms for the formation of postoperative pleural effusions, 89 had postoperative pleural effusions. Their presence was not related to the type of operation, infection, serum a...

  7. Gastrointestinal causes of abdominal pain.

    Marsicano, Elizabeth; Vuong, Giao Michael; Prather, Charlene M


    Gastrointestinal causes of abdominal pain are numerous. These causes are reviewed in brief here, divided into 2 categories: acute abdominal pain and chronic abdominal pain. They are further subcategorized by location of pain as it pertains to the abdomen.

  8. Identification of nanobacteria from blood and stool of rats suffering severe infection of abdominal cavity%SD大鼠严重腹腔感染前后血、粪纳米细菌的检测

    郑永波; 吴承堂


    目的检测SD大鼠腹腔感染前后血、粪纳米细菌(nanobacteria,NB),探讨NB与严重腹腔感染的相关性.方法40只SD大鼠,通过盲肠结扎加穿孔法制作SD大鼠严重腹腔感染模型,分别于感染前后取血、粪标本进行电镜下观察;NB培养;NB 16S rRNA基因聚合酶链反应(polymerase chain reaction,pCR)扩增,电泳分析.结果电镜下观察NB,感染前、后血阳性率分别为17.5%和35.0%,P=0.118;感染前、后粪阳性率分别为40.0%和32.5%,P=0.250.经28 d培养,结果均未见有NB特异性白色沉淀物形成.PCR法检测NB 16SrRNA基因,感染前、后血阳性率分别为52.5%和90.0%,P=0.000;感染前、后粪阳性率均为95.0%.结论PCR法检测NB 16S rRNA基因,SD大鼠粪普遍阳性,腹腔感染前、后血阳性率差异有显著意义,其作用尚待进一步研究.%Objective: To detect nanobacteria (NB) from blood and stool of rats suffering severe infection of abdominal cavity. Methods: 40 SD rats were involved in the study. The severe infection models of abdominal cavity were made by cecal ligation plus puncture (CLP). The test samples of blood and stool were obtained before or after infected respectively and filtered through 0.22 μm filters to eradicate the general germs and cells. The samples were stained with phosphoric tungstic acid and observed with transmission electron microscopy (TEM). RPMI1640 culture with 10.0% fetal bovine serum (FBS) was added into the filtered samples for culturing NB. Polymerase chain reaction (PCR) was made with the primers that designed from the sequences of NB 16S rRNA gene recorded in the genebank (GenBank accession No. X98419) [1]. PCR products were analyzed by agarose gel electrophoresis. Results: NB was detected with TEM from some samples. The positive rates before and after CLP respectively were 17.5% and 35.0%in the blood samples (P=0.118), 40.0% and 32.5% in the stool samples (P=0.250). We failed to find any white precipitate in any culture bottle in 28 d

  9. Analysis of the Utilization of Antibacterial Agents in Abdominal Cavity In-fection Patients%我院腹腔感染患者抗菌药应用分析

    蔡惠惠; 王义俊; 王芮


    目的:调查分析我院腹腔感染患者的抗菌药使用情况,指导临床合理应用抗菌药物治疗腹腔感染。方法:抽查我院2014年1~7月份腹腔感染出院患者病历共220份,对抗菌药使用情况进行统计分析。结果:220份病历均使用了抗菌药,共涉及10类24种:单一用药92例(占41.8%),二联用药126例(占57.3%),三联用药2例(占0.91%)。应用的抗菌药物以头孢菌素类(含加酶抑制剂复合制剂)的使用率最高;其次为青霉素类(含加酶抑制剂复合制剂);排在第三位的是硝基咪唑类。以两联用药为主,联用类别主要为β-内酰胺类联合硝基咪唑类及β-内酰胺类联合喹诺酮类。平均用药时间5.57 d。进行细菌培养及药敏试验的病例有47例,检出的致病菌主要是革兰阴性菌,有大肠埃希菌、铜绿假单胞菌及肺炎克雷伯菌。结论:我院腹腔感染患者抗菌药应用基本合理,但也存在联合用药不合理、疗程超长等情况,应进一步加强管理。%Objective: To analyze the utilization of antibacterial agents in abdominal infection cases, and to provide guidance for rational use of antibacterial agents in the clinic. Methods: A total of 220 abdominal infection cases were collected in our hospital from January to July of 2014, and the data of antimicrobial agents use were statistically analyzed. Results: There were a total of 24 drugs of 10 categories used in 220 cases, with 92 cases using single drug (57.3%), 126 cases using two drugs (57.3%), and only two cases using three drugs (0.91%). The top three varieties of antibacterials included cephalosporins (with enzyme inhibitor compound preparations), penicillins (with enzyme inhibitor compound preparations) and nitroimidazoles. Two drugs combination was the main application in the antimicrobial drugs, the main combination types were β-lactam+quinolones and β-lactam+ nitroimidazoles. The average

  10. [Inflammatory abdominal aortic aneurysm].

    Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T


    The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

  11. Abdominal candidiasis is a hidden reservoir of echinocandin resistance.

    Shields, Ryan K; Nguyen, M Hong; Press, Ellen G; Clancy, Cornelius J


    FKS mutant Candida isolates were recovered from 24% (6/25) of abdominal candidiasis patients exposed to echinocandin. Candida glabrata (29%) and Candida albicans (14%) mutants were identified. Multidrug-resistant bacteria were recovered from 83% of FKS mutant infections. Mutations were associated with prolonged echinocandin exposure (P = 0.01), breakthrough infections (P = 0.03), and therapeutic failures despite source control interventions (100%). Abdominal candidiasis is a hidden reservoir for the emergence of echinocandin-resistant Candida.

  12. Percutaneous drainage of abdominal abcess

    Men, Sueleyman E-mail:; Akhan, Okan; Koeroglu, Mert


    The mortality in undrained abdominal abscesses is high with a mortality rate ranging between 45 and 100%. The outcome in abdominal abscesses, however, has improved due to advances in image guided percutaneous interventional techniques. The main indications for the catheter drainage include treatment or palliation of sepsis associated with an infected fluid collection, and alleviation of the symptoms that may be caused by fluid collections by virtue of their size, like pancreatic pseudocele or lymphocele. The single liver abscesses may be drained with ultrasound guidance only, whereas the multiple abscesses usually require computed tomography (CT) guidance and placement of multiple catheters. The pancreatic abscesses are generally drained routinely and urgently. Non-infected pancreatic pseudocysts may be simply observed unless they are symptomatic or cause problems such as pain or obstruction of the biliary or the gastrointestinal tract. Percutaneous routes that have been described to drain pelvic abscesses include transrectal or transvaginal approach with sonographic guidance, a transgluteal, paracoccygeal-infragluteal, or perineal approach through the greater sciatic foramen with CT guidance. Both the renal and the perirenal abscesses are amenable to percutaneous drainage. Percutaneous drainage provides an effective and safe alternative to more invasive surgical drainage in most patients with psoas abscesses as well.

  13. Abdominal wall endometriosis.

    Upadhyaya, P; Karak, A K; Sinha, A K; Kumar, B; Karki, S; Agarwal, C S


    Endometriosis of abdominal wall scar following operation on uterus and tubes is extremely rare. The late onset of symptoms after surgery is the usual cause of misdiagnosis. Scar endometriosis is a rare disease which is difficult to diagnose and should always be considered as a differential diagnosis of painful abdominal masses in women. The diagnosis is made only after excision and histopathology of the lesion. Preoperative differentials include hernia, lipoma, suture granuloma or abscess. Hence an awareness of the entity avoids delay in diagnosis, helps clinicians to a more tailored treatment and also avoids unnecessary referrals. We report a case of abdominal endometriosis. The definitive diagnosis of which was established by histopathological studies.

  14. Towards new antituberculotic targets: biochemical characterisation of mycobacterial RNase E/G

    Agnes Csanadi


    Full Text Available The World Health Organization estimates that each year 3 million people die from tuberculosis (TB and 8 million people become infected. No new anti-TB drugs have been introduced in the past 30 years, even though their development becomes increasingly important to face new challenges posed by multidrug-resistant and extensively drug-resistant strains and by acute infection with M. tuberculosis of HIV positive patients. Owing to its apparently important role in RNA metabolism, the RNase E/G family of endoribonucleases can be considered as a promising target for antimicrobial drugs. This consideration promted us to characterise biochemical properties of the M. tuberculosis RNase E/G homologue. To learn more about specific properties of RNase E/G homologues a M. tuberculosis RNase E/G (MycRne was overexpressed in E. coli and purified as a 6His-tagged polypeptide. To characterise MycRne, we used in vitro cleavage assays and primer extension analysis of total RNA extracted from mycobacteria. We show that affinity purified MycRne has an endoribonucleolytic activity, which is dependent on the 5'-phosphorylation status of RNA. We could also show that RNase E/G has Mg2+ dependent activity and similar to E. coli RNase E, MycRne was able to cleave in an intercistronic region of the putative 9S precursor of 5S rRNA. Although, similar to E. coli RNase E, the mycobacterial RNase E/G homologue plays a role in rRNA processing, the substrate specificities of these enzymes show differences. This suggests that RNase E/G can be used as a promising target for antimicrobial drugs that can be optimized to specifically target pathogenic species.

  15. [Intestinal occlusion and abdominal compartment syndrome (ACS)].

    Stagnitti, Franco


    Intestinal occlusion is defined as an independent predictive factor of intra-abdominal hypertension (IAH) which represents an independent predictor of mortality. Baggot in 1951 classified patients operated with intestinal occlusion as being at risk for IAH ("abdominal blow-out"), recommending them for open abdomen surgery proposed by Ogilvie. Abdominal surgery provokes IAH in 44.7% of cases with mortality which, in emergency, triples with respect to elective surgery (21.9% vs 6.8%). In particular, IAH is present in 61.2% of ileus and bowel distension and is responsible for 52% of mortality (54.8% in cases with intra-abdominal infection). These patients present with an increasing intra-abdominal pressure (IAP) which, over 20-25 mmHg, triggers an Abdominal Compartment Syndrome (ACS) with altered functions in some organs arriving at Multiple Organ Dysfunction Syndrome (MODS). The intestine normally covers 58% of abdominal volume but when there is ileus distension, intestinal pneumatosis develops (third space) which can occupy up to 90% of the entire cavity. At this moment, Gastro Intestinal Failure (GIF) can appear, which is a specific independent risk factor of mortality, motor of "Organ Failure". The pathophysiological evolution has many factors in 45% of cases: intestinal pneumatosis is associated with mucosal and serous edema, capillary leakage with an increase in extra-cellular volume and peritoneal fluid collections (fourth space). The successive loss of the mucous barrier permits a bacterial translocation which includes bacteria, toxins, pro-inflammatory factors and oxygen free radicals facilitating the passage from an intra-abdominal to inter-systemic vicious cyrcle. IAH provokes the raising of the diaphragm, and vascular and visceral compressions which induce hypertension in the various spaces with compartmental characteristics. These trigger hypertension in the renal, hepatic, pelvic, thoracic, cardiac, intracranial, orbital and lower extremity areas, giving

  16. A Sir2-like protein participates in mycobacterial NHEJ.

    Zhongdao Li

    Full Text Available In eukaryotic cells, repair of DNA double-strand breaks (DSBs by the nonhomologous end-joining (NHEJ pathway is critical for genome stability. In contrast to the complex eukaryotic repair system, bacterial NHEJ apparatus consists of only two proteins, Ku and a multifunctional DNA ligase (LigD, whose functional mechanism has not been fully clarified. We show here for the first time that Sir2 is involved in the mycobacterial NHEJ repair pathway. Here, using tandem affinity purification (TAP screening, we have identified an NAD-dependent deacetylase in mycobacteria which is a homologue of the eukaryotic Sir2 protein and interacts directly with Ku. Results from an in vitro glutathione S-transferase (GST pull-down assay suggest that Sir2 interacts directly with LigD. Plasmid-based end-joining assays revealed that the efficiency of DSB repair in a sir2 deletion mutant was reduced 2-fold. Moreover, the Δsir2 strain was about 10-fold more sensitive to ionizing radiation (IR in the stationary phase than the wild-type. Our results suggest that Sir2 may function closely together with Ku and LigD in the nonhomologous end-joining pathway in mycobacteria.

  17. Mycobacterial carbohydrate antigens for serological testing of patients with leprosy.

    Levis, W R; Meeker, H C; Schuller-Levis, G; Sersen, E; Brennan, P J; Fried, P


    To determine whether quantitation of antibodies to mycobacterial carbohydrate determinants would be valuable in serodiagnosis and monitoring of leprosy, we tested serum IgM antibody to Mycobacterium leprae phenolic glycolipid I and IgM and IgG antibodies to Mycobacterium tuberculosis and M. leprae lipoarabinomannan (LAM) by enzyme-linked immunosorbent assay. Seventy-one percent of patients with paucibacillary disease and 85.5% of patients with multibacillary disease were positive for at least one of the three antibodies. The 15% of antibody-negative patients with multibacillary disease were mostly long-term-treated patients, with inactive disease by biopsy. There was excellent agreement between M. tuberculosis LAM and M. leprae LAM in detection of antibodies. Bacillary index and levels of both IgG and IgM antibodies to LAM were positively correlated when all patients were analyzed. When patients with a history of erythema nodosum leprosum (ENL) were analyzed separately, there was no correlation between IgM or IgG antibody to LAM and bacillary index, a result suggesting a possible role for LAM in the pathogenesis of ENL.


    Josephine Pudumai Selvi; Celine Foustina Mary; Karthikeyan Rajashekar


    BACKGROUND Surgical site infection (SSI) is an immense burden on healthcare resources even in the modern era of immaculate sterilization approaches and highly effective antibiotics. An estimated 234 million various surgical procedures, involving skin incisions requiring various types of wound closure techniques, are performed in the world, with the majority resulting in a wound healing by primary intention. Triclosan (5-chloro-2-(2, 4-dichlorophenoxy) phenol) is a broad-spectrum b...

  19. 重组人生长激素对慢性腹腔感染病人蛋白质代谢的影响%Influence of recombinant growth hormone on protein metabolism in chronic abdominal infection

    李元新; 李幼生; 任建安; 李宁; 黎介寿


    目的:研究重组人生长激素对促进慢性腹腔感染病人蛋白质代谢的影响。 方法:20例慢性腹腔感染病人随机分为GH组(TPN+GH)和对照组(TPN),研究时间为10天。分别于研究前与研究结束时进行感染评分,检测血清生长激素(GH)、血清胰岛素样生长因子-1(IGF-1)、血清胰岛素样生长因子结合蛋白-3(IGFBP-3);分别于研究前、研究第3天、第7天及研究结束时,检测血清白蛋白、前白蛋白、转铁蛋白、纤维连接蛋白、C-反应蛋白;测定每天氮平衡及24 h尿肌酐。 结果:研究结束时GH组GH、IGF-1、IGFBP-3显著高于对照组及研究前;研究期间GH组血清白蛋白、前白蛋白、转铁蛋白、纤维连接蛋白升高,而C-反应蛋白下降;氮平衡改善,累计氮平衡显著高于对照组,而24 h尿肌酐则下降。 结论:重组人生长激素能促进慢性腹腔感染病人蛋白质代谢,而IGF-1在其中发挥了重要作用。%Objectives: To study the ameliorated effect of recombinant growth hormone on protein metabolism in chronic abdominal infection.  Methods: 20 patients were divided randomly into two groups. Patients in the control group received TPN only for 10 days, while patients in the GH groups received both rGH(13.5u/d) and TPN for 10 days. Sepsis Score grade and detection of serum Growth Hormone (GH), Insulin like growth factor-1 (IGF-1), and Insulin like growth factor binding protein- 3(IGFBP-3) were carried out on day 0 and day 11, Serum albumin, prealbumin, transferring, fibronectin and C-reaction protein were detected on day 0, day 3, day 7 and day 11, Nitrogen balance and 24-hour urine creatinine secretion were assayed daily.  Results: GH, IGF-1 and IGFBP-3 in the GH group on day 11 were significantly higher than those in the GH group on day 0 and those in the control group on day 11, Serum albumin, prealbumin, transferring and fibronectin increased, while C

  20. Abdominal tuberculosis: Imaging features

    Pereira, Jose M. [Department of Radiology, Hospital de S. Joao, Porto (Portugal)]. E-mail:; Madureira, Antonio J. [Department of Radiology, Hospital de S. Joao, Porto (Portugal); Vieira, Alberto [Department of Radiology, Hospital de S. Joao, Porto (Portugal); Ramos, Isabel [Department of Radiology, Hospital de S. Joao, Porto (Portugal)


    Radiological findings of abdominal tuberculosis can mimic those of many different diseases. A high level of suspicion is required, especially in high-risk population. In this article, we will describe barium studies, ultrasound (US) and computed tomography (CT) findings of abdominal tuberculosis (TB), with emphasis in the latest. We will illustrate CT findings that can help in the diagnosis of abdominal tuberculosis and describe imaging features that differentiate it from other inflammatory and neoplastic diseases, particularly lymphoma and Crohn's disease. As tuberculosis can affect any organ in the abdomen, emphasis is placed to ileocecal involvement, lymphadenopathy, peritonitis and solid organ disease (liver, spleen and pancreas). A positive culture or hystologic analysis of biopsy is still required in many patients for definitive diagnosis. Learning objectives:1.To review the relevant pathophysiology of abdominal tuberculosis. 2.Illustrate CT findings that can help in the diagnosis.

  1. [The abdominal catastrophe].

    Seiler, Christian A


    Patients with an abdominal catastrophe are in urgent need of early, interdisciplinary medical help. The treatment plan should be based on medical priorities and clear leadership. First priority should be given to achieve optimal oxygenation of blood and stabilization of circulation during all treatment-phases. The sicker the patient, the less invasive the (surgical) treatment should to be, which means "damage control only". This short article describes 7 important, pragmatic rules that will help to increase the survival of a patient with an abdominal catastrophe. Preexisting morbidity and risk factors must be included in the overall risk-evaluation for every therapeutic intervention. The challenge in patients with an abdominal catastrophe is to carefully balance the therapeutic stress and the existing resistance of the individual patient. The best way to avoid abdominal disaster, however, is its prevention.

  2. Abdominal and Pelvic CT

    Full Text Available ... contrast materials and a metallic taste in your mouth that lasts for at most a minute or ... can diagnose many causes of abdominal pain or injury from trauma with very high accuracy, enabling faster ...

  3. Abdominal x-ray

    ... are, or may be, pregnant. Alternative Names Abdominal film; X-ray - abdomen; Flat plate; KUB x-ray ... Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also ...

  4. Abdominal and Pelvic CT

    Full Text Available ... often used to determine the cause of unexplained pain. CT scanning is fast, painless, noninvasive and accurate. ... help diagnose the cause of abdominal or pelvic pain and diseases of the internal organs, small bowel ...

  5. Abdominal and Pelvic CT

    Full Text Available ... is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. ... GI) contrast exams and ultrasound are preferred for evaluation of acute abdominal conditions in babies, such as ...

  6. Abdominal ultrasound (image)

    Abdominal ultrasound is a scanning technique used to image the interior of the abdomen. Like the X-ray, MRI, ... it has its place as a diagnostic tool. Ultrasound scans use high frequency sound waves to produce ...

  7. Abdominal exploration - slideshow

    ... ency/presentations/100049.htm Abdominal exploration - series—Normal anatomy To use the ... Overview The abdomen contains many vital organs: the stomach, the small intestine (jejunum and ileum), the large ...

  8. Abdominal and Pelvic CT

    Full Text Available ... is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. ... GI) contrast exams and ultrasound are preferred for evaluation of acute abdominal conditions in babies, such as ...

  9. Diagnosis and treatment of liver trauma complicated with intra-abdominal infections%肝脏外伤并发腹腔感染的分析及诊治

    张雯雯; 何蕾; 万涛; 吕少诚; 徐明月; 刘同友; 路辉; 史宪杰


    OBJECTIVE To explore the measures for diagnosis and treatment of liver trauma complicated with intraabdominal infections so as to guide the prevention and treatment of intra-abdominal infections.METHODS We retrospectively analyzed the clinical data of 64 patients with liver trauma between Jan 2000 and Sep 2012,including 7 cases of conservative treatment and 57 cases of surgical treatment,and all the cases were treated with prevention of infections,liver protection,and nutritional support.RESULTS Of the 64 cases of patients,there were 23 cases of peritoneal infections with the infection rate of 35.9 %.No simple liver trauma patients suffered from complicating intrabdominal infection,while among the patients with gastrointestinal trauma the incidence of peritoneal infections was 85.7%,and the incidence of the patients with the AAST grading Ⅳ was 51.5%.Totally 41 strains of pathogens were isolated,among which there were 15 (36.6%) strains of Escherichia coli,10 (24.4%) strains of Enterococcus faecalis,and 8 (19.5%) strains of Enterococcus faecium,which ranked the top three species of the pathogens.Of totally 23 cases of patients with peritoneal infections,22 cases were cured with the cure rate of 95.65 %.CONCLUSION The incidence of intraabdominal infections is high in the patients with complex liver trauma,especially the patients with multi-organ trauma.The integrated treatment with micro-invasive operations on the basis of trauma-control surgery idea can effectively cure the intraabdominal infections and decrease the mortality.%目的 探讨肝脏外伤并发腹腔感染的诊治方法,以期为肝脏外伤并发腹腔感染的预防治疗起到指导作用.方法 回顾性分析医院2000年1月-2012年9月64例肝脏外伤患者的临床资料,其中7例行保守治疗,57例行手术治疗,均予预防性抗感染、保肝、营养等治疗方法.结果 64例患者中23例出现腹腔感染,感染率为35.9%,其中单纯性肝脏外伤患者无

  10. Linear abdominal trauma.

    Danto, L A; Wolfman, E F


    Three cases of blunt abdominal trauma are presented to exemplify the mechanism of trauma and the problems of diagnosis associated with any linear blow to the abdomen. The mechanisms of visceral injury are reviewed, and special attention is directed to the abdominal wall injury that can be present in these patients. This injury has special implications in directing the operative approach and repair. An unusual aortic occlusion is described which is peculiar to this type of injury.

  11. Antimicrobial susceptibility of gram-negative pathogens isolated from patients with complicated intra-abdominal infections in South African hospitals (SMART Study 2004-2009): impact of the new carbapenem breakpoints.

    Brink, Adrian J; Botha, Roelof F; Poswa, Xoliswa; Senekal, Marthinus; Badal, Robert E; Grolman, David C; Richards, Guy A; Feldman, Charles; Boffard, Kenneth D; Veller, Martin; Joubert, Ivan; Pretorius, Jan


    The Study for Monitoring Antimicrobial Resistance Trends (SMART) follows trends in resistance among aerobic and facultative anaerobic gram-negative bacilli (GNB) isolated from complicated intra-abdominal infections (cIAIs) in patients around the world. During 2004-2009, three centralized clinical microbiology laboratories serving 59 private hospitals in three large South African cities collected 1,218 GNB from complicated intra-abdominal infections (cIAIs) and tested them for susceptibility to 12 antibiotics according to the 2011 Clinical Laboratory Standards Institute (CLSI) guidelines. Enterobacteriaceae comprised 83.7% of the isolates. Escherichia coli was the species isolated most commonly (46.4%), and 7.6% of these were extended-spectrum β-lactamase (ESBL)-positive. The highest ESBL rate was documented for Klebsiella pneumoniae (41.2%). Overall, ertapenem was the antibiotic most active against susceptible species for which it has breakpoints (94.6%) followed by amikacin (91.9%), piperacillin-tazobactam (89.3%), and imipenem-cilastatin (87.1%), whereas rates of resistance to ceftriaxone, cefotaxime, ciprofloxacin, and levofloxacin were documented to be 29.7%, 28.7%, 22.5%, and 21.1%, respectively. Multi-drug resistance (MDR), defined as resistance to three or more antibiotic classes, was significantly more common in K. pneumoniae (27.9%) than in E. coli (4.9%; p<0.0001) or Proteus mirabilis (4.1%; p<0.05). Applying the new CLSI breakpoints for carbapenems, susceptibility to ertapenem was reduced significantly in ESBL-positive E. coli compared with ESBL-negative isolates (91% vs. 98%; p<0.05), but this did not apply to imipenem-cilastatin (95% vs. 99%; p=0.0928). A large disparity between imipenem-cilastatin and ertapenem susceptibility in P. mirabilis and Morganella morganii was documented (24% vs. 96% and 15% vs. 92%, respectively), as most isolates of these two species had imipenem-cilastatin minimum inhibitory concentrations in the 2-4 mcg/mL range, which

  12. Ventral Abdominal Hernia

    Georgi Tchernev


    Full Text Available A 63-year-old Caucasian female patient presented with redness of the both foot and lower legs, as well as edema of the left lower leg, accompanied by subjective complaints of burning. Fever was not reported. Well-circumscribed oval shaped tumor formation was revealed also on the abdominal wall, with hyperpigmented and depigmented areas on its ulcerated surface, measuring approximately 10/10cm in diameter, with soft-elastic texture on palpation.  The lesion occurred in 2011, according to the patient’s history. No subjective complaints were reported in association. The performed ultrasonography revealed intestinal loops in the hernial sac, without incarceration. The diagnosis of ventral abdominal hernia without mechanical ileus was made. The patient was referred for planned surgical procedure, because of her refusal on this stage.The clinical manifestation of the tumor formation on the abdominal wall, required wide spectrum of differential diagnosis, including aneurysm of the abdominal aorta, abdominal tumor, subcutaneous tumor or metastasis or hernia. In the presented cases, the abdominal wall mass was a sporadic clinical finding in the framework of the total-body skin examination in patient with erysipelas. The lack of subjective symptoms, as well as the reported history for hysterectomy and previously abscessus were not enough indicative symptoms for the correct diagnosis. The diagnosis of non-complicated hernia was made via ultrasonography, while the clinical differentiation between hernia and other life-threatening conditions as aneurysms or tumor was not possible.

  13. 胸部物理治疗集束化管理在严重腹腔感染患者中的应用%Application of chest physiotherapy bundle management in patients with severe abdominal infection

    江方正; 叶向红; 李维勤; 彭南海; 赵允召; 任建安


    Objective To explore the application of chest physiotherapy bundle management in patients with severe abdominal infection. Methods Totally 120 ICU patients with severe abdominal infection were divided into two groups. The patients in the experimental group received chest physiotherapy bundle management,including three-step half-closed lip breathing,four-step effective cough,five-step back-slap and six-step nebulization. The patients in the control group received routine respiratory care. The heart rate,blood pressure,oxygen saturation(SpO2), respiratory rate and autonomous expectoration capacity at 24h,48h and 168h were recorded. Moreover,the incidences of atelectasis,pulmonary infection and trachea intubation at 48h and 168h were recorded. Results The patients' autonomous expectoration capacity at 168h in the experimental-group was significantly better than that in the control group(P<0.05). The heart rate,SpO2 and respiratory rate at 24h,48h and 168h in the experimental group were significantly better than that in the control group(P<0.05 or P<0.01). Moreover,the incidences of atelectasis,pulmonary infection and tracheal intubation in the experinebtal group were significantly lower than those in the control group (P<0.05). Conclusion The application of chest physiotherapy bundle management can improve the level of SpO2 and autonomous expectoration capacity, reduce the incidence of atelectasis, intubation and pulmonary infection.%目的 探讨胸部物理治疗集束化管理在严重腹腔感染患者中的应用.方法 选择入住我科ICU的严重腹腔感染患者120例,按入院单双号顺序分为两组,单号为试验组60例,采取胸部物理治疗集束化管理及三步缩唇呼吸法、四步有效咳嗽法、五步叩背法、六步雾化吸入法;双号为对照组60例,采取呼吸道常规护理.观察并记录两组患者24h、48h、168h心率、血压、血氧饱和度(SpO2)、呼吸频率及自主排痰能力,以及48h、168h肺不张的发

  14. Nitric Oxide Production Inhibition and Anti-Mycobacterial Activity of Extracts and Halogenated Sesquiterpenes from the Brazilian Red Alga Laurencia Dendroidea J. Agardh.

    Biá Ventura, Thatiana Lopes; da Silva Machado, Fernanda Lacerda; de Araujo, Marlon Heggdorne; de Souza Gestinari, Lísia Mônica; Kaiser, Carlos Roland; de Assis Esteves, Francisco; Lasunskaia, Elena B; Soares, Angélica Ribeiro; Muzitano, Michelle Frazão


    Red algae of the genus Laurencia J. V. Lamouroux are a rich source of secondary metabolites with important pharmacological activities such as anti-tumoral, anti-inflammatory, anti-fungal, anti-viral, anti-leishmanial, anti-helminthic, anti-malarial, anti-trypanosomal, anti-microbial as well as anti-bacterial against Mycobacterium tuberculosis. In the present study, we evaluated the inhibition of nitric oxide (NO) and tumor necrosis factor-α production and the anti-mycobacterial activity of crude extracts from the red Alga Laurencia dendroidea (from the South-Eastern coast of Brazil). Halogenated sesquiterpenes elatol (1), obtusol (2) and cartilagineol (3), previously isolated from this Alga by our group, were also studied. The lipopolysaccharide-activated macrophage cells (RAW 264.7) were used as inflammation model. Cytotoxic effect was determined using a commercial lactate dehydrogenase (LDH) kit and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. The growing Mycobacterium inhibition was verified against Mycobacterium bovis Bacillus Calmette-Guérin and M. tuberculosis H37 Rv strains. The crude extract from Alga collected at Angra dos Reis, RJ, Brazil, was the most active inhibitor of both mycobacterial growth (half maximal inhibitory concentration [IC50] 8.7 ± 1.4 μg/mL) and NO production by activated macrophages (IC50 5.3 ± 1.3 μg/mL). The assays with isolated compounds revealed the anti-mycobacterial activity of obtusol (2), whereas (-)-elatol (1) inhibited the release of inflammatory mediators, especially NO. To our knowledge, this is the first report describing an anti-mycobacterial effect of L. dendroidea extract and demonstrating the association of this activity with obtusol (2). The described effects of active compounds from L. dendroidea are promising for the control of inflammation in infectious diseases and specifically, against mycobacterial infections associated with exacerbated inflammation. Inflammation is strongly involved

  15. Abdominal and Pelvic CT

    Full Text Available ... as: infections such as appendicitis , pyelonephritis or infected fluid collections, also known as abscesses. inflammatory bowel disease ... caused by a burst appendix or an infected fluid collection and the subsequent spread of infection. CT ...

  16. Epidemiology and trends in the antibiotic susceptibilities of Gram-negative bacilli isolated from patients with intra-abdominal infections in the Asia-Pacific region, 2010-2013.

    Chang, Ya-Ting; Coombs, Geoffrey; Ling, Thomas; Balaji, V; Rodrigues, Camilla; Mikamo, Hiroshige; Kim, Min-Ja; Rajasekaram, Datin Ganeswrie; Mendoza, Myrna; Tan, Thean Yen; Kiratisin, Pattarachai; Ni, Yuxing; Barry, Weinman; Xu, Yingchun; Chen, Yen-Hsu; Hsueh, Po-Ren


    This study was conducted to investigate the epidemiology and antimicrobial susceptibility patterns of Gram-negative bacilli (GNB) isolated from intra-abdominal infections (IAIs) in the Asia-Pacific region (APR) from 2010-2013. A total of 17 350 isolates were collected from 54 centres in 13 countries in the APR. The three most commonly isolated GNB were Escherichia coli (46.1%), Klebsiella pneumoniae (19.3%) and Pseudomonas aeruginosa (9.8%). Overall, the rates of extended-spectrum β-lactamase (ESBL)-producing E. coli and K. pneumoniae were 38.2% and 24.3%, respectively, and they were highest in China (66.6% and 38.7%, respectively), Thailand (49.8% and 36.5%, respectively) and Vietnam (47.9% and 30.4%, respectively). During 2010-2013, the rates of ESBL-producing E. coli and K. pneumoniae isolates causing community-associated (CA) IAIs (collected 80%) causing IAIs, except for Acinetobacter calcoaceticus-baumannii (ACB) complex (30.9% for HA-IAI isolates). All of the antimicrobial agents tested exhibited <45% in vitro activity against ACB complex. Antimicrobial resistance is a persistent threat in the APR and continuous monitoring of evolutionary trends in the susceptibility patterns of GNB causing IAIs in this region is mandatory. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  17. 晚期糖基化终末产物受体在腹腔感染脓毒症中的研究进展%Recent progress of RAGE in sepsis induced by intra-abdominal infection

    廖延年(综述); 黄骞; 黎介寿(审校)


    Sepsis caused by complicated intra-abdominal infection has a poor prognosis since the mechanism of sepsis has not been fully clarified .Research about the effect of Receptor of Advanced Glycation Endproducts on sepsis was paid extensive attention . In this paper , the construction and function of RAGE , the relationship between RAGE and inflammation and action of RAGE during sepsis are summarized .%严重腹腔感染导致的脓毒症预后不佳,与其机制的未充分阐明有关。近年来关于晚期糖基化终末产物受体( re-ceptor of advanced glycation endproducts , RAGE)在脓毒症中的作用的研究受到广泛关注。文中就RAGE的结构与功能,RAGE与炎症的关系以及RAGE在腹腔感染脓毒症中的作用等问题作一综述。

  18. Anthelmintic Therapy Modifies the Systemic and Mycobacterial Antigen-Stimulated Cytokine Profile in Helminth-Latent Mycobacterium tuberculosis Coinfection.

    Anuradha, Rajamanickam; Munisankar, Saravanan; Bhootra, Yukthi; Dolla, Chandrakumar; Kumaran, Paul; Nutman, Thomas B; Babu, Subash


    Helminth infections are known to modulate cytokine responses in latent tuberculosis (LTB). However, very few studies have examined whether this modulation is reversible upon anthelmintic therapy. We measured the systemic and mycobacterial (TB) antigen-stimulated levels of type 1, type 2, type 17, and regulatory cytokines in individuals with LTB and with or without coexistent Strongyloides stercoralis infection before and after anthelmintic therapy. Our data reveal that individuals with LTB and coexistent S. stercoralis infection have significantly lower levels of systemic and TB antigen-stimulated type 1 (gamma interferon [IFN-γ], tumor necrosis factor alpha [TNF-α], and interleukin-2 [IL-2]) and type 17 (IL-17A and/or IL-17F) cytokines and significantly higher levels of systemic but not TB antigen-stimulated type 2 (IL-4 and IL-5) and regulatory (transforming growth factor beta [TGF-β]) cytokines. Anthelmintic therapy resulted in significantly increased systemic levels of type 1 and/or type 17 cytokines and in significantly decreased systemic levels of type 2 and regulatory (IL-10 and TGF-β) cytokines. In addition, anthelmintic therapy resulted in significantly increased TB antigen-stimulated levels of type 1 cytokines only. Our data therefore confirm that the modulation of systemic and TB antigen-stimulated cytokine responses in S. stercoralis-LTB coinfection is reversible (for the most part) by anthelmintic treatment. Copyright © 2017 American Society for Microbiology.

  19. Abdominal emergencies in pediatrics.

    Coca Robinot, D; Liébana de Rojas, C; Aguirre Pascual, E


    Abdominal symptoms are among the most common reasons for pediatric emergency department visits, and abdominal pain is the most frequently reported symptom. Thorough history taking and physical examination can often reach the correct diagnosis. Knowing the abdominal conditions that are most common in each age group can help radiologists narrow the differential diagnosis. When imaging tests are indicated, ultrasonography is usually the first-line technique, enabling the diagnosis or adding relevant information with the well-known advantages of this technique. Nowadays, plain-film X-ray studies are reserved for cases in which perforation, bowel obstruction, or foreign body ingestion is suspected. It is also important to remember that abdominal pain can also occur secondary to basal pneumonia. CT is reserved for specific indications and in individual cases, for example, in patients with high clinical suspicion of abdominal disease and inconclusive findings at ultrasonography. We review some of the most common conditions in pediatric emergencies, the different imaging tests indicated in each case, and the imaging signs in each condition.

  20. Predictors of Treatment Response to Tesamorelin, a Growth Hormone-Releasing Factor Analog, in HIV-Infected Patients with Excess Abdominal Fat.

    Alexandra Mangili

    Full Text Available Tesamorelin, a synthetic analog of human growth hormone-releasing factor, decreases visceral adipose tissue (VAT in human immunodeficiency virus (HIV-infected patients with lipodystrophy.1 To evaluate the utility of patient characteristics and validated disease-risk scores, namely indicator variables for the metabolic syndrome defined by the International Diabetes Federation (MetS-IDF or the National Cholesterol Education Program (MetS-NCEP and the Framingham Risk Score (FRS, as predictors of VAT reduction during tesamorelin therapy at 3 and 6 months, and 2 To explore the characteristics of patients who reached a threshold of VAT 1.7 mmol/L, and white race had a significant impact on likelihood of response to tesamorelin after 6 months of therapy (interaction p-values 0.054, 0.063, and 0.025, respectively. No predictive factors were identified at 3 months. The odds of a VAT reduction to <140 cm2 for subjects treated with tesamorelin was 3.9 times greater than that of subjects randomized to placebo after controlling for study, gender, baseline body mass index (BMI and baseline VAT (95% confidence interval [CI] 2.03; 7.44.Individuals with baseline MetS-NCEP, elevated triglyceride levels, or white race were most likely to experience reductions in VAT after 6 months of tesamorelin treatment. The odds of response of VAT <140 cm2 was 3.9 times greater for tesamorelin-treated patients than that of patients receiving placebo.

  1. Who Has Mycobacterial Disease? A Cross Sectional Study in Agropastoral Communities in Tanzania.

    Andrew Martin Kilale

    Full Text Available To determine and describe clinical symptoms, demographic characteristics and environmental exposures as determinants of pulmonary mycobacterial diseases among patients examined for tuberculosis in agropastoral communities in Northern Tanzania.This was a cross sectional study. Sputum samples were collected from patients attending three hospitals in Tanzania, and were investigated for pulmonary tuberculosis by microscopy between November 2010 and June 2012. The patients were interviewed about background information, and potential exposure to mycobacteria.We examined 1,711 presumptive tuberculosis cases where 936 (54.2% were males and 775 (45.3% females. Of all the study participants, 277 (16% were found to have sputum samples positive for mycobacteria; 228 (13% were smear positive, 123 (7% were culture positive and 74 (4% were positive by both smear microscopy and culture. Of the 123 mycobacterial culture positive, 15 (12.2% had non-tuberculous mycobacteria. Males were more likely than females to be positive for mycobacteria. Factors associated with mycobacterial disease were loss of appetite, age groups below 41 years, and being a male. Among HIV negative patients, loss of appetite, age below 20 years and being a male were associated with being mycobacterial positive. Among HIV positive patients, males and those patients with a persistently coughing family member were more likely to harbor mycobacteria.The findings in this study show that both M. tuberculosis and non-tuberculous mycobacterial strains were prevalent in the study community. Some risk factors were identified. Although the reported predictors may improve screening for mycobacterial diseases, their use requires some precaution.

  2. Specific detection of the cleavage activity of mycobacterial enzymes using a quantum dot based DNA nanosensor

    Jepsen, Morten Leth; Harmsen, Charlotte; Godbole, Adwait Anand; Nagaraja, Valakunja; Knudsen, Birgitta R.; Ho, Yi-Ping


    We present a quantum dot based DNA nanosensor specifically targeting the cleavage step in the reaction cycle of the essential DNA-modifying enzyme, mycobacterial topoisomerase I. The design takes advantages of the unique photophysical properties of quantum dots to generate visible fluorescence recovery upon specific cleavage by mycobacterial topoisomerase I. This report, for the first time, demonstrates the possibility to quantify the cleavage activity of the mycobacterial enzyme without the pre-processing sample purification or post-processing signal amplification. The cleavage induced signal response has also proven reliable in biological matrices, such as whole cell extracts prepared from Escherichia coli and human Caco-2 cells. It is expected that the assay may contribute to the clinical diagnostics of bacterial diseases, as well as the evaluation of treatment outcomes.We present a quantum dot based DNA nanosensor specifically targeting the cleavage step in the reaction cycle of the essential DNA-modifying enzyme, mycobacterial topoisomerase I. The design takes advantages of the unique photophysical properties of quantum dots to generate visible fluorescence recovery upon specific cleavage by mycobacterial topoisomerase I. This report, for the first time, demonstrates the possibility to quantify the cleavage activity of the mycobacterial enzyme without the pre-processing sample purification or post-processing signal amplification. The cleavage induced signal response has also proven reliable in biological matrices, such as whole cell extracts prepared from Escherichia coli and human Caco-2 cells. It is expected that the assay may contribute to the clinical diagnostics of bacterial diseases, as well as the evaluation of treatment outcomes. Electronic supplementary information (ESI) available: Characterization of the QD-based DNA Nanosensor. See DOI: 10.1039/c5nr06326d

  3. Mycobacterium tuberculosis Zinc Metalloprotease-1 Elicits Tuberculosis-specific Humoral Immune Response Independent of Mycobacterial Load in Pulmonary and Extra-Pulmonary Tuberculosis Patients

    Mani Harika eVemula


    Full Text Available Conventionally, facultative intracellular pathogen, Mycobacterium tuberculosis (M.tb, the tuberculosis (TB causing bacilli in human is cleared by cell-mediated immunity (CMI with CD4+ T cells playing instrumental role in protective immunity, while antibody-mediated immunity (AMI is considered non-protective. This longstanding convention has been challenged with recent evidences of increased susceptibility of hosts with compromised AMI and monoclonal antibodies conferring passive protection against TB and other intracellular pathogens. Therefore, novel approaches towards vaccine development include strategies aiming at induction of humoral response along with CMI. This necessitates the identification of mycobacterial proteins with properties of immunomodulation and strong immunogenicity. In this study, we determined the immunogenic potential of M.tb Zinc metalloprotease-1 (Zmp1, a secretory protein essential for intracellular survival and pathogenesis of M.tb. We observed that Zmp1 was secreted by in vitro grown M.tb under granuloma-like stress conditions (acidic, oxidative, iron deficiency and nutrient deprivation and generated Th2 cytokine microenvironment upon exogenous treatment of Peripheral Blood Mononulear Cells (PBMCs with recombinant Zmp1 (rZmp1. This was supported by recording specific and robust humoral response in TB patients in a cohort of 295. The anti-Zmp1 titers were significantly higher in TB patients (n=121 as against healthy control (n=62, household contacts (n=89 and non-specific infection controls (n=23. A significant observation of the study is the presence of equally high titers of anti-Zmp1 antibodies in a range of patients with high bacilli load (sputum bacilli load of 300+ per mL to paucibacillary smear-negative pulmonary tuberculosis (PTB cases. This clearly indicated the potential of Zmp1 to evoke an effective humoral response independent of mycobacterial load. Such mycobacterial proteins can be explored as antigen

  4. Abdominal paracentesis and thoracocentesis.

    Lee, Ser Yee; Pormento, James G; Koong, Heng Nung


    Abdominal paracentesis and thoracocentesis are common bedside procedures with diagnostic, therapeutic and palliative roles. We describe a useful and familiar a useful and familiar technique with the use of a multiple lumen catheter commonly used for central venous line insertion for drainage of ascites or moderate to large pleural effusions. The use of a multiple lumen catheter allows easier and more rapid aspiration of fluid with a smaller probability of the side holes being blocked as compared to the standard needle or single catheter methods. This is particularly useful in situations where the dedicated commercial kits for thoracocentesis and abdominal paracentesis are not readily available.

  5. Childhood abdominal cystic lymphangioma

    Konen, Osnat; Rathaus, Valeria; Shapiro, Myra [Department of Diagnostic Imaging, Meir General Hospital, Sapir Medical Centre, Kfar Saba (Israel); Dlugy, Elena [Department of Paediatric Surgery, Schneider Medical Centre, Sackler School of Medicine, Tel-Aviv University (Israel); Freud, Enrique [Department of Paediatric Surgery, Sapir Medical Centre, Sackler School of Medicine, Tel-Aviv University (Israel); Kessler, Ada [Department of Diagnostic Imaging, Sourasky Medical Centre, Tel-Aviv (Israel); Horev, Gadi [Department of Diagnostic Imaging, Schneider Medical Centre, Tel-Aviv (Israel)


    Background: Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics. Clinical presentation is variable and may be misleading; therefore, complex imaging studies are necessary in the evaluation of this condition. US and CT have a major role in the correct preoperative diagnosis and provide important information regarding location, size, adjacent organ involvement, and expected complications. Objective: To evaluate the clinical and imaging findings of seven children with proven abdominal cystic lymphangioma. Materials and methods: Clinical and imaging files of seven children with pathologically proven abdominal lymphangioma, from three university hospitals, were retrospectively evaluated. Patient's ages ranged from 1 day to 6 years (mean, 2.2 years). Symptoms and signs included evidence of inflammation, abnormal prenatal US findings, chronic abdominal pain, haemorrhage following trauma, clinical signs of intestinal obstruction, and abdominal distension with lower extremities lymphoedema. Plain films of five patients, US of six patients and CT of five patients were reviewed. Sequential imaging examinations were available in two cases. Results: Abdominal plain films showed displacement of bowel loops by a soft tissue mass in five of six patients, two of them with dilatation of small bowel loops. US revealed an abdominal multiloculated septated cystic mass in five of six cases and a single pelvic cyst in one which changed in appearance over 2 months. Ascites was present in three cases. CT demonstrated a septated cystic mass of variable sizes in all available five cases. Sequential US and CT examinations in two patients showed progressive enlargement of the masses, increase of fluid echogenicity, and thickening of walls or septa in both cases, with multiplication of septa in one case. At surgery, mesenteric lymphangioma was found in five patients and retroperitoneal lymphangioma in the other two

  6. [Abdominal actinomycosis with IUD].

    Kamprath, S; Merker, A; Kühne-Heid, R; Schneider, A


    We report a case of abdominal actinomycosis in a 54 year old woman using an intrauterine device for a period of 8 years. The most important finding was a tuboovarialabscess at the left pelvic side with involvement of the serosa of the jejunum, ileum, sigma, and omentum majus. Intraoperative exploration showed a solid retroperitoneal infiltration between the pelvic side wall and sigma. Another infiltration was found on the left side of the abdominal wall. The diagnosis was confirmed by histopathological examination and the patient was treated by a combination of Aminopenicillin and Metronidazol. After a period of three months we observed a complete regression of the clinical and the MRI findings.

  7. Z-plasty for uterus-to-abdominal-wall fistula

    Lou Xiaoli; Zhang Mingli; Cui Ying; Song Jianxing


    Objective: Uterus-to-abdominal-wall fistula is a very rare complication after uterine-incision delivery over the last decades. It can even lead to death. Mainly, the fistula occurs when big tension and critical infection exist within the incision of uterus and abdominal wall. Methods: The authors described the clinical presentation, pathology of uterus-to-abdominal-wall fistula, and reported their experience in 6 cases who underwent Z-plasty operation for this rare complication from January 1998 to January 2008. Results: All flaps survived completely and all the wounds in abdominal walls healed very well. The six cases were followed up for 1 to 5 years, and no fistula recurrence occurred. Conclusion: Z-plasty technique is a very simple and efficient approach to repair uterus to abdominal fistula after uterine-incision delivery.

  8. Rapid rebound of the Treg compartment in DEREG mice limits the impact of Treg depletion on mycobacterial burden, but prevents autoimmunity.

    Luciana Berod

    Full Text Available The development of an effective vaccine against tuberculosis (Tb represents one of the major medical challenges of this century. Mycobacterium bovis Bacille Calmette-Guerin (BCG, the only vaccine available at present, is mostly effective at preventing disseminated Tb in children, but shows variable protection against pulmonary Tb, the most common form in adults. The reasons for this poor efficacy are not completely understood, but there is evidence that T regulatory cells (Tregs might be involved. Similarly, Tregs have been associated with the immunosuppression observed in patients infected with Tb and are therefore believed to play a role in pathogen persistence. Thus, Treg depletion has been postulated as a novel strategy to potentiate M. bovis BCG vaccination on one side, while on the other, employed as a therapeutic approach during chronic Tb infection. Yet since Tregs are critically involved in controlling autoimmune inflammation, elimination of Tregs may therefore also incur the danger of an excessive inflammatory immune response. Thus, understanding the dynamics and function of Tregs during mycobacterial infection is crucial to evaluate the potential of Treg depletion as a medical option. To address this, we depleted Tregs after infection with M. bovis BCG or Mycobacterium tuberculosis (Mtb using DEREG mice, which express the diphtheria toxin (DT receptor under the control of the FoxP3 locus, thereby allowing the selective depletion of FoxP3+ Tregs. Our results show that after depletion, the Treg niche is rapidly refilled by a population of DT-insensitive Tregs (diTregs and bacterial load remains unchanged. On the contrary, impaired rebound of Tregs in DEREG × FoxP3GFP mice improves pathogen burden, but is accompanied by detrimental autoimmune inflammation. Therefore, our study provides the proof-of-principle that, although a high degree of Treg depletion may contribute to the control of mycobacterial infection, it carries the risk of

  9. Abdominal and Pelvic CT

    Full Text Available ... internal organs, small bowel and colon, such as: infections such as appendicitis , pyelonephritis or infected fluid collections, ... invasive diagnostic procedures. When pain is caused by infection and inflammation, the speed, ease and accuracy of ...

  10. Antimicrobial susceptibility of Gram-negative ESKAPE pathogens isolated from hospitalized patients with intra-abdominal and urinary tract infections in Asia-Pacific countries: SMART 2013-2015.

    Karlowsky, James A; Hoban, Daryl J; Hackel, Meredith A; Lob, Sibylle H; Sahm, Daniel F


    Gram-negative ESKAPE pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) are responsible for increases in antimicrobial-resistant infections worldwide. We determined in vitro susceptibilities to eight parenteral antimicrobial agents using Clinical and Laboratory Standards Institute broth microdilution methodology for Gram-negative ESKAPE pathogens isolated from hospitalized patients with intra-abdominal infections (IAIs) (n=3052) and urinary tract infections (UTIs) (n=1088) in 11 Asia-Pacific countries/regions from 2013 to 2015. Amikacin (98.3, 96.4 %), imipenem (97.1, 95.5 %) and ertapenem (95.3, 93.2 %) demonstrated the highest rates of susceptibility for isolates of K. pneumoniae from IAI and UTI, respectively, whereas susceptibility to advanced-generation cephalosporins was <84 and <71 %, respectively. K. pneumoniae with an extended-spectrum β-lactamase-positive phenotype were more common in UTI (27.1 %) than IAI (16.2 %). Imipenem and amikacin were the most active agents against extended-spectrum β-lactamase-positive K. pneumoniae from IAI (95.1, 91.8 %) and UTI (94.9, 92.3 %), respectively, whereas <54 % were susceptible to piperacillin-tazobactam. Against Enterobacter spp. and P. aeruginosa, amikacin demonstrated the highest rates of susceptibility for isolates from IAI (99.7, 95.5 %) and UTI (90.9, 91.5 %), respectively. K. pneumoniae, Enterobacter spp. and P. aeruginosa from urine demonstrated lower susceptibility to levofloxacin (74.1, 81.8 and 73.8 %) than from IAI (87.6, 91.8 and 85.4 %). For A. baumannii, rates of susceptibility to all agents tested were <43 %. We conclude that the studied Gram-negative ESKAPE pathogens demonstrated reduced susceptibility to commonly prescribed advanced-generation cephalosporins, piperacillin-tazobactam and levofloxacin, while amikacin and carbapenems were the most active. Ongoing surveillance to monitor evolving resistance trends and

  11. Non-major histocompatibility complex-restricted cytotoxic activity of blood mononuclear cells stimulated with secreted mycobacterial proteins and other mycobacterial antigens

    Ravn, P; Pedersen, B K


    Several observations indicate that non-major histocompatibility complex (MHC)-restricted cytotoxicity, mediated for example by natural killer cells and lymphokine-activated killer cells, may serve as an important antimicrobial defense mechanism. The purpose of the present study was to investigate...... the influences of different mycobacterial antigens on non-MHC-restricted cytotoxicity and further to investigate the ways by which various lymphocyte subpopulations contribute to the development of this cytotoxicity. Non-MHC-restricted cytotoxicity was induced following stimulation of mononuclear cells......+ cells proliferated and expressed interleukin-2 receptors following stimulation with mycobacterial antigens. Depletion studies after antigen stimulation showed that the cytotoxic effector cells were CD16+ CD56+ and CD4-; the CD4+ cells alone did not mediate non-MHC-restricted cytotoxicity. To evaluate...

  12. Clinical and ultrasonographic features of abdominal tuberculosis in HIV positive adults in Zambia

    Vermund Sten H


    Full Text Available Abstract Background The diagnosis of abdominal tuberculosis (TB is difficult, especially so in health care facilities in developing countries where laparoscopy and colonoscopy are rarely available. There is little information on abdominal TB in HIV infection. We estimated the prevalence and clinical features of abdominal (excluding genitourinary TB in HIV infected adults attending the University Teaching Hospital, Zambia. Methods We screened 5,609 medical inpatients, and those with fever, weight loss, and clinical features suggestive of abdominal pathology were evaluated further. A clinical algorithm was used to specify definitive investigations including laparoscopy or colonoscopy, with culture of biopsies and other samples. Results Of 140 HIV seropositive patients with these features, 31 patients underwent full evaluation and 22 (71% had definite or probable abdominal TB. The commonest presenting abdominal features were ascites and persistent tenderness. The commonest ultrasound findings were ascites, para-aortic lymphadenopathy (over 1 cm in size, and hepatomegaly. Abdominal TB was associated with CD4 cell counts over a wide range though 76% had CD4 counts Conclusion The clinical manifestations of abdominal TB in our HIV-infected patients resembled the well-established pattern in HIV-uninfected adults. Patients with fever, weight loss, abdominal tenderness, abdominal lymphadenopathy, ascites and/or hepatomegaly in Zambia have a high probability of abdominal TB, irrespective of CD4 cell count.

  13. Adult abdominal hernias.

    Murphy, Kevin P


    Educational Objectives and Key Points. 1. Given that abdominal hernias are a frequent imaging finding, radiologists not only are required to interpret the appearances of abdominal hernias but also should be comfortable with identifying associated complications and postrepair findings. 2. CT is the imaging modality of choice for the assessment of a known adult abdominal hernia in both elective and acute circumstances because of rapid acquisition, capability of multiplanar reconstruction, good spatial resolution, and anatomic depiction with excellent sensitivity for most complications. 3. Ultrasound is useful for adult groin assessment and is the imaging modality of choice for pediatric abdominal wall hernia assessment, whereas MRI is beneficial when there is reasonable concern that a patient\\'s symptoms could be attributable to a hernia or a musculoskeletal source. 4. Fluoroscopic herniography is a sensitive radiologic investigation for patients with groin pain in whom a hernia is suspected but in whom a hernia cannot be identified at physical examination. 5. The diagnosis of an internal hernia not only is a challenging clinical diagnosis but also can be difficult to diagnose with imaging: Closed-loop small-bowel obstruction and abnormally located bowel loops relative to normally located small bowel or colon should prompt assessment for an internal hernia.

  14. Abdominal and Pelvic CT

    Full Text Available ... as ulcerative colitis or Crohn's disease , pancreatitis or liver cirrhosis. cancers of the liver, kidneys, pancreas, ovaries and bladder as well as ... injuries to abdominal organs such as the spleen, liver, kidneys or other internal organs in cases of ...

  15. Penetrating abdominal trauma


    inal trauma (PAT) in our area, and to try to identify a pattern of organ-specific injury ... laparotomy due to persistent abdominal pain, after a period of observation of about .... in the ini- tial assessment who turned out to be free of visceral injuries.

  16. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... are the limitations of Abdominal Ultrasound Imaging? What is Abdominal Ultrasound Imaging? Ultrasound is safe and painless, ... through the blood vessels. top of page How is the procedure performed? For most ultrasound exams, you ...

  17. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... particularly valuable for evaluating abdominal, pelvic or scrotal pain in children. Preparation will depend on the type ... help a physician determine the source of abdominal pain, such as gallstones, kidney stones, abscesses or an ...

  18. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... or kidneys. top of page What are some common uses of the procedure? Abdominal ultrasound imaging is ... Except for traumatic injury, appendicitis is the most common reason for emergency abdominal surgery. Ultrasound imaging can ...

  19. Screening for Abdominal Aortic Aneurysm

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) has issued a final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final ...

  20. Abdominal aortic aneurysm repair - open

    ... this page: // Abdominal aortic aneurysm repair - open To use the sharing features on this page, please enable JavaScript. Open abdominal aortic aneurysm repair is surgery to fix a widened part ...

  1. Fournier's gangrene secondary to intra-abdominal processes.

    Gerber, G S; Guss, S P; Pielet, R W


    We report 2 cases of necrotizing fasciitis of the perineum, perianal area, and male genitalia (Fournier's gangrene) that arose secondary to intra-abdominal infectious processes (ruptured appendicitis and diverticulitis). Management consisted of immediate debridement of necrotic tissue, exploratory laparotomy, and diverting colostomy. The presence of an acute abdominal process was not immediately evident on initial evaluation of either patient. This demonstrates the critical importance of considering intra-abdominal infection in patients with Fournier's gangrene when the more commonly seen urinary tract, perirectal, and traumatic causes are not readily apparent.

  2. [Abdominal tuberculosis in children. A review apropos of 13 cases].

    Vidal, M L; del Castillo, F; Arroba, M L; Borque, C; García Hortelano, J


    Thirteen cases of abdominal tuberculosis are presented; some of them in active or symptomatic stage and others in latent or abdominal calcification form. Many of these patients were diagnosed through the finding of a source of infected cattle after diagnosis of one of symptomatic patients. Pathogenesis, clinical findings and diagnostic difficulty are commented, as well a sanitary importance of the problem, since M. bovis is still a currently found organism in daily practice.

  3. Mycobacterial species diversity at a general hospital on the island of Crete: first detection of Mycobacterium lentiflavum in Greece.

    Neonakis, Ioannis K; Gitti, Zoe; Kourbeti, Irene S; Michelaki, Helen; Baritaki, Maria; Alevraki, Georgia; Papadomanolaki, Evangelia; Tsafaraki, Ekaterini; Tsouri, Anna; Baritaki, Stavroula; Krambovitis, Elias; Spandidos, Demetrios A


    The objective of the present study was to investigate the diversity of mycobacterial isolates in a general hospital in Crete, Greece. 48 positive Lowenstein-Jensen cultures over a 3-y period were analysed by means of AccuProbe and GenoType assays. Non-tuberculous mycobacteria (NTM) comprised the majority of the isolates (56.3%, 27/48) vs 33.3% (16/48) of M. tuberculosis; 10.4% of the isolates could not be classified. Among NTM, M. lentiflavum was the predominant species isolated (9/27) followed by M. kansasii, M. gordonae and M. peregrinum, whereas no M. avium complex isolates were detected. This is the first detection of M. lentiflavum in Greece. The susceptibilities of the M. lentiflavum isolates to an extended panel of antibiotics were determined by the proportions method and the medical files of the 9 patients were reviewed. Three isolates were from urine, which is an unusual site. All strains exhibited multidrug resistance. The patients were adults with immunosuppression or predisposing conditions for NTM infection. Diagnosis of true infection was either not pursued or the patients died shortly after isolation.

  4. The HyVac4 subunit vaccine efficiently boosts BCG-primed anti-mycobacterial protective immunity.

    Rolf Billeskov

    Full Text Available BACKGROUND: The current vaccine against tuberculosis (TB, BCG, has failed to control TB worldwide and the protective efficacy is moreover limited to 10-15 years. A vaccine that could efficiently boost a BCG-induced immune response and thus prolong protective immunity would therefore have a significant impact on the global TB-burden. METHODS/FINDINGS: In the present study we show that the fusion protein HyVac4 (H4, consisting of the mycobacterial antigens Ag85B and TB10.4, given in the adjuvant IC31® or DDA/MPL effectively boosted and prolonged immunity induced by BCG, leading to improved protection against infection with virulent M. tuberculosis (M.tb. Increased protection correlated with an increased percentage of TB10.4 specific IFNγ/TNFα/IL-2 or TNFα/IL-2 producing CD4 T cells at the site of infection. Moreover, this vaccine strategy did not compromise the use of ESAT-6 as an accurate correlate of disease development/vaccine efficacy. Indeed both CD4 and CD8 ESAT-6 specific T cells showed significant correlation with bacterial levels. CONCLUSIONS/SIGNIFICANCE: H4-IC31® can efficiently boost BCG-primed immunity leading to an increased protective anti-M.tb immune response dominated by IFNγ/TNFα/IL-2 or TNFα/IL2 producing CD4 T cells. H4 in the CD4 T cell inducing adjuvant IC31® is presently in clinical trials.

  5. Antimicrobial susceptibility and extended-spectrum beta-lactamase rates in aerobic gram-negative bacteria causing intra-abdominal infections in Vietnam: report from the Study for Monitoring Antimicrobial Resistance Trends (SMART 2009-2011).

    Biedenbach, Douglas J; Bouchillon, Samuel K; Hoban, Daryl J; Hackel, Meredith; Phuong, Doan Mai; Nga, Tran Thi Thanh; Phuong, Nguyen Tran My; Phuong, Tran Thi Lan; Badal, Robert E


    Treatment options for multidrug-resistant pathogens remain problematic in many regions and individual countries, warranting ongoing surveillance and analysis. Limited antimicrobial susceptibility information is available for pathogens from Vietnam. This study determined the bacterial susceptibility of aerobic gram-negative pathogens of intra-abdominal infections among patients in Vietnam during 2009-2011. A total of 905 isolates were collected from 4 medical centers in this investigation as part of the Study for Monitoring Antimicrobial Resistance Trends. Antimicrobial susceptibility and extended-spectrum beta-lactamase (ESBL) rates among the appropriate species were determined by a central laboratory using Clinical and Laboratory Standards Institute methods. Among the species collected, Escherichia coli (48.1% ESBL-positive) and Klebsiella pneumoniae (39.5% ESBL-positive) represented the majority (46.4%) of the isolates submitted for this study. Ertapenem MIC90 values were lowest for these 2 species at 0.12 and 0.25μg/mL and remained unchanged for ESBL-positive isolates. Imipenem MIC90 values were also the same for all isolates and ESBL-positive strains at 0.25 and 0.5μg/mL, respectively. Ertapenem MIC90 values for additional species with sufficient numbers for analysis, including Enterobacter cloacae, Proteus mirabilis, Acinetobacter baumannii, and Pseudomonas aeruginosa, were 1, 0.06, >4, and >4μg/mL, respectively. Analysis of beta-lactamases in a subset of 132 phenotypically ESBL-positive Enterobacteriaceae demonstrated that CTX-M variants, particularly CTX-M-27 and CTX-M-15, were the predominant enzymes. High resistance rates in Vietnam hospitals dictate continuous monitoring as antimicrobial inactivating enzymes continue to spread throughout Asia and globally.

  6. Surveillance of antimicrobial susceptibility of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections in China: the 2002-2009 Study for Monitoring Antimicrobial Resistance Trends (SMART).

    Yang, Qiwen; Wang, Hui; Chen, Minjun; Ni, Yuxing; Yu, Yunsong; Hu, Bijie; Sun, Ziyong; Huang, Wenxiang; Hu, Yunjian; Ye, Huifen; Badal, Robert E; Xu, Yingchun


    The objective of this study was to investigate the distribution and susceptibility of aerobic and facultative Gram-negative bacilli (GNB) isolated from patients with intra-abdominal infections (IAIs) in China. From 2002 to 2009, minimum inhibitory concentrations of 14 antibiotics for 3420 aerobic and facultative GNB from up to eight hospitals in six cities were determined by the broth microdilution method. Enterobacteriaceae comprised 82.9% (2834/3420) of the total isolates, with Escherichia coli (49.2%) being the most commonly isolated species followed by Klebsiella pneumoniae (17.0%), Enterobacter cloacae (5.8%) and Citrobacter freundii (2.3%). Amongst the antimicrobial agents tested, the three carbapenems (ertapenem, imipenem and meropenem) were the most active agents against Enterobacteriaceae, with susceptibility rates of 96.1-99.6% (2002-2009), 98.2-100% (2002-2009) and 99.6-100% (2002-2004), respectively, followed by amikacin (86.8-95.1%) and piperacillin/tazobactam (84.5-94.3%). Susceptibility rates of all tested third- and fourth-generation cephalosporins against Enterobacteriaceae declined by nearly 30%, with susceptibility rates of 40.2%, 39.1%, 56.3% and 51.8% in 2009 for ceftriaxone, cefotaxime, ceftazidime and cefepime, respectively. The occurrence of extended-spectrum β-lactamases increased rapidly, especially for E. coli (from 20.8% in 2002 to 64.9% in 2009). Susceptibility of E. coli to ciprofloxacin decreased from 57.6% in 2002 to 24.2% in 2009. The least active agent against Enterobacteriaceae was ampicillin/sulbactam (SAM) (25.3-44.3%). In conclusion, Enterobacteriaceae were the major pathogens causing IAIs, and carbapenems retained the highest susceptibility rates over the 8-year study period. Third- and fourth-generation cephalosporins, fluoroquinolones and SAM may not be ideal choices for empirical therapy of IAIs in China.

  7. Clinical analysis of antimicrobial resistance of Gram-negative bacilli isolated from patients with intra-abdominal infections%腹腔感染革兰阴性细菌耐药性临床分析

    田文广; 黄文祥; 贾蓓; 辛小娟; 李崇智; 郑行萍; 史方静


    Objective To investigate epidemiological characteristics of Gram-negative bacilli (GNB) isolated from patients with non-recurrent intra-abdominal infections in our hospitals from 2008 to 2010, and to analyze antimicrobial resistance of GNB to common antibiotics and ESBLs-producing ratio of GNB. Methods A total of 290 cases of GNB were isolated from patients with intra-abdominal infections from 2008 to 2010. In antimicrobial susceptibility test, agar dilution method was applied for MIC determination according to NCCLS guidelines. All the data were analyzed using WHONET 5. 4 and SPSS 13. 0. Results In the total of 290 GNB, enterobacteriaceae accounted for 82. 7% and non-fermentative bacteria accounted for 17. 93%. There were six types of common bacteria in which E. Coli accounted for 55. 3% , and the ratio of Acinetobacter baumannii complex increased apparently (7. 96%). The positive rates of ESBLs production in E. Coli and Klebsiella spp were 74. 38% and 55. 56% , respectively. E. Coli was highly sensitive to carbapenems, piperacillin/tazobaetam and amikacin, but not to the third-generation cephalosporins and cefepime. The non-ESBLs-producing Klebsiella spp was sensitive to the twelve common anti-GNB antibiotics, while ESBLs-producing Klebsiella spp was sensitive to amikacin, piperacillin/tazobaetam and carbapenems. The susceptibility rates of Pseudomonas aerltgillosa to imipenem, piperacillin/tazobaetam and amikacin were all above 90% and to cefepime and two quinolones were 80% to 90% , but the susceptibility rate to ceftazidime decreased below 80%. The drug resistance rate of Acinetobacter baumannii to carbapenems was above 80%. Multidrug resistant (MDR) strains accounted for 32% , mainly including Acinetobacter baumannii complex and Pseudomonas aerltgillosa.Eighty percent MDR strains were resistant to almost all commonly used antibiotics. Conclusion The antimicrobial resistance of GNB isolated from patients with intra-abdominal infections increases apparently

  8. Evidence for a previously unrecognized mycobacterial endosymbiont in Acanthamoeba castellanii strain Ma (ATCC ® 50370 ™).

    Glaser, Kathleen C; Hetrick, Neil D; Molestina, Robert E


    We describe the isolation of a mycobacterium from Acanthamoeba castellanii strain Ma (ATCC(®) 50370(™)). The mycobacterium resides within vacuoles of A. castellanii, can be cultured by routine methodologies, and is a member of the Mycobacterium avium complex. Previously unrecognized mycobacterial endosymbionts are likely common among strains of Acanthamoeba housed at culture collections.

  9. New live mycobacterial vaccines: the Geneva consensus on essential steps towards clinical development

    Kamath, A.T.; Fruth, U.; Brennan, M.; Dobbelaer, R.; Hubrechts, P.; Ho, M.M.; Mayner, R.E.; Thole, J.E.R.; Walker, K.B.; Liu, C.M.; Lambert, P.H.


    As the disease caused by Mycobacterium tuberculosis continues to be a burden, which the world continues to suffer, there is a concerted effort to find new vaccines to combat this problem. Of the various vaccines strategies, one viable option is the development of live mycobacterial vaccines. A meeti

  10. Dissecting the membrane cholesterol requirement for mycobacterial entry into host cells.

    Viswanathan, Gopinath; Jafurulla, Md; Kumar, G Aditya; Raghunand, Tirumalai R; Chattopadhyay, Amitabha


    Mycobacteria are intracellular pathogens that can invade and survive within host macrophages, and are a major cause of mortality and morbidity worldwide. The molecular mechanism involved in the internalization of mycobacteria is poorly understood. In this work, we have explored the role of host membrane cholesterol in the entry of the avirulent surrogate mycobacterial strain Mycobacterium smegmatis into THP-1 macrophages. Our results show that depletion of host membrane cholesterol using methyl-β-cyclodextrin results in a significant reduction in the entry of M. smegmatis into host cells. More importantly, we show that the inhibition in the ability of M. smegmatis to enter host macrophages could be reversed upon replenishment of membrane cholesterol. To the best of our knowledge, these results constitute the first report showing that membrane cholesterol replenishment can reverse the inhibition in the entry of mycobacteria into host cells. In addition, we demonstrate that cholesterol complexation using amphotericin B (without physical depletion) is sufficient to inhibit mycobacterial entry. Importantly, we observed a significant reduction in mycobacterial entry upon enrichment of host membrane cholesterol. Taken together, our results demonstrate, for the first time, that an optimum host plasma membrane cholesterol is necessary for the entry of mycobacteria. These results assume relevance in the context of developing novel therapeutic strategies targeting cholesterol-mediated mycobacterial host cell entry.

  11. Naive helper T cells from BCG-vaccinated volunteers produce IFN-gamma and IL-5 to mycobacterial antigen-pulsed dendritic cells.

    JoĂŤl Pestel


    Full Text Available Mycobacterium bovis bacillus Calmette-GuĂŠrin (BCG is a live vaccine that has been used in routine vaccination against tuberculosis for nearly 80 years. However, its efficacy is controversial. The failure of BCG vaccination may be at least partially explained by the induction of poor or inappropriate host responses. Dendritic cells (DCs are likely to play a key role in the induction of immune response to mycobacteria by polarizing the reactivity of T lymphocytes toward a Th1 profile, contributing to the generation of protective cellular immunity against mycobacteria. In this study we aimed to investigate the production of Th1 and Th2 cytokines by naive CD4+ T cells to mycobacterial antigen-pulsed DCs in the group of young, healthy BCG vaccinated volunteers. The response of naive helper T cells was compared with the response of total blood lymphocytes. Our present results clearly showed that circulating naive CD45RA+CD4+ lymphocytes from BCG-vaccinated subjects can become effector helper cells producing IFN-gamma and IL-5 under the stimulation by autologous dendritic cells presenting mycobacterial protein antigen-PPD or infected with live M. bovis BCG bacilli.

  12. Naive helper T cells from BCG-vaccinated volunteers produce IFN-gamma and IL-5 to mycobacterial antigen-pulsed dendritic cells.

    Kowalewicz-Kulbat, Magdalena; Kaźmierczak, Dominik; Donevski, Stefan; Biet, Franck; Pestel, Joël; Rudnicka, Wiesława


    Mycobacterium bovis bacillus Calmette-Guérin (BCG) is a live vaccine that has been used in routine vaccination against tuberculosis for nearly 80 years. However, its efficacy is controversial. The failure of BCG vaccination may be at least partially explained by the induction of poor or inappropriate host responses. Dendritic cells (DCs) are likely to play a key role in the induction of immune response to mycobacteria by polarizing the reactivity of T lymphocytes toward a Th1 profile, contributing to the generation of protective cellular immunity against mycobacteria. In this study we aimed to investigate the production of Th1 and Th2 cytokines by naive CD4+ T cells to mycobacterial antigen-pulsed DCs in the group of young, healthy BCG vaccinated volunteers. The response of naive helper T cells was compared with the response of total blood lymphocytes. Our present results clearly showed that circulating naive CD45RA+CD4+ lymphocytes from BCG-vaccinated subjects can become effector helper cells producing IFN-gamma and IL-5 under the stimulation by autologous dendritic cells presenting mycobacterial protein antigen-PPD or infected with live M. bovis BCG bacilli.

  13. Abdominal sacral colpopexy for massive genital prolapse.

    Powell; Joseph


    Objective: A retrospective study to determine the success and complications of abdominal sacral colpopexy in correcting massive genital prolapse over an 8-year period between September 1989 and January 1997.Methods: The charts were reviewed for 3 patients with massive procidentia and 15 patients with symptomatic posthysterectomy vaginal vault prolapse, who desired preservation of sexual function and underwent abdominal sacral colpopexy with Marlex mesh at two community teaching hospitals.Results: In 16 of the 18 patients, one or more concurrent procedures were performed at the same time, including three Burch colpocystourethropexies and one Raz bladder neck suspension, which successfully controlled urinary stress incontinence. In three cases, staging procedures were done for ovarian neoplasia. There were no intraoperative complications. One patient developed a superficial abdominal wound infection, one patient had a deep venous thrombosis in her left leg 7 days postoperatively, and one patient experienced a 1 cm area of graft erosion 10 months postoperative requiring partial resection. Duration of follow-up has varied from 8 months to 5 years. One patient died 43 months after surgery of unrelated causes. No patients developed recurrent prolapse.Conclusions: Abdominal sacral colpopexy is a successful operation for the correction of prolapse. Serious complications are infrequent. Photographs of the technique and a review of the literature are presented.

  14. Chronic mycobacterial meningitis due to Mycobacterium chelonae: a case report

    Shokrallah Salmanzadeh


    Full Text Available We report a case of chronic meningitis due to Mycobacterium chelonae. This organism is a rapidly growing Mycobacterium (RGM and can be found worldwide in environmental sources such as soil, dust, and water. M. chelonae is an uncommon cause of meningitis; the majority of infections caused by this organism are localized cutaneous or soft tissue infections, and rarely lung infections. The organism is indistinguishable phenotypically, so we applied PCR based on the rpoB gene sequence followed by restriction fragment length polymorphism (RFLP for molecular identification. The subsequent sequencing of RFLP products revealed 99.7% similarity with M. chelonae.

  15. Chronic mycobacterial meningitis due to Mycobacterium chelonae: a case report.

    Salmanzadeh, Shokrallah; Honarvar, Negin; Goodarzi, Hamed; Khosravi, Azar Dokht; Nashibi, Roohangiz; Serajian, Amir Arsalan; Hashemzadeh, Mohammad


    We report a case of chronic meningitis due to Mycobacterium chelonae. This organism is a rapidly growing Mycobacterium (RGM) and can be found worldwide in environmental sources such as soil, dust, and water. M. chelonae is an uncommon cause of meningitis; the majority of infections caused by this organism are localized cutaneous or soft tissue infections, and rarely lung infections. The organism is indistinguishable phenotypically, so we applied PCR based on the rpoB gene sequence followed by restriction fragment length polymorphism (RFLP) for molecular identification. The subsequent sequencing of RFLP products revealed 99.7% similarity with M. chelonae.

  16. Physicians' Abdominal Auscultation

    John, Gade; Peter, Kruse; Andersen, Ole Trier


    Background: Abdominal auscultation has an important position in the physical examination of the abdomen. Little is known about rater agreement. The aim of this study was to describe rater agreement and thus, indirectly, the value of the examination. Methods: In a semi-virtual setup 12 recordings...... of the intestinal sounds from 8 patients with acute abdominal pain and 4 healthy volunteers were presented to 100 physicians. The physicians were asked to characterize the intestinal sounds as normal or pathologic. Fisher's exact test was used for comparison between groups of physicians. Results: Overall, 72......% of the answers with regard to healthy volunteers concluded that the sounds were normal (equalling agreement), whereas 64% of answers with regard to intestinal obstruction concluded that the sounds were pathologic (but agreement was higher due to agreement on wrong diagnosis in one case). Bowel sounds from...

  17. Endometrioma de parede abdominal

    Italo Accetta

    Full Text Available OBJETIVO: Relatar a experiência dos autores com as manifestações clínicas e o tratamento cirúrgico em pacientes com endometrioma de parede abdominal. MÉTODOS: Análise retrospectiva das pacientes operadas por endometrioma de parede abdominal, dando ênfase aos dados relativos à idade, sintomas, cesariana prévia, relação dos sintomas com o ciclo menstrual, exames físicos e complementares, tratamento cirúrgico, evolução pós-operatória e resultado histopatológico dos espécimes. RESULTADOS: Foram operadas 14 pacientes no período estudado, com idade entre 28 e 40 anos. A presença de massa e dor local que piorava durante a menstruação foram as queixas principais. Ultrassonografia e tomografia computadorizada foram exames importantes em localizar precisamente a doença. O tratamento cirúrgico foi exérese ampla da tumoração e dos tecidos comprometidos. As pacientes evoluíram satisfatoriamente e o histopatológico confirmou a suspeita de endometrioma de parede abdominal em todos os casos. CONCLUSÃO: Foi nítida a relação entre cesariana prévia e endometrioma de parede abdominal e estudos ultrassonográficos e tomográficos auxiliaram a planejar a abordagem cirúrgica permitindo a exérese da tumoração e de todos os tecidos adjacentes comprometidos.

  18. Ruptured abdominal aortic aneurysm.

    Sachs, T; Schermerhorn, M


    Ruptured abdominal aortic aneurysm (AAA) continues to be one of the most lethal vascular pathologies we encounter. Its management demands prompt and efficient evaluation and repair. Open repair has traditionally been the mainstay of treatment. However, the introduction of endovascular techniques has altered the treatment algorithm for ruptured AAA in most major medical centers. We present recent literature and techniques for ruptured AAA and its surgical management.

  19. Abdominal aspergillosis: CT findings

    Yeom, Suk Keu, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Kim, Hye Jin, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Byun, Jae Ho, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Kim, Ah Young, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Lee, Moon-Gyu, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Ha, Hyun Kwon, E-mail: [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of)


    Objective: In order to retrospectively evaluate the CT findings of abdominal aspergillosis in immunocompromised patients. Materials and methods: CT scans were reviewed with regard to the sites, number, morphologic appearance, attenuation, and the contrast enhancement patterns of the lesions in six patients (5 women, 1 man; mean age, 43.4 years; range, 23-59 years) with pathologically proved abdominal aspergillosis by two gastrointestinal radiologists in consensus. Medical records were also reviewed to determine each patient's clinical status and outcome. Results: All patients were immunocompromised state: 4 patients received immunosuppressive therapy for solid organ transplantation and 2 patients received chemotherapy for acute myeloid leukemia. Aspergillosis involved blood vessels (n = 3), liver (n = 2), spleen (n = 2), gastrointestinal tract (n = 2), native kidney (n = 1), transplanted kidney (n = 1), peritoneum (n = 1), and retroperitoneum (n = 1). CT demonstrated solid organ or bowel infarction or perforation secondary to vascular thrombosis or pseudoaneurysm, multiple low-attenuating lesions of solid organs presenting as abscesses, concentric bowel wall thickening mimicking typhlitis, or diffuse or nodular infiltration of the peritoneum and retroperitoneum. Conclusion: Familiarity with findings commonly presenting as angioinvasive features or abscesses on CT, may facilitate the diagnosis of rare and fatal abdominal aspergillosis.

  20. Infections

    ... Does My Child Need? How to Safely Give Acetaminophen Is It a Cold or the Flu? Is the Flu Vaccine a Good Idea for Your Family? Too Late for the Flu Vaccine? Common Childhood Infections Can Chronic Ear Infections Cause Long-Term Hearing Loss? Chickenpox Cold Sores Common Cold Diarrhea Fever and ...

  1. Granulomatous encephalomyelitis and intestinal ganglionitis in a spectacled Amazon parrot (Amazona albifrons) infected with Mycobacterium genavense.

    Gomez, G; Saggese, M D; Weeks, B R; Hoppes, S M; Porter, B F


    An approximately 30-year-old male spectacled Amazon parrot (Amazona albifrons) was presented with a 2-week history of ataxia, head shaking, weight loss and seizures. Gross findings on necropsy examination included atrophy of the musculature, ruffled feathers and minimal epicardial and abdominal fat. Microscopically, there were perivascular cuffs of macrophages with fewer lymphocytes in the grey and white matter of the brain and spinal cord. These lesions were accompanied by gliosis and mild vacuolation of the white matter. In the small intestine, up to 70% of the intestinal ganglia were effaced by infiltrates of macrophages and fewer lymphocytes. The intestinal lamina propria contained multiple inflammatory aggregates of a similar nature. Ziehl-Neelsen staining revealed the presence of numerous bacilli within the cytoplasm of macrophages in the central nervous system (CNS) and enteric ganglia. Amplification of the DNAJ gene confirmed a mycobacterial infection and subsequent polymerase chain reaction (PCR) using a species-specific primer confirmed the aetiology as Mycobacterium genavense. Infection of the CNS with Mycobacterium spp. is uncommon and has not been previously reported in a parrot. This case is unusual in that the organism exhibited tropism for neural tissue.

  2. Abdominal wall repair with human acellular dermal autograft

    Roel E. Genders


    Full Text Available Repair of abdominal wall defects in the presence of contamination or infection is a significant problem. The loss of tissue warrants enforcement of the abdominal wall, preferably by autologous material. However, autologous repair often requires extensive surgery. This paper presents a review of available literature of placement of an acellular human dermis to repair an abdominal fascia defect, in contaminated as well as in non-contaminated surgical fields. It is illustrated with a case report that describes the successful reconstruction of an infected abdominal wall defect with a human acellular dermis allograft. A systematic literature review was undertaken with searches performed in the Pubmed and Cochrane databases for the period up till March 2009, using the search terms Alloderm [Substance Name], Hernia [Mesh] and the key words acellular dermis, acellular dermal matrix, human acellular dermal allograft and abdominal wall defect. To assess methodological quality, each article was subjected to a modification of the methodological index for non-randomized studies (MINORS according to Slim et al. Two items from the original index were not included because none of the studies selected had an unbiased assessment of the study end points and in none of the studies was a prospective calculation of the study size performed. Seventeen studies were included in the review. Data were extracted regarding study design, number of patients, surgical technique, followup period, contaminated or non-contaminated area of the fascia defect, mortality and morbidity (hemorrhage, seroma, wound dehiscence, infection of the operative procedure, the longterm results (removal of the graft, reherniation and bulging and level of evidencey. A total of 169 short-term complications and 151 longterm complications occurred after 643 surgical procedures reconstructing both contaminated and clean abdominal wall defects by implantation of an HADA. Human acellular dermal allograft

  3. Distribution of infecting bacteria and an analysis of drug resistance after abdominal surgery in children%小儿腹部伤口术后感染细菌分布及耐药分析



    目的:对小儿腹部伤口术后感染细菌分布以及耐药情况进行分析探讨,为今后的临床检验工作提供可靠的理论依据。方法:抽取2012年6月-2014年6月我院收治的小儿腹部伤口感染患者1022例,对其术后感染引流物病原菌进行培养、分离、鉴定,并展开药敏试验,统计分析试验结果。结果:在1022例感染患儿中,腹部外科病原菌分离率依次为铜绿假单胞菌、大肠埃希菌、克雷伯菌属,除此之外还包括革兰阳性需氧菌、厌氧菌、变形梭杆菌等,药敏结果证实,革兰阴性需氧菌对亚胺培南的敏感性较高,对氨苄西林的耐药率较高。结论:小儿腹部伤口术后感染病原菌分布较广,对抗生素存在明显的耐药现象,临床应对其给予重视,积极采取有效手段进行干预,减少耐药的发生。coli, klebsiella, gram-positive aerobic and anaerobic bacteria, fusobacterius varium. Drug allergy test conifrmed the higher susceptibility of gram-negative aerobic bacteria to imipenem, and higher resistance rate to ampicillin. Conclusion: Infecting bacteria are widespread and signiifcantly resist to antibiotic. In clinic, the phenomenon should be paid more attention.%Objective: To analyze distribution of infecting bacteria and on analysis of drug resistance after abdominal surgery in children, in order to provide a reliable theoretical basis for future clinical inspection. Methods: Pathogenic bacteria of drain in 1022 cases were cultured, separated, identiifed and tested by drug allergy. Results: Pathogens can be divided into pseudomonas aeruginosa, escherichia coli, klebsiella, gram-positive aerobic and anaerobic bacteria, fusobacterius varium. Drug allergy test confirmed the higher susceptibility of gram-negative aerobic bacteria to imipenem, and higher resistance rate to ampicillin. Conclusion: Infecting bacteria are widespread and significantly resist to antibiotic. In clinic, the

  4. 腹部术后患者合并肺部感染54例临床分析%Clinical analysis of 54 patients with postoperative lung infection in abdominal operations



    Objective To analyze the causes of postoperative lung infections in patients with pefitonectomy and give preventive strategy.Methods The clinical data of 54 patients with postoperative lung infectiom who were performed peritonectomy in our hospital were retrospectively analyzed.Results 54 case8 were analyzed.Of those cases,39 cases were male and 15 female,the average age was 65.4 years,below 60 years wag 13 cases,and others were over 60 years.The mean hospitalization time wag 17.4 days.Patients performed binary tract system operation wag 17,gagtrocnteric system 23,and inguinal hernia 14.Before operation,the patients accompanied with chronic cardiopulmonary disease were 33,gastroenteric tubing 28,radiotherapy/chemotherapy treated 5 and tracheal intubation 3.Condusion The most dangerous factors for postoperative lung infections in elderly inguinal hernia included elder age,chronic cardio and pulmonary primary diseases,preoperative radiotherapy and/or chemotherapy,gagtrocnteric tubing,and trachea/intubafion.Preoperative active treatment with chronic eardio and pulmonary primary diseases,strengthen nutrition and surpport therapy,reduce the chance of gastroenteric tubing,and tracheal intubation are effective for preven-ting postoperafive lung infections in abdominal operations.%目的 探讨腹部手术后患者合并肺部感染的原因及预防策略.方法 对54例腹部术后合并肺部感染患者的临床资料进行分析.结果 54例患者中男39例,女15例,年龄20~79岁,平均65.4岁,其中≤60岁13例,>60岁41例.平均住院时间17.4 d.胆道系统手术17例,胃肠系统手术23例,腹股沟疝手术14例.术前伴慢性心肺基础疾病者33例.术前留置胃肠减压管28例,术前行放化疗者5例,气管插管3例.结论 高龄、慢性心肺基础疾病,术前放化疗、留置胃肠减压管为腹部术后患者合并肺部感染的危险因素.术前积极治疗心肺基础疾病,加强营养支持治疗以提高机体免疫力,减少

  5. Doença pulmonar por Mycobacterium tuberculosis e micobactérias não-tuberculosas entre pacientes recém-diagnosticados como HIV positivos em Moçambique, África Mycobacterium tuberculosis and nontuberculous mycobacterial isolates among patients with recent HIV infection in Mozambique

    Elizabete Abrantes Nunes


    -rifampicina continua sendo a escolha apropriada para o início do tratamento.OBJECTIVE: Mycobacteriosis is frequently diagnosed among HIV-infected patients. In Mozambique, where few patients are under antiretroviral therapy and the prevalence of tuberculosis is high, there is need for better characterization of mycobacteria at the species level, as well as for the identification of patterns of resistance to antituberculous drugs. METHODS: We studied a sample of 503 HIV-infected individuals suspected of having pulmonary tuberculosis. Of those 503, 320 tested positive for mycobacteria through sputum smear microscopy or culture of bronchoalveolar lavage fluid. RESULTS: Acid-fast bacilli were observed in the sputum of 73% of the individuals presenting positive cultures. Of 277 isolates tested, only 3 were nontuberculous mycobacteria: 2 were identified as Mycobacterium avium and one was identified as M. simiae. Strains initially characterized as M. tuberculosis complex through polymerase chain reaction restriction analysis (PRA of the hsp65 gene were later confirmed as such through PRA of the gyrB gene. Among the M. tuberculosis isolates, resistance patterns were as follows: to isoniazid, 14%; to rifampin, 6%; and multidrug resistance, 5%. Previously treated cases showed significantly higher rates of resistance to first-line antituberculous drugs. The most common radiological pattern was interstitial infiltrate (in 67%, followed by mediastinal lymph node enlargement (in 30%, bronchiectasis (in 28%, miliary nodules (in 18% and cavitation (in 12%. Patients infected with nontuberculous mycobacteria presented clinical profiles indistinguishable from those of other patients. The median CD4 lymphocyte count in this group was 134 cells/mm³. CONCLUSIONS: There is a strong association between tuberculosis and AIDS in Mozambique, as expected in a country with a high prevalence of tuberculosis. Although drug resistance rates are high, the isoniazid-rifampin regimen continues to be the appropriate

  6. Actinomycosis Presenting as an Abdominal Mass in a Child

    Rahsan Özcan


    Full Text Available Abdominal actinomycosis in childhood period is very rare and a relation to trauma is not well established. Herein we report a case that appeared subsequent to abdominal trauma. A 17 years old boy presented with left lower quadrant abdominal mass and signs of acute abdomen. The symptoms of abdominal discomfort began after a fall from height 3 months before admission. There were signs of acute abdomen at physical examination. Ultrasound of abdomen demonstrated a mass; CT scan findings pointed to a suspicious “internal hernia”. An emergency laparotomy was performed. During surgery, a mass located over sigmoid colon and infiltrating the lateral abdominal wall was found. It was removed en bloc with the adjacent omentum. Except for the thickened sigmoid colon, no other pathologies were present at laparotomy. The pathology specimen revealed the actinomyces infection. The patient was treated with oral penicillin after discharge and the follow-up was uneventful. We advocate, keeping the actinomyces infection in mind in cases presenting with abdominal mass of unknown origin in childhood period.

  7. Analysis of closed abdominal injury in pregnant women

    TU Chang-di; WANG Shao-juan; ZHOU Ri-guang; WEI Yang-yi; TAN Qiang


    Objective: To explore the characteristics of closed abdominal injury in pregnancy women and its treatment.Methods: The clinical data of 37 pregnancy patients with closed abdominal injury treated in our hospital from June 1993 to June 2003 were collected and analyzed.Results: All the 37 patients were treated with operation. Among them 2 early pregnancy patients with intestinal rupture and 1 patient with retroperitoneal hematoma were treated under laparoscope; in other 34 pregnancy patients laparotomy was performed. Of the 34 patients 8 used cesarean section because premature separation of placenta and enlarged womb interrupted the management of intra-abdominal organ injury. In the 37 patients 33 (89.1%) were cured, 4 (10.8%) die, postoperative complication rate was 16.2% (6/37). Two patients (5.4%) suffered from abdominal cavity infection, 3 (8.1%) from pulmonary infection, and 1 (2.7%) had multi-organ failure.Conclusions: For pregnancy patients with closed abdominal injury, besides obsteric diseases intra-abdominal injury should be given much attention. Accurate diagnosis and timely treatment can gain the time to save the life of both mother and fetus.

  8. A multicenter trial of the efficacy and safety of tigecycline versus imipenem/cilastatin in patients with complicated intra-abdominal infections [Study ID Numbers: 3074A1-301-WW; Identifier: NCT00081744

    Babinchak Timothy


    Full Text Available Abstract Background Complicated intra-abdominal infections (cIAI remain challenging to treat because of their polymicrobial etiology including multi-drug resistant bacteria. The efficacy and safety of tigecycline, an expanded broad-spectrum glycylcycline antibiotic, was compared with imipenem/cilastatin (IMI/CIS in patients with cIAI. Methods A prospective, double-blind, multinational trial was conducted in which patients with cIAI randomly received intravenous (IV tigecycline (100 mg initial dose, then 50 mg every 12 hours [q12h] or IV IMI/CIS (500/500 mg q6h or adjusted for renal dysfunction for 5 to14 days. Clinical response at the test-of-cure (TOC visit (14–35 days after therapy for microbiologically evaluable (ME and microbiological modified intent-to-treat (m-mITT populations were the co-primary efficacy endpoint populations. Results A total of 825 patients received ≥ 1 dose of study drug. The primary diagnoses for the ME group were complicated appendicitis (59%, and intestinal (8.8% and gastric/duodenal perforations (4.6%. For the ME group, clinical cure rates at TOC were 80.6% (199/247 for tigecycline versus 82.4% (210/255 for IMI/CIS (95% CI -8.4, 5.1 for non-inferiority tigecycline versus IMI/CIS. Corresponding clinical cure rates within the m-mITT population were 73.5% (227/309 for tigecycline versus 78.2% (244/312 for IMI/CIS (95% CI -11.0, 2.5. Nausea (31.0% tigecycline, 24.8% IMI/CIS [P = 0.052], vomiting (25.7% tigecycline, 19.4% IMI/CIS [P = 0.037], and diarrhea (21.3% tigecycline, 18.9% IMI/CIS [P = 0.435] were the most frequently reported adverse events. Conclusion This study demonstrates that tigecycline is as efficacious as imipenem/cilastatin in the treatment of patients with cIAI.

  9. Menaquinone synthesis is critical for maintaining mycobacterial viability during exponential growth and recovery from non-replicating persistence.

    Dhiman, Rakesh K; Mahapatra, Sebabrata; Slayden, Richard A; Boyne, Melissa E; Lenaerts, Anne; Hinshaw, Jerald C; Angala, Shiva K; Chatterjee, Delphi; Biswas, Kallolmay; Narayanasamy, Prabagaran; Kurosu, Michio; Crick, Dean C


    Understanding the basis of bacterial persistence in latent infections is critical for eradication of tuberculosis. Analysis of Mycobacterium tuberculosis mRNA expression in an in vitro model of non-replicating persistence indicated that the bacilli require electron transport chain components and ATP synthesis for survival. Additionally, low microM concentrations of aminoalkoxydiphenylmethane derivatives inhibited both the aerobic growth and survival of non-replicating, persistent M. tuberculosis. Metabolic labelling studies and quantification of cellular menaquinone levels suggested that menaquinone synthesis, and consequently electron transport, is the target of the aminoalkoxydiphenylmethane derivatives. This hypothesis is strongly supported by the observations that treatment with these compounds inhibits oxygen consumption and that supplementation of growth medium with exogenous menaquinone rescued both growth and oxygen consumption of treated bacilli. In vitro assays indicate that the aminoalkoxydiphenylmethane derivatives specifically inhibit MenA, an enzyme involved in the synthesis of menaquinone. Thus, the results provide insight into the physiology of mycobacterial persistence and a basis for the development of novel drugs that enhance eradication of persistent bacilli and latent tuberculosis.

  10. Abdominal actinomycosis associated with intrauterine device: CT features.

    Laurent, T; de Grandi, P; Schnyder, P


    Abdominal actinomycosis is a severe and progressive peritoneal infection, due to an anerobic gram-positive bacterium, Actinomyces israelii. The presence of a long-standing intrauterine device (IUD) is a well-known risk factor in young women. We report two cases of pelviperitoneal actinomycosis appearing in two young women with acute low abdominal pain. Abdominal CT demonstrated multiple solid or encapsulated peritoneal masses with marked contrast enhancement and infiltration of the adjacent mesenteric fat. Laparoscopy confirmed the presence of intraperitoneal abscesses which contained Actinomyces israelii. High doses of amoxicillin and clavulanic acid (Augmentine) were given and following CT scan after 2 and 6 weeks showed a slow, but complete, resolution of the lesions. Although the radiologic presentation of actinomycosis is nonspecific, the diagnosis should be raised in the presence of pseudotumoral mesenteric infiltration, particularly in young women with an IUD. Abdominal CT is a useful method for diagnosis and for follow-up.

  11. Abdominal aortic aneurysm surgery

    Gefke, K; Schroeder, T V; Thisted, B


    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems....

  12. Abdominal perfusion computed tomography.

    Ogul, Hayri; Bayraktutan, Ummugulsum; Kizrak, Yesim; Pirimoglu, Berhan; Yuceler, Zeynep; Sagsoz, M Erdem; Yilmaz, Omer; Aydinli, Bulent; Ozturk, Gurkan; Kantarci, Mecit


    The purpose of this article is to provide an up to date review on the spectrum of applications of perfusion computed tomography (CT) in the abdomen. New imaging techniques have been developed with the objective of obtaining a structural and functional analysis of different organs. Recently, perfusion CT has aroused the interest of many researchers who are studying the applicability of imaging modalities in the evaluation of abdominal organs and diseases. Per-fusion CT enables fast, non-invasive imaging of the tumor vascular physiology. Moreover, it can act as an in vivo biomarker of tumor-related angiogenesis.

  13. Lower Abdominal Pain.

    Carlberg, David J; Lee, Stephen D; Dubin, Jeffrey S


    Although most frequently presenting with lower abdominal pain, appendicitis, colitis, and diverticulitis can cause pain throughout the abdomen and can cause peritoneal and retroperitoneal symptoms. Evaluation and management of lower intestinal disease requires a nuanced approach by the emergency physician, sometimes requiring computed tomography, ultrasonography, MRI, layered imaging, shared decision making, serial examination, and/or close follow-up. Once a presumed or confirmed diagnosis is made, appropriate treatment is initiated, and may include surgery, antibiotics, and/or steroids. Appendicitis patients should be admitted. Diverticulitis and inflammatory bowel disease can frequently be managed on an outpatient basis, but may require admission and surgical consultation.

  14. Dolor abdominal recurrente .

    Rodrigo De Vivero


    Full Text Available El dolor abdominal recurrente (DAR es un problema frecuente en la consulta médica y en la subespecialidad médica y quirúrgica. El DAR es frecuentemente funcional, es decir, sin una causa orgánica aparente. El diagnóstico diferencial debe incluir pérdida de peso, sangrado gastrointestinal, fiebre persistente, diarrea crónica y vómito importante. En este artículo se revisa el diagnóstico y tratamiento, pruebas diagnósticas y manejo farmacológico y ambiental.

  15. [Differential diagnosis of abdominal pain].

    Frei, Pascal


    Despite the frequency of functional abdominal pain, potentially dangerous causes of abdominal pain need to be excluded. Medical history and clinical examination must focus on red flags and signs for imflammatory or malignant diseases. See the patient twice in the case of severe and acute abdominal pain if lab parameters or radiological examinations are normal. Avoid repeated and useless X-ray exposure whenever possible. In the case of subacute or chronic abdominal pain, lab tests such as fecal calprotectin, helicobacter stool antigen and serological tests for celiac disease are very useful. Elderly patients may show atypical or missing clinical signs. Take care of red herrings and be skeptical whether your initial diagnosis is really correct. Abdominal pain can frequently be an abdominal wall pain.

  16. Abdominal wall blocks in adults

    Børglum, Jens; Gögenür, Ismail; Bendtsen, Thomas F


    Purpose of review Abdominal wall blocks in adults have evolved much during the last decade; that is, particularly with the introduction of ultrasound-guided (USG) blocks. This review highlights recent advances of block techniques within this field and proposes directions for future research.......  Recent findings Ultrasound guidance is now considered the golden standard for abdominal wall blocks in adults, even though some landmark-based blocks are still being investigated. The efficiency of USG transversus abdominis plane blocks in relation to many surgical procedures involving the abdominal wall...... been introduced with success. Future research should also investigate the effect of specific abdominal wall blocks on neuroendocrine and inflammatory stress response after surgery.  Summary USG abdominal wall blocks in adults are commonplace techniques today. Most abdominal wall blocks are assigned...

  17. Primary congenital abdominal aortic aneurysm: a case report with perinatal serial follow-up imaging

    Kim, Jung Im; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung [Seoul National University College of Medicine, Seoul National University Hospital, Department of Radiology, Seoul (Korea); Kim, Sang Joon [Seoul National University College of Medicine, Seoul National University Hospital, Department of Surgery, Seoul (Korea); Seo, Jeong-Wook [Seoul National University College of Medicine, Seoul National University Hospital, Department of Pathology, Seoul (Korea)


    Abdominal aortic aneurysms in neonates and infants are rare and are usually associated with infection, vasculitis, connective tissue disorder, or iatrogenic trauma such as umbilical catheterization. An idiopathic congenital abdominal aortic aneurysm is the least common category and there are few descriptions of the imaging features. We present the antenatal and postnatal imaging findings of an idiopathic congenital abdominal aortic aneurysm including the findings on US, MRI and CT. (orig.)

  18. Abdominal cystic lymphangioma mimicking appendicitis.

    Wake, Sarah; Abhyankar, Aruna; Hutton, Kim


    A cystic lymphangioma arising within the abdomen is a rare entity in children. It may present with an abdominal mass and symptoms of abdominal pain, vomiting, and anorexia. These nonspecific clinical symptoms are often attributed to more common acute pediatric conditions. In this report, we describe two pediatric cases of intra-abdominal cystic lymphangioma that were initially diagnosed and treated as appendicitis. True diagnosis was only achieved on surgical excision and pathological investigation of cystic material.

  19. Abdominal Cystic Lymphangioma Mimicking Appendicitis

    Wake, Sarah; Abhyankar, Aruna; Hutton, Kim


    A cystic lymphangioma arising within the abdomen is a rare entity in children. It may present with an abdominal mass and symptoms of abdominal pain, vomiting, and anorexia. These nonspecific clinical symptoms are often attributed to more common acute pediatric conditions. In this report, we describe two pediatric cases of intra-abdominal cystic lymphangioma that were initially diagnosed and treated as appendicitis. True diagnosis was only achieved on surgical excision and pathological investi...

  20. Abdominal pregnancy- a case report.

    Okafor, Ii; Ude, Ac; Aderibigbe, Aso; Amu, Oc; Udeh, Pe; Obianyo, Nen; Ani, Coc


    A case of abdominal pregnancy in a 39 year old female gravida 4, para 0(+3) is presented. Ultrasonography revealed a viable abdominal pregnancy at 15 weeks gestational age. She was initially managed conservatively. Surgical intervention became necessary at 20 weeks gestational age following Ultrasound detection of foetal demise. The maternal outcome was favourable. This case is presented to highlight the dilemma associated with diagnosis and management of abdominal pregnancy with a review of literature.

  1. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... through blood vessels. Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Children's (pediatric) abdominal ultrasound imaging produces pictures ...

  2. Anti-mycobacterial natural products from the Canadian medicinal plant Juniperus communis.

    Carpenter, Caitlyn D; O'Neill, Taryn; Picot, Nadia; Johnson, John A; Robichaud, Gilles A; Webster, Duncan; Gray, Christopher A


    Common juniper, Juniperus communis, is amongst the plants most frequently used by the indigenous peoples of North America for medicinal purposes. The First Nations of the Canadian Maritimes use infusions of juniper primarily as a tonic and for the treatment of tuberculosis. Previous investigations of extracts derived from the aerial parts of J. communis have shown it to possess anti-mycobacterial activity. The aim of the study is to isolate and identify anti-mycobacterial constituents from the aerial parts of J. communis. Methanolic extracts of J. communis needles and branches were subjected to bioassay guided fractionation using the microplate resazurin assay (MRA) to assess inhibitory activity against Mycobacterium tuberculosis strain H37Ra. The anti-mycobacterial constituents were identified by NMR, MS and polarimetry. The diterpenes isocupressic acid and communic acid and the aryltetralin lignan deoxypodophyllotoxin were isolated from the J. communis extract. Isocupressic acid and communic acid (isolated as an inseparable 3:2 mixture of cis and trans isomers) displayed MICs of 78 μM and 31 μM and IC(50)s of 46 μM and 15 μM against M. tuberculosis H37Ra respectively. Deoxypodophyllotoxin was less active, with a MIC of 1004 μM and an IC(50) of 287 μM. Isocupressic acid, communic acid and deoxypodophyllotoxin were identified as the principal constituents responsible for the anti-mycobacterial activity of the aerial parts of J. communis. Although further research will be required to evaluate the relative activities of the two communic acid isomers, this work validates an ethnopharmacological use of this plant by Canadian First Nations and Native American communities. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  3. Infections

    Virginia Vanzzini Zago


    Full Text Available This is a retrospective, and descriptive study about the support that the laboratory of microbiology aids can provide in the diagnosis of ocular infections in patients whom were attended a tertiary-care hospital in México City in a 10-year-time period. We describe the microbiological diagnosis in palpebral mycose; in keratitis caused by Fusarium, Aspergillus, Candida, and melanized fungi; endophthalmitis; one Histoplasma scleritis and one mucormycosis. Nowadays, ocular fungal infections are more often diagnosed, because there is more clinical suspicion and there are easy laboratory confirmations. Correct diagnosis is important because an early medical treatment gives a better prognosis for visual acuity. In some cases, fungal infections are misdiagnosed and the antifungal treatment is delayed.

  4. Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

    Marincek, B. [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland)


    Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films - bowel obstruction, pneumoperitoneum, and the search of ureteral calculi - are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain. (orig.)

  5. Mycobacterial laminin-binding histone-like protein mediates collagen-dependent cytoadherence

    André Alves Dias


    Full Text Available When grown in the presence of exogenous collagen I, Mycobacterium bovis BCG was shown to form clumps. Scanning electron microscopy examination of these clumps revealed the presence of collagen fibres cross-linking the bacilli. Since collagen is a major constituent of the eukaryotic extracellular matrices, we assayed BCG cytoadherence in the presence of exogenous collagen I. Collagen increased the interaction of the bacilli with A549 type II pneumocytes or U937 macrophages, suggesting that BCG is able to recruit collagen to facilitate its attachment to host cells. Using an affinity chromatography approach, we have isolated a BCG collagen-binding protein corresponding to the previously described mycobacterial laminin-binding histone-like protein (LBP/Hlp, a highly conserved protein associated with the mycobacterial cell wall. Moreover, Mycobacterium leprae LBP/Hlp, a well-characterized adhesin, was also able to bind collagen I. Finally, using recombinant fragments of M. leprae LBP/Hlp, we mapped the collagen-binding activity within the C-terminal domain of the adhesin. Since this protein was already shown to be involved in the recognition of laminin and heparan sulphate-containing proteoglycans, the present observations reinforce the adhesive activities of LBP/Hlp, which can be therefore considered as a multifaceted mycobacterial adhesin, playing an important role in both leprosy and tuberculosis pathogenesis.

  6. The influence of haemoglobin and iron on in vitro mycobacterial growth inhibition assays

    Tanner, Rachel; O’Shea, Matthew K.; White, Andrew D.; Müller, Julius; Harrington-Kandt, Rachel; Matsumiya, Magali; Dennis, Mike J.; Parizotto, Eneida A.; Harris, Stephanie; Stylianou, Elena; Naranbhai, Vivek; Bettencourt, Paulo; Drakesmith, Hal; Sharpe, Sally; Fletcher, Helen A.; McShane, Helen


    The current vaccine against tuberculosis, live attenuated Mycobacterium bovis BCG, has variable efficacy, but development of an effective alternative is severely hampered by the lack of an immune correlate of protection. There has been a recent resurgence of interest in functional in vitro mycobacterial growth inhibition assays (MGIAs), which provide a measure of a range of different immune mechanisms and their interactions. We identified a positive correlation between mean corpuscular haemoglobin and in vitro growth of BCG in whole blood from healthy UK human volunteers. Mycobacterial growth in peripheral blood mononuclear cells (PBMC) from both humans and macaques was increased following the experimental addition of haemoglobin (Hb) or ferric iron, and reduced following addition of the iron chelator deferoxamine (DFO). Expression of Hb genes correlated positively with mycobacterial growth in whole blood from UK/Asian adults and, to a lesser extent, in PBMC from South African infants. Taken together our data indicate an association between Hb/iron levels and BCG growth in vitro, which may in part explain differences in findings between whole blood and PBMC MGIAs and should be considered when using such assays. PMID:28256545

  7. Structure and function of the mycobacterial transcription initiation complex with the essential regulator RbpA

    Hubin, Elizabeth A.; Fay, Allison; Xu, Catherine; Bean, James M.; Saecker, Ruth M.; Glickman, Michael S.; Darst, Seth A.; Campbell, Elizabeth A. (Rockefeller); (SKI)


    RbpA and CarD are essential transcription regulators in mycobacteria. Mechanistic analyses of promoter open complex (RPo) formation establish that RbpA and CarD cooperatively stimulate formation of an intermediate (RP2) leading to RPo; formation of RP2 is likely a bottleneck step at the majority of mycobacterial promoters. Once RPo forms, CarD also disfavors its isomerization back to RP2. We determined a 2.76 Å-resolution crystal structure of a mycobacterial transcription initiation complex (TIC) with RbpA as well as a CarD/RbpA/TIC model. Both CarD and RbpA bind near the upstream edge of the -10 element where they likely facilitate DNA bending and impede transcription bubble collapse. In vivo studies demonstrate the essential role of RbpA, show the effects of RbpA truncations on transcription and cell physiology, and indicate additional functions for RbpA not evident in vitro. This work provides a framework to understand the control of mycobacterial transcription by RbpA and CarD.

  8. Mycobacterial DNA extraction for whole-genome sequencing from early positive liquid (MGIT) cultures.

    Votintseva, Antonina A; Pankhurst, Louise J; Anson, Luke W; Morgan, Marcus R; Gascoyne-Binzi, Deborah; Walker, Timothy M; Quan, T Phuong; Wyllie, David H; Del Ojo Elias, Carlos; Wilcox, Mark; Walker, A Sarah; Peto, Tim E A; Crook, Derrick W


    We developed a low-cost and reliable method of DNA extraction from as little as 1 ml of early positive mycobacterial growth indicator tube (MGIT) cultures that is suitable for whole-genome sequencing to identify mycobacterial species and predict antibiotic resistance in clinical samples. The DNA extraction method is based on ethanol precipitation supplemented by pretreatment steps with a MolYsis kit or saline wash for the removal of human DNA and a final DNA cleanup step with solid-phase reversible immobilization beads. The protocol yielded ≥0.2 ng/μl of DNA for 90% (MolYsis kit) and 83% (saline wash) of positive MGIT cultures. A total of 144 (94%) of the 154 samples sequenced on the MiSeq platform (Illumina) achieved the target of 1 million reads, with 90% coverage achieved. The DNA extraction protocol, therefore, will facilitate fast and accurate identification of mycobacterial species and resistance using a range of bioinformatics tools. Copyright © 2015, Votintseva et al.

  9. Gamma Interferon Production by Bovine γδ T Cells following Stimulation with Mycobacterial Mycolylarabinogalactan Peptidoglycan

    Vesosky, B.; Turner, O. C.; Turner, J.; Orme, I. M.


    A large percentage of lymphocytes in the blood of cattle express the γδ T-cell receptor, but specific functions for these cells have not yet been clearly defined. There is evidence, however, that human, murine, and bovine γδ T cells have a role in the immune response to mycobacteria. This study investigated the ability of bovine γδ T cells to expand and produce gamma interferon (IFN-γ) in response to stimulation with mycobacterial products. Bovine γδ T cells, isolated from the peripheral blood of healthy cattle, expanded following in vitro stimulation with live mycobacteria, mycobacterial crude cell wall extract, and Mycobacterium bovis culture filtrate proteins. In addition, purified γδ T cells, cocultured with purified monocytes and interleukin-2, consistently produced significant amounts of IFN-γ in response to mycobacterial cell wall. The IFN-γ-inducing component of the cell wall was further identified as a proteolytically resistant, non-sodium dodecyl sulfate-soluble component of the mycolylarabinogalactan peptidoglycan. PMID:15271921

  10. Tetrahydrolipstatin Inhibition, Functional Analyses, and Three-dimensional Structure of a Lipase Essential for Mycobacterial Viability

    Crellin, Paul K.; Vivian, Julian P.; Scoble, Judith; Chow, Frances M.; West, Nicholas P.; Brammananth, Rajini; Proellocks, Nicholas I.; Shahine, Adam; Le Nours, Jerome; Wilce, Matthew C.J.; Britton, Warwick J.; Coppel, Ross L.; Rossjohn, Jamie; Beddoe, Travis (Monash); (Centenary)


    The highly complex and unique mycobacterial cell wall is critical to the survival of Mycobacteria in host cells. However, the biosynthetic pathways responsible for its synthesis are, in general, incompletely characterized. Rv3802c from Mycobacterium tuberculosis is a partially characterized phospholipase/thioesterase encoded within a genetic cluster dedicated to the synthesis of core structures of the mycobacterial cell wall, including mycolic acids and arabinogalactan. Enzymatic assays performed with purified recombinant proteins Rv3802c and its close homologs from Mycobacterium smegmatis (MSMEG{_}6394) and Corynebacterium glutamicum (NCgl2775) show that they all have significant lipase activities that are inhibited by tetrahydrolipstatin, an anti-obesity drug that coincidently inhibits mycobacterial cell wall biosynthesis. The crystal structure of MSMEG{_}6394, solved to 2.9 {angstrom} resolution, revealed an {alpha}/{beta} hydrolase fold and a catalytic triad typically present in esterases and lipases. Furthermore, we demonstrate direct evidence of gene essentiality in M. smegmatis and show the structural consequences of loss of MSMEG{_}6394 function on the cellular integrity of the organism. These findings, combined with the predicted essentiality of Rv3802c in M. tuberculosis, indicate that the Rv3802c family performs a fundamental and indispensable lipase-associated function in mycobacteria.

  11. Extended mesh repair with external oblique muscle reinforcement for abdominal wall contour abnormalities following TRAM flap.

    Israeli, Ron; Hazani, Ron; Feingold, Randall S; DeNoto, George; Scheiner, Marc S


    Many patients undergoing reconstructive surgery after mastectomy opt for reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap. Among the morbidities related to TRAM flap reconstruction is the development of abdominal wall contour abnormalities, including bulges or hernias. Several repair techniques at the flap abdominal wall donor site have been described for use at the time of flap harvest in an attempt to reduce the risk of such abdominal wall complications. For patients that develop abdominal wall contour abnormalities, numerous reconstructive options have been reported, with mixed results. Ten patients were identified as having abdominal wall contour abnormalities after a TRAM flap and underwent an extended mesh repair with external oblique muscle reinforcement. The mesh was secured to the bony landmarks of the lower abdomen and the abdominal wall fascia. All patients achieved complete resolution of abdominal wall bulging. In the follow-up period, no recurrences, infections, or seromas were noted. One patient, who failed an earlier repair at the inferior abdominal wall, reported symptoms consistent with a scar neuroma. Symptoms were treated successfully with gabapentin and a nonsteroidal anti-inflammatory drug. We propose a novel and reliable method of lower abdominal wall reconstruction for patients with post-TRAM flap abdominal wall contour abnormalities. This technique incorporates the use of a large Marlex mesh reinforced with bilateral external oblique muscle flaps. We report a series of 10 patients who have achieved resolution of their symptoms and have regained a natural, flat-appearing abdominal wall contour.

  12. Simultaneous repair of abdominal aortic aneurysm and resection of unexpected, associated abdominal malignancies.

    Illuminati, Giulio; Calio', Francesco G; D'Urso, Antonio; Lorusso, Riccardo; Ceccanei, Gianluca; Vietri, Francesco


    The management of unexpected intra-abdominal malignancy, discovered at laparotomy for elective treatment of an abdominal aortic aneurysm (AAA), is controversial. It is still unclear whether both conditions should be treated simultaneously or a staged approach is to be preferred. To contribute in improving treatment guidelines, we retrospectively reviewed the records of patients undergoing laparotomy for elective AAA repair. From January 1994 to March 2003, 253 patients underwent elective, trans-peritoneal repair of an AAA. In four patients (1.6%), an associated, unexpected neoplasm was detected at abdominal exploration, consisting of one renal, one gastric, one ileal carcinoid, and one ascending colon tumor. All of them were treated at the same operation, after aortic repair and careful isolation of the prosthetic graft. The whole series' operative mortality was 3.6%. None of the patients simultaneously treated for AAA and tumor resection died in the postoperative period. No graft-related infections were observed. Simultaneous treatment of AAA and tumor did not prolong significantly the mean length of stay in the hospital, compared to standard treatment of AAA alone. Except for malignancies of organs requiring major surgical resections, simultaneous AAA repair and resection of an associated, unexpected abdominal neoplasm can be safely performed, in most of the patients, sparing the need for a second procedure. Endovascular grafting of the AAA can be a valuable tool in simplifying simultaneous treatment, or in staging the procedures with a very short delay.

  13. Endovascular Exclusion of an Abdominal Aortic Aneurysm in Patients with Concomitant Abdominal Malignancy: Early Experience

    Choi, You Ri; Chang, Nam Kyu [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of); Shin, Hyo Hyun; Oh, Hyun Jun; Kim, Jae Kyu; Choi, Soo Jin Na; Chung, Sang Young [Chonnam National University Hospital, Gwangju (Korea, Republic of); Yim, Nam Yeol [Armed Forces Yangju Hospital, Yangju (Korea, Republic of)


    To assess the outcomes of endovascular aortic aneurysm repair (EVAR) for the treatment of an abdominal aortic aneurysm in patients undergoing curative surgical treatment for concomitant abdominal malignancy. The study included 12 patients with abdominal neoplasia and an abdominal aortic aneurysm (AAA), which was treated by surgery and stent EVAR. The neoplasm consisted of the gastric, colorectal, pancreas, prostate, and gall bladder. The follow up period was 3-21 months (mean 11.8 months). All medical records and imaging analyses were reviewed by CTA and/or color Doppler US, retrospectively. Successful endoluminal repair was accomplished in all twelve patients. The mean interval time between EVAR and surgery was 58.6 days. Small amounts of type 2 endoleaks were detected in two patients (17%). One patient developed adult respiratory distress syndrome after Whipple's operation 20 days after surgery, which led to hopeless discharge. No procedure-related mortality, morbidity, or graft-related infection was noted. Exclusion of AAA in patients with accompanying malignancy show with a relatively low procedure morbidity and mortality. Hence, endoluminal AAA repair in patients with synchronous neoplasia may allow greater flexibility in the management of an offending malignancy

  14. [Abdominal artery aneurysm and associated surgical abdominal diseases: towards optimal timing].

    Stilo, Francesco; Mirenda, Francesco; Mandolfino, Tommaso; La Spada, Michele; D'Alfonso, Mario; Carmignani, Amedeo; De Caridi, Giovanni; Benedetto, Filippo; Spinelli, Francesco


    The purpose of this study was to assess which modalities offered the best timing in the treatment of abdominal aortic aneurysms associated with other abdominal surgical diseases. From January 1984 to December 2002, 372 patients underwent surgery for abdominal aortic aneurysms, 350 men (94%) and 22 women (6%), mean age 72 years. Of these 10% were operated on urgently. The traditional open technique was used in 307 patients, and the endovascular method in the remaining 65 cases. In 40 patients (11%) we observed other associated abdominal diseases which were treated during the same operation in 34 cases (85%). We had three deaths in the 34 cases treated in the same operation (9%). In the remaining cases no perioperative mortality was registered. There were no cases of prosthesis infection. The mean hospital stay was 9 days. Simultaneous treatment appears, on the one hand, to carry an increased operative risk and increased mortality and, on the other, to present the advantage of having to perform only one surgical procedure. The advent of the endovascular method allows us to postpone the treatment of the associated disease without increasing the technical difficulty of the second operation.

  15. Mycobacterial Hsp65 potentially cross-reacts with autoantibodies of diabetes sera and also induces (in vitro) cytokine responses relevant to diabetes mellitus.

    Rani, Pittu Sandhya; Babajan, Banaganapalli; Tulsian, Nikhil K; Begum, Mahabubunnisa; Kumar, Ashutosh; Ahmed, Niyaz


    Diabetes mellitus is a multifactorial disease and its incidence is increasing worldwide. Among the two types of diabetes, type-2 accounts for about 90% of all diabetic cases, whereas type-1 or juvenile diabetes is less prevalent and presents with humoral immune responses against some of the autoantigens. We attempted to test whether the sera of type-1 diabetes patients cross-react with mycobacterial heat shock protein 65 (Hsp65) due to postulated epitope homologies between mycobacterial Hsp65 and an important autoantigen of type-1 diabetes, glutamic acid decarboxylase-65 (GAD65). In our study, we used either recombinant mycobacterial Hsp65 protein or synthetic peptides corresponding to some of the potential epitopes of mycobacterial Hsp65 that are shared with GAD65 or human Hsp60, and a control peptide sourced from mycobacterial Hsp65 which is not shared with GAD65, Hsp60 and other autoantigens of type-1 diabetes. The indirect ELISA results indicated that both type-1 diabetes and type-2 diabetes sera cross-react with conserved mycobacterial Hsp65 peptides and recombinant mycobacterial Hsp65 protein but do not do so with the control peptide. Our results suggest that cross-reactivity of mycobacterial Hsp65 with autoantibodies of diabetes sera could be due to the presence of significantly conserved peptides between mycobacterial Hsp65 and human Hsp60 rather than between mycobacterial Hsp65 and GAD65. The treatment of human peripheral blood mononuclear cells (PBMCs) with recombinant mycobacterial Hsp65 protein or the synthetic peptides resulted in a significant increase in the secretion of cytokines such as IL-1β, IL-8, IL-6, TNF-α and IL-10. Taken together, these findings point towards a dual role for mycobacterial Hsp65: in inducing autoimmunity and in inflammation, the two cardinal features of diabetes mellitus.

  16. Abdominal Complications after Severe Burns


    abdominal compartment syndrome, schemic bowel, biliary disease , peptic ulcer disease and astritis requiring laparotomy, small bowel obstruction, rimary fungal...complications in- luded trauma exploratory laparotomy, abdominal com- artment syndrome, ischemic bowel, biliary disease , peptic lcer disease and gastritis, large...because it was almost uniformly ssociated with serious lethal burns. This was in the period efore effective gastric acid control, explaining the high

  17. Videolaparoscopia no trauma abdominal

    Átila Varela Velho

    Full Text Available A videolaparoscopia (VL vem contribuindo de forma crescente, para diagnóstico e terapêutica de várias afecções cirúrgicas abdominais, introduzindo profundas mudanças na cirurgia contemporânea. Esse avanço incorporou-se também às urgências traumáticas, fazendo parte da avaliação diagnóstica e, às vezes, da terapêutica do trauma abdominal. Os autores apresentam uma revisão concisa da literatura sobre a VL no trauma, atualizando o tema e discutindo os aspectos mais relevantes das indicações, limitações e complicações do método.

  18. Abdominal aortic aneurysms

    Lindholt, Jes Sanddal


    Although the number of elective operations for abdominal aortic aneurysms (AAA) is increasing, the sex- and age-standardised mortality rate of AAAs continues to rise, especially among men aged 65 years or more. The lethality of ruptured AAA continues to be 80-95%, compared with 5-7% by elective...... inhibit further AAA progression. All 4 existing RCTs point in the same direction, viz. in favour of screening of men aged 65 and above. We found that screening significantly reduced AAA-related mortality by 67% within the first five years (NNT = 352). Restriction of screening to men with previous...... year gained was 157 euro [1,170 DKK] and the cost per QALY at 178 euro [1,326 DKK]. In all, the ethical dilemma of the prophylactic operation, and the limited psychological side effects seem not to outweigh the benefits of screening. Conclusively, we found that offering men aged 65-73 years screening...

  19. A mycotic aneurysm of the abdominal aorta in a child

    W. Suijker (W.); J.H.L.J. Bergmeijer (Jan Hein); J.J. Hamming (J.); J.C. Molenaar


    textabstractA 6-year-old boy with a previous history of intracardiac correction of a partial atrioventricular canal defect presented with infective endocarditis. Despite antibiotic therapy and reoperation, he developed a mycotic abdominal aneurysm. In situ aortoiliac reconstruction with a prosthesis

  20. Pathways of peritoneal tumour recurrence after abdominal surgical trauma

    M.E.E. van Rossen (Marie Elma)


    textabstractThe peritoneum is the largest and the most complex arranged serous membrane in the body that lines both the intra-abdominal wall and the viscera contained within the peritoneal cavity. It is capable of walling off infections and has several functions such as the ability to synthesise, se

  1. Case report: Filariasis presenting as an intra-abdominal cyst

    Abhay K Kapoor


    Full Text Available Filariasis is an endemic infection seen in the tropical and subtropical regions of the world, presenting with lymphatic dysfunction in the form of lymphocele, hydrocele, chyluria, or groin lymphadenovarix. We report a rare presentation of filariasis as an intra-abdominal cystic mass.

  2. Total abdominal colectomy

    ... the rectum. This can cause an infection or abscess. Scarring of the connection between the small intestine ... More Crohn disease Ileostomy Total proctocolectomy and ileal - anal pouch Total proctocolectomy with ileostomy Ulcerative colitis Patient ...

  3. Abdominal migraine in the differential diagnosis of acute abdominal pain.

    Cervellin, Gianfranco; Lippi, Giuseppe


    Although traditionally regarded as a specific pediatric disease, abdominal migraine may also be observed in adults. Unfortunately, however, this condition is frequently overlooked in the differential diagnosis of abdominal pain in the emergency department (ED). A 30-year-old woman presented to our ED complaining of abdominal pain and vomiting, lasting for 12 hours. The pain was periumbilical, continuous, and not associated with fever or diarrhea. The physical examination and the results of conventional blood tests were normal. The patient was treated with intravenous ketoprofen, metoclopramide, and ranitidine, obtaining a prompt relief of symptoms. She had a history of similar episodes in the last 15 years, with several ED visits, blood test examinations, ultrasonography of the abdomen, and upper gastrointestinal endoscopies. Celiac disease, porphyry, sickle cell disease, and inflammatory bowel disease were all excluded. In July 2012, she became pregnant, and she delivered a healthy baby on April 2013. Until November 2014, she has remained asymptomatic. Based on the clinical characteristics of the abdominal pain episodes, the exclusion of any alternative diagnosis, and the relief of symptoms during and after pregnancy, a final diagnosis of abdominal migraine could be established. A skilled emergency physician should always consider abdominal migraine in the differential diagnosis of patients admitted to the ED with abdominal pain, especially when the attacks are recurrent and no alternative diagnosis can be clearly established.

  4. Infection


    Interactions between biofilms and the environment. FEMS Microbiol Rev. 1997;20:291–303. 4. Webb LX, Wagner W, Carroll D, et al. Osteomyelitis and...treatment of osteomyelitis . Biomed Mater. 2008;3: 034114. 6. Gristina AG. Biomaterial-centered infection: microbial adhesion versus tissue integration...vertebral osteomyelitis . Spine. 2007;32: 2996–3006. 15. Beckham JD, Tuttle K, Tyler KL. Reovirus activates transforming growth factor ß and bone

  5. Abdominal drainage following cholecystectomy: high, low, or no suction?

    McCormack, T T; Abel, P D; Collins, C. D.


    A prospective trial to assess the effect of suction in an abdominal drain following cholecystectomy was carried out. Three types of closed drainage system were compared: a simple tube drain, a low negative pressure drain, and a high negative pressure drain: 120 consecutive patients undergoing cholecystectomy were randomly allocated to one of the three drainage groups. There was no significant difference in postoperative pyrexia, wound infection, chest infection, or hospital stay. This study f...

  6. Multidrug resistant tuberculosis versus non-tuberculous mycobacterial infections: a CT-scan challenge

    Kahkouee, Shahram; Esmi, Elham; Moghadam, Azadeh; Karam, Mehrdad Bakhshayesh; Mosadegh, Leila; Salek, Solmaz; Tabarsi, Payam, E-mail: [Chronic Respiratory Disease Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Science, Tehran (Iran, Islamic Republic of)


    Introduction: clinical, laboratory and imaging findings in patients with multidrug resistant tuberculosis (MDR-TB) and non-tuberculosis mycobacterium (NTM) are similar, and the majority of these patients present with positive smear for Acid Fast Bacilli (ADB) and no response to first line anti-TB treatment, so sputum culture and PCR are necessary, especially in NTM. Objective: In this study we evaluate more details of imaging findings to help earlier diagnosis of pathogens. Materials and methods: 66 patients with positive smear for AFB and no response to first line anti-TB drugs were divided into two groups by PCR and culture: MDR-TB (43 patients) and NTM (23 patients). Age, sex, history of anti-TB treatment, smoking and CT-scan findings (parenchymal, pleural and mediastinal variables) by details and lobar distribution were analyzed. Results: mean age of NTM patients was slightly higher (52 versus 45) and there is no significant difference in sex and smoking. In MDR-TB group, history of anti-TB treatment and evidence of chronic pulmonary disease such as calcified and fibrodestructed parenchyma, volume loss and pleural thickening were higher significantly. Cavities in MDR-TB were thick wall in the background of consolidation, while NTM cavities were more thin-walled with adjacent satellite nodules in same segment or lobe. Prevalence of bronchiectasis was similar in both groups, while bronchiectasis in MDR-TB group was in fibrobronchiectatic background in upper lobes, and in NTM group the distribution was more uniform with slightly middle lobes predominance. Prevalence and distribution of nodular infiltrations were similar more in Tree in Buds and scattered pattern. Calcified or non-calcified lymph nodes and also pleural changes were more frequent in MDR-TB but prevalence of lymphadenopathy was mildly higher in NTM. (author)

  7. Multidrug resistant tuberculosis versus non-tuberculous mycobacterial infections: a CT-scan challenge

    Shahram Kahkouee

    Full Text Available INTRODUCTION: Clinical, laboratory and imaging findings in patients with multidrug resistanttuberculosis (MDR-TB and non-tuberculosis mycobacterium (NTM are similar, and the majority of these patients present with positive smear for Acid Fast Bacilli (ADB and no response to first line anti-TB treatment, so sputum culture and PCR are necessary, especially in NTM. OBJECTIVE: In this study we evaluate more details of imaging findings to help earlier diagnosis of pathogens. MATERIALS AND METHODS: 66 patients with positive smear for AFB and no response to first line anti-TB drugs were divided into two groups by PCR and culture: MDR-TB (43 patients and NTM (23 patients. Age, sex, history of anti-TB treatment, smoking and CT-scan findings (parenchymal, pleural and mediastinal variables by details and lobar distribution were analyzed. RESULTS: Mean age of NTM patients was slightly higher (52 versus 45 and there is no significant difference in sex and smoking. In MDR-TB group, history of anti-TB treatment and evidence of chronic pulmonary disease such as calcified and fibrodestructed parenchyma, volume loss and pleural thickening were higher significantly. Cavities in MDR-TB were thickwall in the background of consolidation, while NTM cavities were more thin-walled with adjacent satellite nodules in same segment or lobe. Prevalence of bronchiectasis was similar in both groups, while bronchiectasis in MDR-TB group was in fibrobronchiectatic background in upper lobes, and in NTM group the distribution was more uniform with slightly middle lobes predominance. Prevalence and distribution of nodular infiltrations were similar more in Tree in Buds and scattered pattern. Calcified or non-calcified lymph nodes and also pleural changes were more frequent in MDR-TB but prevalence of lymphadenopathy was mildly higher in NTM. CONCLUSION: A check-list with multiple variables is helpful for differentiation between the two groups.

  8. Multidrug resistant tuberculosis versus non-tuberculous mycobacterial infections: a CT-scan challenge

    Shahram Kahkouee


    Full Text Available INTRODUCTION: Clinical, laboratory and imaging findings in patients with multidrug resistanttuberculosis (MDR-TB and non-tuberculosis mycobacterium (NTM are similar, and the majority of these patients present with positive smear for Acid Fast Bacilli (ADB and no response to first line anti-TB treatment, so sputum culture and PCR are necessary, especially in NTM. OBJECTIVE: In this study we evaluate more details of imaging findings to help earlier diagnosis of pathogens. MATERIALS AND METHODS: 66 patients with positive smear for AFB and no response to first line anti-TB drugs were divided into two groups by PCR and culture: MDR-TB (43 patients and NTM (23 patients. Age, sex, history of anti-TB treatment, smoking and CT-scan findings (parenchymal, pleural and mediastinal variables by details and lobar distribution were analyzed. RESULTS: Mean age of NTM patients was slightly higher (52 versus 45 and there is no significant difference in sex and smoking. In MDR-TB group, history of anti-TB treatment and evidence of chronic pulmonary disease such as calcified and fibrodestructed parenchyma, volume loss and pleural thickening were higher significantly. Cavities in MDR-TB were thickwall in the background of consolidation, while NTM cavities were more thin-walled with adjacent satellite nodules in same segment or lobe. Prevalence of bronchiectasis was similar in both groups, while bronchiectasis in MDR-TB group was in fibrobronchiectatic background in upper lobes, and in NTM group the distribution was more uniform with slightly middle lobes predominance. Prevalence and distribution of nodular infiltrations were similar more in Tree in Buds and scattered pattern. Calcified or non-calcified lymph nodes and also pleural changes were more frequent in MDR-TB but prevalence of lymphadenopathy was mildly higher in NTM. CONCLUSION: A check-list with multiple variables is helpful for differentiation between the two groups.

  9. Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients

    Shabanzadeh, Daniel M; Sørensen, Lars T


    : To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery.......: To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery....

  10. Ascariasis as a cause of recurrent abdominal pain.

    Guzman, Gerly Edson; Teves, Pedro Montes; Monge, Eduardo


    Ascariasis is the most common helminthic infection in developing countries. It may cause chronic abdominal pain, tenderness and bloating. Our aim is to report a case of acute episodic abdominal pain and pancreatitis associated with ascariasis. We report a 59-year-old female patient who was admitted for acute abdominal pain, having had several previous similar events before one of them was diagnosed as acute idiopathic pancreatitis. On admission, her physical exam was normal. Laboratory results showed hemoglobin 12.2 g/dL, white blood cell count 11 900 cells/mm(3), eosinophils 420 cells/mm(3), serum amylase 84 IU/mL, lipase 22 IU/mL and normal liver function tests. Abdominal ultrasound and a plain abdominal X-ray were also normal. An upper endoscopy showed round white worms in the duodenum and the stomach, some of them with bile in their intestines. The intestinal parasites were diagnosed as Ascaris lumbricoides, and the patient was started on albendazole, with full recovery within a week. We believe that ascariasis should be considered in patients with recurrent abdominal pain and idiopathic pancreatitis.

  11. [Abdominal wall closure by incisional hernia and herniation after laparostoma].

    Mischinger, H-J; Kornprat, P; Werkgartner, G; El Shabrawi, A; Spendel, S


    As hernias and abdominal wall defects have a variety of etiologies each with its own complications and comorbidities in various constellations, efficient treatment requires patient-oriented management. There is no recommended standard treatment and the very different clinical pictures demand an individualized interdisciplinary approach. Particularly in the case of complicated hernias, the planning of the operation should focus on the problems posed by the individual patient. Treatment mainly depends on the etiology of the hernia, immediate or long-term complications and the efficiency of individual repair techniques. Abdominal wall repair for recurrent herniation requires direct closure of the fascia generally using the sublay technique with a lightweight mesh. It is still unclear whether persistent inflammation, mesh dislocation, fistula formation or other long-term complications are due to certain materials or to the surgical technique. With mesh infections it has been shown to be advantageous to remove a polytetrafluoroethylene (PTFE) mesh, while the combination of systemic and local treatment appears to suffice for a polypropylene or polyester mesh. Heavier meshes in the sublay position or plastic reconstruction with autologous tissue are indicated as substitutes for the abdominal wall for giant hernias, repeated recurrences and large abdominal wall defects. A laparostoma is increasingly more often created to treat septic intra-abdominal processes but is very often responsible for a complicated hernia. If primary repair of the abdominal wall is not an option, resorbable material or split skin is used for coverage under the auspices of a planned hernia repair.

  12. Absidia Corymbifera in an immune competent accident victim with multiple abdominal injuries: case report

    Belfiori, Rita; Terenzi, Adelmo; Marchesini, Laura; Repetto, Antonella


    We report a case of mucormycosis in a healthy 17-year-old accident victim with multiple abdominal injuries which was caused by infection with Absidia Corymbifera, a ubiquitous saphrophyte in the ground...

  13. Bacterial Translocation and Change in Intestinal Permeability in Patients after Abdominal Surgery

    Zhi QIAO; Zhanliang LI; Jiye LI; Lianrong LU; Yi LV; Junyou LI


    sely related with bacterial translocation. Intestinal bacterial translocation (most commonly E. coli) might occur at early stage (2 h) after ab-dominal surgery. Postoperative SIRS and infection might bear a close relationship with bacterial translocation.

  14. [Diagnostic difficulties in pediatric abdominal pain with potential appendicitis].

    Iwańczak, Barbara; Stawarski, Andrzej; Czernik, Jerzy; Bronowickip, Krzysztof; Iwańczak, Franciszek; Pytrus, Tomasz; Klempous, Jan; Godziński, Jan


    Pediatric abdominal pain is one of the most common symptom of children brought to attention of primary care physicians and pediatric surgeons. In many children clinical symptoms may be uncharacteristic and may lead to diagnostic difficulties. Clinical analysis of children with right lower quadrant abdominal pain suspected of appendicitis or children with periappendicular mass. The histories of 14 children aged from 18 months to 17 years treated in Pediatric Clinic were analysed. All children were operated because of right lower quadrant abdominal pain or abdominal mass before admission to the Pediatric Clinic or during hospitalization in Pediatric Clinic. Intraoperatively in all children pathologies other than appendicitis were the cause of symptoms. The most often Crohn's disease were recognized (9 children), in 2 cases with concomitant other pathologies (fecal tumor of appendix in one case and with peritoneal abscess after perforation of intestinal wall). Sporadically the inflammation of the mesenterial lymph nodes caused by Yersinia infection suggested appendicitis. In one boy with ulcerative colitis, during exacerbation of the disease appendicitis complicated by rupture and peritonitis was observed. In 18-month old child with right lower quadrant abdominal mass invagination complicated by perforation of the ileum was recognized. In the case of 14-years old boy 6 months after appendectomy we observed mechanical intestinal obstruction complicated by perforation and peritonitis. Carcinoid of the appendix was the cause of abdominal pain in one child. 1. Appendicitis is the most frequent surgical etiology of the right lower quadrant pediatric abdominal pain. 2. Despite new diagnostic imagines there are no definite criteria to recognize appendicitis, in most cases physical examination and very carefull evaluation of abdominal pain are the most important. 3. All children with periappendipected of Crohn's disease. 4. All children with equivocal presentations of

  15. [Swimming pool lung -- extrinsic allergic alveolitis or mycobacterial disease?].

    Koschel, D; Pietrzyk, C; Sennekamp, J; Müller-Wening, D


    There have been several recent reports of pulmonary disease resulting from exposure to Mycobacterium avium complex in indoor hot tubs. The disease is thought to be due either to infection or extrinsic allergic alveolitis (EAA). In this report we describe the case of a patient who developed episodes of fever, dyspnea and cough 4-6 hours after cleaning his indoor swimming pool. A diagnosis of EAA was made on finding a restrictive lung function pattern with gas exchange abnormalities, a predominant lymphocytosis in the bronchoalveolar lavage, diffuse ground-glass opacities in the lower lobes on high-resolution computer tomography, and specific IgG antibody activity to the swimming pool water. There was no precipitin reaction or specific IgG antibody activity to microbes extracted from the water. Interestingly, the water contained Mycobacterium avium complex (MAC) in huge amounts and in this case the histopathological features of the lung biopsy specimens differed from those seen in typical EAA, but were similar to those described in "hot tub lung" caused by mycobacteria. Solely by avoidance of cleaning the swimming pool, without any pharmacological treatment, the patient recovered completely within three months. To the best of our knowledge, this is the first report of EAA possibly associated with MAC exposure in a swimming pool environment.

  16. Síndrome compartimental abdominal

    Misael Guzmán Nápoles

    Full Text Available Desde el siglo XIX se conocen los efectos negativos del aumento de la presión intraabdominal, pero no se le prestó la debida atención a este trastorno hasta la última década del pasado siglo y la primera del actual. En este artículo exponemos las definiciones de los términos presión intrabdominal, hipertensión intrabdominal y síndrome compartimental abdominal, que fueron tomadas por consenso y aprobadas por la World Society of the Abdominal Compartment Syndrome. En nuestro medio, para el diagnóstico de la hipertensión intrabdominal y del síndrome compartimental abdominal se requiere medir la presión intrabdominal, secundariamente la presión de perfusión abdominal y se deben correlacionar estos datos con signos de deterioro clínico en el paciente. Las medidas terapéuticas médicas en relación con el síndrome compartimental abdominal son limitadas; cuando este es sintomático la descompresión abdominal es el tratamiento ya establecido. Enfatizamos en que el diagnóstico temprano de la hipertensión intrabdominal y del síndrome compartimental abdominal contribuyen a disminuir el desarrollo de un síndrome de disfunción múltiple de órganos y por tanto a reducir la mortalidad en estos pacientes. Con el objetivo de actualizar los conocimientos sobre hipertensión intrabdominal y síndrome compartimental abdominal, su diagnóstico y tratamiento, realizamos una minuciosa revisión actualizada de diversos artículos referentes al síndrome compartimental abdominal, tanto en el ámbito nacional como internacional.

  17. [Surgical treatment of patients for abdominal sepsis].

    Kryvoruchko, I A; Usenko, O Iu; Andreieshchev, S A


    Results of surgical treatment of 201 patients, suffering abdominal sepsis (AS), which have occurred after operations on abdominal organs, were analyzed. Expediency of application of modern scales for the patients state severity estimation, prognostic sign-posts and dynamic of the pathological process course in every patient was substantiated. Existing systems of prognostication (APACHE II, SOFA, MODS) are applied restrictedly for diagnosis of infection in patients, what demands relaparotomy performance in presence of clinical signs of intraabdominal infection, which persists. For prognostication of the treatment result and determination of indications for relaparotomy conduction in patients, suffering severe AS and infectious-toxic shock (ITSH), the most informative is application of the Manheim's index of peritonitis together with analysis of clinico-laboratory indices for formation of groups of patients in risk, to whom reoperation is indicated. Advantages of relaparotomy "on demand" conduction were proved in comparison with "programmed" relaparotomy during the staged surgical treatment of patients, suffering severe AS and ITSH. Complex surgical treatment with substantiation of indications and choice of adequate method of intervention secures improvement of the treatment results in these severely ill patients.


    Zahir Hussain


    Full Text Available BACKGROUND Abdominal wound dehiscence is a preventable complication, but is still seen. When present, it poses problem in the management of the case, increases the morbidity and mortality of the patient. The present study is a prospective study done from January 2010-May 2016 with an objective to find out the incidence of wound dehiscence, the most common pathologies associated with dehiscence and to find out the statistical significance of the difference risk factors causing wound dehiscence and to evaluate the role of tension sutures in prevention of wound dehiscence. MATERIALS AND METHODS 291 major laparotomies were followed from January 2010-September 2016. There were 21 cases of dehiscence and from the remaining 270 cases, 58 patients were chosen as controls who underwent the same procedure, but without dehiscence. 15 factors were analysed and compared between the dehiscence and control groups. RESULTS The incidence was found to be 7.2%. Peritonitis was the most common pathology. The significant factors were age more than 50, wound infection. Tension suture application has shown to reduce the incidence of wound dehiscence. CONCLUSIONS  Intra-abdominal sepsis (peritonitis increases the incidence of wound dehiscence.  Age >50, Uraemic, Jaundiced, Obesity, Malnutrition increases the incidence of wound dehiscence.  Wound infection was a highly significant factor having 8 times more risk of dehiscence.

  19. Non-major histocompatibility complex-restricted cytotoxic activity of blood mononuclear cells stimulated with secreted mycobacterial proteins and other mycobacterial antigens

    Ravn, P; Pedersen, B K


    Several observations indicate that non-major histocompatibility complex (MHC)-restricted cytotoxicity, mediated for example by natural killer cells and lymphokine-activated killer cells, may serve as an important antimicrobial defense mechanism. The purpose of the present study was to investigate...... the influences of different mycobacterial antigens on non-MHC-restricted cytotoxicity and further to investigate the ways by which various lymphocyte subpopulations contribute to the development of this cytotoxicity. Non-MHC-restricted cytotoxicity was induced following stimulation of mononuclear cells...... the influence of CD4+ cells on the development of non-MHC-restricted cytotoxicity, blood mononuclear cells were depleted of CD4+ cells before antigen stimulation. When mononuclear cells were incubated with purified protein derivative or short-term culture filtrate in the absence of CD4+ cells, cytotoxic...

  20. An abdominal tuberculosis case mimicking an abdominal mass

    year-old child with an unusual clinical presentation ... Keywords: abdominal tuberculosis, child, diagnosis. Departments of .... vomiting, gas distension, diarrhea, or constipation), whereas ... senteric echo in the acute stage with peritoneal involve-.

  1. Economics of abdominal wall reconstruction.

    Bower, Curtis; Roth, J Scott


    The economic aspects of abdominal wall reconstruction are frequently overlooked, although understandings of the financial implications are essential in providing cost-efficient health care. Ventral hernia repairs are frequently performed surgical procedures with significant economic ramifications for employers, insurers, providers, and patients because of the volume of procedures, complication rates, the significant rate of recurrence, and escalating costs. Because biological mesh materials add significant expense to the costs of treating complex abdominal wall hernias, the role of such costly materials needs to be better defined to ensure the most cost-efficient and effective treatments for ventral abdominal wall hernias.

  2. Abdominal aortic feminism.

    Mortimer, Alice Emily


    A 79-year-old woman presented to a private medical practice 2 years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6 cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4 days in intensive care where she recovered well. She was discharged after a 12 day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer. 2014 BMJ Publishing Group Ltd.

  3. Micromanaging Abdominal Aortic Aneurysms

    Lars Maegdefessel


    Full Text Available The contribution of abdominal aortic aneurysm (AAA disease to human morbidity and mortality has increased in the aging, industrialized world. In response, extraordinary efforts have been launched to determine the molecular and pathophysiological characteristics of the diseased aorta. This work aims to develop novel diagnostic and therapeutic strategies to limit AAA expansion and, ultimately, rupture. Contributions from multiple research groups have uncovered a complex transcriptional and post-transcriptional regulatory milieu, which is believed to be essential for maintaining aortic vascular homeostasis. Recently, novel small noncoding RNAs, called microRNAs, have been identified as important transcriptional and post-transcriptional inhibitors of gene expression. MicroRNAs are thought to “fine tune” the translational output of their target messenger RNAs (mRNAs by promoting mRNA degradation or inhibiting translation. With the discovery that microRNAs act as powerful regulators in the context of a wide variety of diseases, it is only logical that microRNAs be thoroughly explored as potential therapeutic entities. This current review summarizes interesting findings regarding the intriguing roles and benefits of microRNA expression modulation during AAA initiation and propagation. These studies utilize disease-relevant murine models, as well as human tissue from patients undergoing surgical aortic aneurysm repair. Furthermore, we critically examine future therapeutic strategies with regard to their clinical and translational feasibility.

  4. [Monitoring of intra-abdominal pressure and abdominal perfusion pressure in urgent abdominal surgery].

    Raĭbuzhis, E N; Fot, E V; Gaĭdukov, K M; Kirov, M Iu


    To evaluate the changes in intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) during perioperative period in urgent abdominal surgery and to assess the relationship of these parameters with gas exchange and tissue perfusion. Twenty-four patients undergoing emergency abdominal surgery were enrolled into a prospective observational study. We recorded IAP APP, mean arterial pressure, arterial and venous blood gases after induction of anesthesia, at the end of surgery, and 6, 12, 48 and 72 h postoperatively. LAP was measured by nasogastric tube using CiMON monitor (Pulsion Medical Systems, Germany). In addition, we studied the relationship of IAP and APP with blood gases parameters. We observed perioperative increase of IAP (> 12 mm Hg) in 75% of enrolled patients, tendency to postoperative rise of IAP and transient increase of arterial lactate at 6 h after surgery. APP remained within normal values. We found positive correlation of APP with PaO2/FiO2 and ScvO2 at 72 hours after surgery. Transient perioperative increase of IAP was observed in 75% patients undergoing urgent abdominal surgery; however in parallel with intensive care the abdominal perfusion pressure remained within normal values. Abdominal perfusion is related with arterial oxygenation and central venous saturation.

  5. Detection of Mycobacterial Lipoarabinomannan with A Monoclonal Antibody Qualitative ELISA in Urine of Tuberculous Meningitis Patients

    Sylvia Rachmayati


    Full Text Available BACKGROUND: Tuberculous meningitis is the most severe manifestation of tuberculosis. The diagnostic approach of tuberculous meningitis is difficult. Combination of clinical, laboratory and radiological criteria were used in diagnostic approach of tuberculous meningitis. Urinary mycobacterial lipoarabinomannan (LAM antigen detection is a promising diagnostic tool. Detection of mycobacterial antigen in concentrated urine sample is predicted to improve the positivity rate of the qualitative enzyme-linked immunosorbent assay (ELISA diagnostic tool. The purpose of this study is to examine the detection ability of a monoclonal antibody qualitative ELISA in concentrated and unconcentrated urine of tuberculous meningitis patients. METHODS: This research is a descriptive, cross-sectionally designed. The study was conducted in the Clinical Pathology Department laboratory of Dr. Hasan Sadikin Hospital, in July-October 2014. A total of 27 patients diagnosed as tuberculous meningitis patients were included and the subjects were classified into possible and probable criteria according to consensus criteria. The subjects were classified as definite if the cerebrospinal fluid culture was positive for Mycobacterial tuberculosis growth. The subjects were examined for the presence of LAM in unconcentrated and concentrated urine with a monoclonal antibody qualitative ELISA method. RESULTS: Unconcentrated urinary LAM examination positivity was 0% while in concentrated urine was 14.8%. The positivity of concentrated urinary LAM were higher among the definite criteria group. CONCLUSION: Concentrating urine sample increase the positivity rate of urinary LAM detection with ELISA method as high as 14.8%. The urinary antigen detection is higher among the definite tuberculous meningitis patients. KEYWORDS: LAM, concentrated urine, tuberculous meningitis, qualitative ELISA

  6. Characterization and comparison of mycobacterial antigens by two-dimensional immunoelectrophoresis.

    Roberts, D B; Wright, G L; Affronti, L F; Reich, M


    Two-dimensional immunoelectrophoresis (2D-IEP), in which a complex of antigens is subjected to electrophoresis first through an agarose matrix in one direction and secondly through an antiserum-agarose matrix at right angles to the first direction, was evaluated as a tool for analysis of mycobacterial antigens. Cell extracts from four species of mycobacteria, Mycobacterium tuberculosis (four strains), M. bovis strain BCG, M. scrofulaceum, and M. phlei, were assayed by 2D-IEP with four anti-mycobacterial antisera. Besides displaying the precipitin curves in a more easily interpreted format than did conventional immunoelectrophoresis (IEP), 2D-IEP offered greater sensitivity in terms of numbers of precipitin curves when like reactions were compared with IEP patterns. As many as 60 immunoprecipitates were observed on 2D-IEP slides compared to 18 on comparable IEP plates. Technical reproducibility of patterns from run to run was excellent. Other parameters, such as the influence of using different batches of antigen on the pattern, are discussed. Each of the cell extract antigens gave a unique pattern of precipitin peaks which could be easily differentiated from the patterns given by the other mycobacterial cell extracts when reacted with any of the antisera in 2D-IEP. Since both the species and strains of mycobacteria could be easily and reproducibly differentiated solely on the basis of two-dimensional immunoelectrophoretic patterns obtained with any of the antisera employed in this study, it may be possible, by using IEP, to differentiate and identify all species and strains of mycobacteria with one standard, highly sensitive antiserum, rather than a battery of antisera.

  7. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... imaging can also: help a physician determine the source of abdominal pain, such as gallstones, kidney stones, ... Send us your feedback Did you find the information you were looking for? Yes No Please type ...

  8. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... children. Except for traumatic injury, appendicitis is the most common reason for emergency abdominal surgery. Ultrasound imaging ... of page How is the procedure performed? For most ultrasound exams, you will be positioned lying face- ...

  9. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... located within a child's abdomen. A Doppler ultrasound study may be part of a child's abdominal ultrasound ... pain from the procedure. If a Doppler ultrasound study is performed, your child may actually hear pulse- ...

  10. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... of page What are some common uses of the procedure? Abdominal ultrasound imaging is performed to evaluate ... for ultrasound examinations. top of page What does the equipment look like? Ultrasound scanners consist of a ...

  11. Disseminated Intra-Abdominal Hydatidosis

    Concha, Fátima; Maguiña, Ciro; Seas, Carlos


    We present the case of a 26-year-old male Peruvian patient who presented with disseminated intra-abdominal hydatidosis. The patient was treated with surgical removal of the cysts and prolonged medical treatment with albendazole. PMID:24006293

  12. Abdominal Actinomycetoma With Lymphnode Involvement

    Damisetty Rajetha


    Full Text Available Actinomycotic mycetoma of the anterior abdominal wall with inguinal lymphnode involvement, an exceedingly rare entity is described here with mycological histological features. Remarkable therapeutic response was noted with Welsh regimen.

  13. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... your doctor if there are specific instructions for eating and drinking prior to the exam. Your child ... for laboratory testing help detect the presence and cause of an apparent enlarged abdominal organ identify the ...

  14. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... valuable for evaluating abdominal, pelvic or scrotal pain in children. Preparation will depend on the type of ... examinations do not use ionizing radiation (as used in x-rays ), thus there is no radiation exposure ...

  15. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... of an apparent enlarged abdominal organ identify the location of abnormal fluid in the abdomen help determine ... places the transducer on the skin in various locations, sweeping over the area of interest or angling ...

  16. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... collects the sounds that bounce back and a computer then uses those sound waves to create an ... located within a child's abdomen. A Doppler ultrasound study may be part of a child's abdominal ultrasound ...

  17. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... ultrasound images are captured in real-time, they can show the structure and movement of the body's ... kidneys bladder testicles ovaries uterus Abdominal ultrasound images can be used to help diagnose appendicitis in children. ...

  18. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... child's abdominal ultrasound examination. Doppler ultrasound , also called color Doppler ultrasonography, is a special ultrasound technique that ... and processes the sounds and creates graphs or color pictures that represent the flow of blood through ...

  19. Children's (Pediatric) Abdominal Ultrasound Imaging

    Full Text Available ... of page What are some common uses of the procedure? Abdominal ultrasound imaging is performed to evaluate ... for ultrasound examinations. top of page What does the ultrasound equipment look like? Ultrasound scanners consist of ...

  20. Systemic BCG immunization induces persistent lung mucosal multifunctional CD4 T(EM cells which expand following virulent mycobacterial challenge.

    Daryan A Kaveh

    Full Text Available To more closely understand the mechanisms of how BCG vaccination confers immunity would help to rationally design improved tuberculosis vaccines that are urgently required. Given the established central role of CD4 T cells in BCG induced immunity, we sought to characterise the generation of memory CD4 T cell responses to BCG vaccination and M. bovis infection in a murine challenge model. We demonstrate that a single systemic BCG vaccination induces distinct systemic and mucosal populations of T effector memory (T(EM cells in vaccinated mice. These CD4+CD44(hiCD62L(loCD27⁻ T cells concomitantly produce IFN-γ and TNF-α, or IFN-γ, IL-2 and TNF-α and have a higher cytokine median fluorescence intensity MFI or 'quality of response' than single cytokine producing cells. These cells are maintained for long periods (>16 months in BCG protected mice, maintaining a vaccine-specific functionality. Following virulent mycobacterial challenge, these cells underwent significant expansion in the lungs and are, therefore, strongly associated with protection against M. bovis challenge. Our data demonstrate that a persistent mucosal population of T(EM cells can be induced by parenteral immunization, a feature only previously associated with mucosal immunization routes; and that these multifunctional T(EM cells are strongly associated with protection. We propose that these cells mediate protective immunity, and that vaccines designed to increase the number of relevant antigen-specific T(EM in the lung may represent a new generation of TB vaccines.

  1. Functional heterogeneity and anti-mycobacterial effects of mouse mucosal associated invariant T (MAIT) cells specific for riboflavin metabolites1

    Sakala, Isaac G.; Kjer-Nielsen, Lars; Eickhoff, Christopher S.; Wang, Xiaoli; Blazevic, Azra; Liu, Ligong; Fairlie, David P.; Rossjohn, Jamie; McCluskey, James; Fremont, Daved H.; Hansen, Ted H.; Hoft, Daniel F.


    Mucosal associated invariant T (MAIT) cells have a semi-invariant TCR Vα chain, and their optimal development is dependent upon commensal flora and expression of the non-polymorphic MHC class I-like molecule MR1. MAIT cells are activated in an MR1-restricted manner by diverse strains of bacteria and yeast suggesting a widely shared Ag. Recently, human and mouse MR1 were found to bind bacterial riboflavin metabolites (ribityllumazines, RL Ag) capable of activating MAIT cells. Here we use MR1/RL tetramers to study MR1-dependency, subset heterogeneity and protective effector functions important for tuberculosis (TB) immunity. Although tetramer+ cells were detected in both MR1+/+ and MR1−/− TCR Vα19i transgenic (Tg) mice, MR1 expression resulted in significantly increased tetramer+ cells co-expressing TCR Vβ6/8, NK1.1, CD44 and CD69, that displayed more robust in vitro responses to IL-12+IL-18 and RL Ag, indicating that MR1 is necessary for the optimal development of the classic murine MAIT cell memory/effector subset. In addition, tetramer+ MAIT cells expressing CD4, CD8 or neither developing in MR1+/+ Vα19i Tg mice had disparate cytokine profiles in response to RL Ag. Therefore, murine MAIT cells are considerably more heterogeneous than previously thought. Most notably, after mycobacterial pulmonary infection heterogeneous subsets of tetramer+ Vα19i Tg MAIT cells expressing CXCR3 and α4β1 were recruited into the lungs and afforded early protection. In addition, Vα19iCα−/−MR+/+ mice were significantly better protected than Vα19iCα−/−MR1−/−, wild type and MR1−/− non-transgenic mice. Overall, we demonstrate considerable functional diversity of MAIT cell responses, and also that MR1-restricted MAIT cells are important for TB protective immunity. PMID:26063000

  2. Updates on abdominal desmoid tumors


    Desmoid tumor is a monoclonal, fibroblastic proliferation arising in musculoaponeurotic structures. This connective tissue hyperplasia infiltrates locally, recurs frequentiy after resection but does not metastasize. Abdominal desmoid occurs sporadically, in association with some familial syndromes and often represents a clinical dilemma for surgeons. The enigmatic biology and anatomical location of abdominal desmoids make treatment recommendations difficult. This distinct pathological entity is reviewed with a specific focus on aetiology and management.

  3. The mycobacterial acyltransferase PapA5 is required for biosynthesis of cell wall-associated phenolic glycolipids.

    Chavadi, Sivagami Sundaram; Onwueme, Kenolisa C; Edupuganti, Uthamaphani R; Jerome, Jeff; Chatterjee, Delphi; Soll, Clifford E; Quadri, Luis E N


    Phenolic glycolipids (PGLs) are non-covalently bound components of the outer membrane of many clinically relevant mycobacterial pathogens, and play important roles in pathogen biology. We report a mutational analysis that conclusively demonstrates that the conserved acyltransferase-encoding gene papA5 is essential for PGL production. In addition, we provide an in vitro acyltransferase activity analysis that establishes proof of principle for the competency of PapA5 to utilize diol-containing polyketide compounds of mycobacterial origin as acyl-acceptor substrates. Overall, the results reported herein are in line with a model in which PapA5 catalyses the acylation of diol-containing polyketides to form PGLs. These studies advance our understanding of the biosynthesis of an important group of mycobacterial glycolipids and suggest that PapA5 might be an attractive target for exploring the development of antivirulence drugs.

  4. Management of Infections with Rapidly Growing

    Jong Hwan Kim


    Full Text Available Background Infection caused by rapidly growing mycobacteria (RGM is not uncommon, andthe prevalence of RGM infection has been increasing. Clinical diagnosis is difficult becausethere are no characteristic clinical features. There is also no standard antibiotic regimenfor treating RGM infection. A small series of patients with RGM infections was studied toexamine their treatments and outcomes.Methods A total of 5 patients who had developed postoperative infections from January2009 to December 2010 were retrospectively reviewed. Patients were initially screened using amycobacteria rapid screening test (polymerase chain reaction [PCR]-reverse blot hybridizationassay. To confirm mycobacterial infection, specimens were cultured for nontuberculousmycobacteria and analyzed by 16 S ribosomal RNA and rpoB gene PCR.Results The patients were treated with intravenous antibiotics during hospitalization,and oral antibiotics were administered after discharge. The mean duration of follow-upwas 9 months, and all patients were completely cured of infection with a regimen of acombination of antibiotics plus surgical treatment. Although none of the patients developedrecurrence, there were complications at the site of infection, including hypertrophic scarring,pigmentation, and disfigurement.Conclusions Combination antibiotic therapy plus drainage of surgical abscesses appeared tobe effective for the RGM infections seen in our patients. Although neither the exact dosagenor a standardized regimen has been firmly established, we propose that our treatment canprovide an option for the management of rapidly growing mycobacterial infection.

  5. A prospective, multi centre, randomized clinical study to compare the efficacy and safety of Ertapenem 3 days versus Ampicillin - Sulbactam 3 days in the treatment of localized community acquired intra-abdominal infection. (T.E.A. Study: Three days Ertapenem vs three days Ampicillin-sulbactam

    Gazzotti Filippo


    Full Text Available Abstract Background The recommendations outlined in the latest guidelines published by the Surgical Infection Society (SIS and the Infectious Disease Society of America (IDSA regarding the proper duration of antibiotic therapy in patients with intra-abdominal infections are limited and non-specific. This ambiguity is due mainly to the lack of clinical trials on the topic of optimal duration of therapy. It is well known that the overuse of antibiotics has several important consequences such as increased treatment costs, reduced clinical efficacy, and above all, the increased emergence of antibiotic-resistant pathogens. Ampicillin-Sulbactam is a commonly used "first line" antibiotic for intra-abdominal infections. Ertapenem and Ampicillin-sulbactam are recommended as primary treatment agents for localized peritonitis by both the SIS and IDSA guidelines. Methods/Design This study is a prospective multi-center randomized investigation. The study will be performed in the Departments of General, Emergency, and Transplant Surgery of Sant'Orsola-Malpighi University Hospital in Bologna, Italy, in the General Surgery Department of the Ospedali Riuniti of Bergamo, Italy, and in the Trauma and Emergency Surgery Department of Maggiore Hospital in Bologna, Italy, and will be conducted by all surgeons willing to participate in the study. The inclusion period of the study will take approximately two years before the planned number of 142 enrolled patients is reached. Discussion Ertapenem and Ampicillin-sulbactam are recommended both as primary treatment agents for localized peritonitis by both the SIS and IDSA guidelines. As one of the discussed topic is the optimal duration of the antibiotic therapy and this ambiguity is due mainly to the lack of clinical trials on the topic, the present study aims for obtain precise data. Trial Registration NCT00630513

  6. Common abdominal emergencies in children.

    D'Agostino, James


    Because young children often present to EDs with abdominal complaints, emergency physicians must have a high index of suspicion for the common abdominal emergencies that have serious sequelae. At the same time, they must realize that less serious causes of abdominal symptoms (e.g., constipation or gastroenteritis) are also seen. A gentle yet thorough and complete history and physical examination are the most important diagnostic tools for the emergency physician. Repeated examinations and observation are useful tools. Physicians should listen carefully to parents and their children, respect their concerns, and honor their complaints. Ancillary tests are inconsistent in their value in assessing these complaints. Abdominal radiographs can be normal in children with intussusception and even malrotation and early volvulus. Unlike the classic symptoms seen in adults, young children can display only lethargy or poor feeding in cases of appendicitis or can appear happy and playful between paroxysmal bouts of intussusception. The emergency physician therefore, must maintain a high index of suspicion for serious pathology in pediatric patients with abdominal complaints. Eventually, all significant abdominal emergencies reveal their true nature, and if one can be patient with the child and repeat the examinations when the child is quiet, one will be rewarded with the correct diagnosis.

  7. Effect of different pneumoperitoneum gases on immunologic function and infection spread in rat abdominal infection model%不同种类气腹对腹腔感染大鼠免疫抑制和感染扩散的影响

    田虎; 张阳德; 廖前德; 亓玉忠


    Objective To observe the effect of different pneumoperitoneum gases on cytokine and immunologic function of macrophages,and infection spread and bactrial translocation in a rat abdominal infection model.Methods Forty male Wistar rats were intraperitoneally injected with solution of Escherichia coli and were randomly divided into four groups as follows:control group,CO2 pneumoperitoneum group,air pneumoperitoneum group and nitrogen pneumoperitoneum group.The animals with pneumoperitoneum underwent anterior abdominal puncture with a transfusion apparatus needle followed by peritoneal insufflation with different gases (CO2,air,N2),with 5 mmHg intracavity pressure and speed at 0.2 L/min for 30min.The control animals only underwent anterior abdominal puncture.The procedures were performed 12 h after the injection of the bacterial solution.Blood samples and ascites were collected 24 h and 48 h after the surgical procedures.Blood was collected from cardiac puncture for measurements of tumor necrosis factor (TNF)-α,intedeukin (IL)-6 and IL-2.Ascites were collected for determination of TNF-α and activity of macrophages.Results (1) After 24 h,the serum levels of TNF-α (μg/L) and IL-6 (μg/L) were significantly lower in the CO2 group (0.557 ±0.064; 0.195 ±0.022) than in the control group (0.674 ±0.069;0.247±0.025),air group (0.682 ±0.068; 0.256 ±0.019) and N2 group (0.713 ±0.072; 0.265 ±0.032),P < 0.05 ; (2) After 24 h and 48 h,the serum levels of IL-2 (μg/L) and the ascites levels of TNF-α (μg/L) were statistically lower in the CO2 group (1.763 ± 0.548,1.694 ±0.519; 0.774±0.095,0.945 ± 0.089) than the control group (3.332 ± 0.753,3.587 ± 0.764 ; 1.029 ± 0.104,1.253 ±0.175),air group (2.867 ± 0.698,2.904 ± 0.686 ; 0.989 ± 0.091,1.270 ± 0.187) and N2 group (3.095 ±0.712,3.112 ±0.725; 1.075 ±0.110,1.353 ±0.201),P <0.05;P <0.01 ; (3) After 24 h and 48 h,the phagocytic rate and the phagocytic index also had a similar change.Conclusion Under

  8. Abdominal wall closure after a stomal reversal procedure.

    López-Cano, Manuel; Pereira, José Antonio; Villanueva, Borja; Vallribera, Francesc; Espin, Eloy; Armengol Carrasco, Manuel; Arbós Vía, María Antonia; Feliu, Xavier; Morales-Conde, Salvador


    The closure of a temporary stoma involves 2 different surgical procedures: the stoma reversal procedure and the abdominal wall reconstruction of the stoma site. The management of the abdominal wall has different areas that should be analyzed such us how to avoid surgical site infection (SSI), the technique to be used in case of a concomitant hernia at the stoma site or to prevent an incisional hernia in the future, how to deal with the incision when the stoma reversal procedure is performed by laparoscopy and how to close the skin at the stoma site. The aim of this paper is to analyze these aspects in relation to abdominal wall reconstruction during a stoma reversal procedure.

  9. [The role of laparoscopy in emergency abdominal surgery].

    Balén, E; Herrera, J; Miranda, C; Tarifa, A; Zazpe, C; Lera, J M


    Abdominal emergencies can also be operated on through the laparoscopic approach: the approach can be diagnostic laparoscopy, surgery assisted by laparoscopy or laparotomy directed according to the findings of the laparoscopy. The general contraindications refer above all to the state of haemodynamic instability of the patient and to seriously ill patients (ASA IV). In the absence of any specific counter-indications for the specific laparoscopic procedure to be carried out, many abdominal diseases requiring emergency surgery can be performed with the laparoscopic approach. The most frequent indications are appendicitis, acute colecistitis, gastroduodenal perforation, occlusion of the small intestine, and some abdominal traumas. With a correct selection of patients and the appropriate experience of the surgeon, the results are excellent and better than open surgery (less infection of the wound, complications, hospital stay and postoperative pain). A detailed explanation is given of the basic aspects of the surgical technique in the most frequent procedures of emergency laparoscopy.

  10. A prospective study on geriatric abdominal surgical emergencies

    Deepak R. Chavan


    Results: 128 patients aged 60 years or more who presented with abdominal emergency surgical conditions were studied. Most common cause for emergency abdominal surgery was perforated peptic ulcer (38% followed by intestinal obstruction (17%. The most common post-operative complication was surgical site infection (29%. Mortality rate was 17%. Most common cause of death was septic shock with multi organ dysfunction. Conclusion: Geriatric population is an important subgroup of population undergoing emergency abdominal surgeries. Most common cause is peptic ulcer perforation followed by intestinal obstruction due to adhesions. More than the age per say, the delay in presentation may be the cause for mortality in this age group. The therapeutic outcome in patients with co morbid factors like hypertension and diabetes mellitus in control, were similar to other patients. [Int J Res Med Sci 2014; 2(3.000: 963-971

  11. Mycobacterium intracellulare infection in a capybara (Hydrochoerus hydrochaeris).

    Pezzone, Natalia; Eberhardt, Ayelen T; Fernández, Analia; Garbaccio, Sergio; Zumárraga, Martín; Gioffré, Andrea; Magni, Carolina; Beldomenico, Pablo M; Marini, M Rocío; Canal, Ana M


    This report describes the first case of Mycobacterium intracellulare infection with typical granulomatous lesions of mycobacteriosis in a capybara (Hydrochoerus hydrochaeris). The individual was a captive-bred young female, part of the control group of an experimental study on stress. Multiple granulomatous lesions were detected in a mesenteric lymph node of this young female. Mycobacterial infection was confirmed by bacteriologic culture and molecular identification methods. Clinical lesions were characterized by histopathology.

  12. Abdominal neurenteric cyst

    Radoje (C)olovi(c); MarJan Micev; Miodrag Jovanovi(c); Slavko Mati(c); Nikica Grubor; Henry Dushan E Atkinson


    immunoexpression, and the respiratory epithelium revealed a CK8 and CK18 immunoprofile without CK 10/13 positive elements, though neither CEA or AFP positive cells were found. To our knowledge, this is the first reported case of an abdominally located neurenteric cyst with no associated spinal anomalies.

  13. Macrophage and T cell dynamics during the development and disintegration of mycobacterial granulomas.

    Egen, Jackson G; Rothfuchs, Antonio Gigliotti; Feng, Carl G; Winter, Nathalie; Sher, Alan; Germain, Ronald N


    Granulomas play a key role in host protection against mycobacterial pathogens, with their breakdown contributing to exacerbated disease. To better understand the initiation and maintenance of these structures, we employed both high-resolution multiplex static imaging and intravital multiphoton microscopy of Mycobacterium bovis BCG-induced liver granulomas. We found that Kupffer cells directly capture blood-borne bacteria and subsequently nucleate formation of a nascent granuloma by recruiting both uninfected liver-resident macrophages and blood-derived monocytes. Within the mature granuloma, these myeloid cell populations formed a relatively immobile cellular matrix that interacted with a highly dynamic effector T cell population. The efficient recruitment of these T cells was highly dependent on TNF-alpha-derived signals, which also maintained the granuloma structure through preferential effects on uninfected macrophage populations. By characterizing the migration of both innate and adaptive immune cells throughout the process of granuloma development, these studies provide a new perspective on the cellular events involved in mycobacterial containment and escape.

  14. Rapid susceptibility testing of Mycobacterium tuberculosis by bioluminescence assay of mycobacterial ATP

    Nilsson, L.E.; Hoffner, S.E.; Ansehn, S.


    Mycobacterial growth was monitored by bioluminescence assay of mycobacterial ATP. Cultures of Mycobacterium tuberculosis H37Rv and of 25 clinical isolates of the same species were exposed to serial dilutions of ethambutol, isoniazid, rifampin, and streptomycin. A suppression of ATP, indicating growth inhibition, occurred for susceptible but not resistant strains within 5 to 7 days of incubation. Breakpoint concentrations between susceptibility and resistance were determined by comparing these results with those obtained by reference techniques. Full agreement was found in 99% of the assays with the resistance ratio method on Lowenstein-Jensen medium, and 98% of the assays were in full agreement with the radiometric system (BACTEC). A main advantage of the bioluminescence method is its rapidity, with results available as fast as with the radiometric system but at a lower cost and without the need for radioactive culture medium. The method provides kinetic data concerning drug effects within available in vivo drug concentrations and has great potential for both rapid routine susceptibility testing and research applications in studies of drug effects on mycobacteria.

  15. Nutritional status and eating disorders: neglected risks factor for nontuberculous mycobacterial lung disease?

    Portillo, Karina; Morera, Josep


    Nontuberculous mycobacterial lung disease (NTMLD) in immunocompetent patients is an increasingly important epidemiologic concern. However, risk factors associated with susceptibility to NTMLD are not completely known. A prevalence of NTMLD appears to be rising, mainly in some populations such as middle-aged or elderly thin women, (a group including those with Lady Windermere syndrome) with neither remarkable history of respiratory disease nor smoking habit. Right middle lobe (RML) and lingula are often involved. Various predisposing factors and genetic defects have been described as possible causes of development of NTMLD, namely: voluntary suppression of cough, RML anatomical factors, menopause and mutations in cystic fibrosis transmembrane conductance regulator (CFTR). Malnutrition is also an important and common risk factor associated with other mycobacterial disease like tuberculosis (TB) and its probable association with NTMLD as have been pointed out for some authors. However, a real description of all nutritional aspects and eating habits of patients prior to NTMLD diagnosis is lacking. We hypothesized that malnutrition and eating disorders like anorexia nervosa could be risk factors that may promoting NTMLD. From a clinical viewpoint, if this hypothesis proves to be correct, eating habits and nutritional aspects should be taken into account in the diagnosis process of suspected NTMLD, since they are easily identifiable and treatable conditions. Copyright © 2011 Elsevier Ltd. All rights reserved.

  16. [Experience of rapid drug desensitization therapy in the treatment of mycobacterial disease].

    Sasaki, Yuka; Kurashima, Atsuyuki; Morimoto, Kozo; Okumura, Masao; Watanabe, Masato; Yoshiyama, Takashi; Ogata, Hideo; Gotoh, Hajime; Kudoh, Shoji; Suzuki, Hiroaki


    Drugs for tuberculosis and non-tuberculosis mycobacterial diseases are limited. In particular, no new drugs for non-tuberculosis mycobacterial disease have been developed in recent years. Antimycobacterial drugs have many adverse reactions, for which drug desensitization therapy has been used. Rapid drug desensitization (RDD) therapy, including antituberculosis drugs and clarithromycin, has been implemented in many regions in Europe and the United States. We investigated the validity of RDD therapy in Japan. We report our experience with RDD therapy in 13 patients who developed severe drug allergy to antimycobacterial treatment. The desensitization protocol reported by Holland and Cernandas was adapted. The underlying diseases were 7 cases of pulmonary Mycobacterium avium complex disease and 6 cases of pulmonary tuberculosis. Isoniazid was readministered in 2 (100%) of 2 patients; rifampicin, in 8 (67.7%) of 12 patients; ethambutol, in 4 (67.7%) of 6 patients; and clarithromycin, in 2 (100%) of 2 patients. In Japan, the desensitization therapy recommended by the Treatment Committee of the Japanese Society for Tuberculosis have been implemented generally. We think RDD therapy is effective and safe as the other desensitization therapy. We will continue to investigate the efficiency of RDD therapy in patients who had discontinued antimycobacterial treatment because of the drug allergic reaction.

  17. Characterization of two heparan sulphate-binding sites in the mycobacterial adhesin Hlp

    Previato Jose O


    Full Text Available Abstract Background The histone-like Hlp protein is emerging as a key component in mycobacterial pathogenesis, being involved in the initial events of host colonization by interacting with laminin and glycosaminoglycans (GAGs. In the present study, nuclear magnetic resonance (NMR was used to map the binding site(s of Hlp to heparan sulfate and identify the nature of the amino acid residues directly involved in this interaction. Results The capacity of a panel of 30 mer synthetic peptides covering the full length of Hlp to bind to heparin/heparan sulfate was analyzed by solid phase assays, NMR, and affinity chromatography. An additional active region between the residues Gly46 and Ala60 was defined at the N-terminal domain of Hlp, expanding the previously defined heparin-binding site between Thr31 and Phe50. Additionally, the C-terminus, rich in Lys residues, was confirmed as another heparan sulfate binding region. The amino acids in Hlp identified as mediators in the interaction with heparan sulfate were Arg, Val, Ile, Lys, Phe, and Thr. Conclusion Our data indicate that Hlp interacts with heparan sulfate through two distinct regions of the protein. Both heparan sulfate-binding regions here defined are preserved in all mycobacterial Hlp homologues that have been sequenced, suggesting important but possibly divergent roles for this surface-exposed protein in both pathogenic and saprophic species.

  18. Crystal structures of Mycobacterial MeaB and MMAA-like GTPases.

    Edwards, Thomas E; Baugh, Loren; Bullen, Jameson; Baydo, Ruth O; Witte, Pam; Thompkins, Kaitlin; Phan, Isabelle Q H; Abendroth, Jan; Clifton, Matthew C; Sankaran, Banumathi; Van Voorhis, Wesley C; Myler, Peter J; Staker, Bart L; Grundner, Christoph; Lorimer, Donald D


    The methylmalonyl Co-A mutase-associated GTPase MeaB from Methylobacterium extorquens is involved in glyoxylate regulation and required for growth. In humans, mutations in the homolog methylmalonic aciduria associated protein (MMAA) cause methylmalonic aciduria, which is often fatal. The central role of MeaB from bacteria to humans suggests that MeaB is also important in other, pathogenic bacteria such as Mycobacterium tuberculosis. However, the identity of the mycobacterial MeaB homolog is presently unclear. Here, we identify the M. tuberculosis protein Rv1496 and its homologs in M. smegmatis and M. thermoresistibile as MeaB. The crystal structures of all three homologs are highly similar to MeaB and MMAA structures and reveal a characteristic three-domain homodimer with GDP bound in the G domain active site. A structure of Rv1496 obtained from a crystal grown in the presence of GTP exhibited electron density for GDP, suggesting GTPase activity. These structures identify the mycobacterial MeaB and provide a structural framework for therapeutic targeting of M. tuberculosis MeaB.

  19. A redox regulatory system critical for mycobacterial survival in macrophages and biofilm development.

    Kerstin A Wolff


    Full Text Available Survival of M. tuberculosis in host macrophages requires the eukaryotic-type protein kinase G, PknG, but the underlying mechanism has remained unknown. Here, we show that PknG is an integral component of a novel redox homeostatic system, RHOCS, which includes the ribosomal protein L13 and RenU, a Nudix hydrolase encoded by a gene adjacent to pknG. Studies in M. smegmatis showed that PknG expression is uniquely induced by NADH, which plays a key role in metabolism and redox homeostasis. In vitro, RenU hydrolyses FAD, ADP-ribose and NADH, but not NAD+. Absence of RHOCS activities in vivo causes NADH and FAD accumulation, and increased susceptibility to oxidative stress. We show that PknG phosphorylates L13 and promotes its cytoplasmic association with RenU, and the phosphorylated L13 accelerates the RenU-catalyzed NADH hydrolysis. Importantly, interruption of RHOCS leads to impaired mycobacterial biofilms and reduced survival of M. tuberculosis in macrophages. Thus, RHOCS represents a checkpoint in the developmental program required for mycobacterial growth in these environments.

  20. Diagnosis and Management of Severe Acute Pancreatitis Complicated with Abdominal Compartment Syndrome

    陶京; 王春友; 陈立波; 杨智勇; 许逸卿; 熊炯炘; 周峰


    Presented in this paper is our experience in the diagnosis and management of abdominal compartment syndrome during severe acute pancreatitis. On the basis of the history of severe acute pancreatitis, after effective fluid resuscitation, if patients developed renal, pulmonary and cardiac insufficiency after abdominal expansion and abdominal wall tension, ACS should be considered.Cystometry could be performed to confirm the diagnosis. Emergency decompressive celiotomy and temporary abdominal closure with a 3 liter sterile plastic bag must be performed. It is also critical to prevent reperfusion syndrome. In 23 cases of ACS, 18 cases received emergency decompressive celiotomy and 5 cases did not. In the former, 3 patients died (16.7 %) while in the later, 4 (80%)died. Total mortality rate was 33.3% (7/21). In 7 death cases, 4 patients developed acute obstructive suppurative cholangitis (AOSC). All the patients who received emergency decompressive celiotomy 5 h after confirmation of ACS survived. The definitive abdominal closure took place mostly 3 to 5 days after emergency decompressive celiotomy, with longest time being 8 days. 6 cases of ACS at infection stage were all attributed to infected necrosis in abdominal cavity and retroperitoneum. ACS could occur in SIRS stage and infection stage during SAP, and has different pathophysiological basis. Early diagnosis, emergency decompressive celiotomy and temporary abdominal closure with a 3L sterile plastic bag are the keys to the management of the condition.

  1. A clinical dilemma: abdominal tuberculosis

    Oya Uygur-Bayramicli; G(u)l Dabak; Resat Dabak


    AIM: To evaluate the clinical, radiological and microbiological properties of abdominal tuberculosis (TB) and to discuss methods needed to get the diagnosis.METHODS: Thirty-one patients diagnosed as abdominal TB between March 1998 and December 2001 at the Gastroenterology Department of Kartal State Hospital,Istanbul, Turkey were evaluated prospectively. Complete physical examination, medical and family history, blood count erythrocyte sedimentation rate, routine biochemical tests,Mantoux skin test, chest X-ray and abdominal ultrasonography (USG) were performed in all cases, whereas microbiological examination of ascites, upper gastrointestinal endoscopy, colonoscopy or barium enema, abdominal tomography, mediastinoscopy, laparoscopy or laparotomy were done when needed.RESULTS: The median age of patients (14 females, 17males) was 34.2 years (range 15-65 years). The most frequent symptoms were abdominal pain and weight loss.Eleven patients had active pulmonary TB. The most common abdominal USG findings were ascites and hepatomegaly. Ascitic fluid analysis performed in 13 patients was found to be exudative and acid resistant bacilli were present in smear and cultured only in one patient with BacTec (3.2 %). Upper gastrointestinal endoscopy yielded nonspecific findings in 16 patients. Colonoscopy performed in 20 patients showed ulcers in 9 (45 %), nodules in 2 (10 %)and, stricture, polypoid lesions, granulomatous findings in terminal ileum and rectal fistula each in one patient (5 %).Laparoscopy on 4 patients showed dilated bowel loops,thickening in the mesentery, multiple ulcers and tubercles on the peritoneum. Patients with abdominal TB were divided into three groups according to the type of involvement.Fifteen patients (48 %) had intestinal TB, L1 patients (35.2 %) had tuberculous peritonitis and 5 (16.8 %)tuberculous lymphadenitis. The diagnosis of abdominal TB was confirmed microbiologically in 5 (16 %) and histopathologically in 19 patients (60.8 %). The

  2. Schistosomiasis mansoni in low transmission areas: abdominal ultrasound

    R Ruiz


    Full Text Available In endemic areas with low prevalence and low intensity of infection, the diagnosis of hepatic pathology due to the Schistosoma mansoni infection is very difficult. In order to establish the hepatic morbidity, a double-blind study was achieved in Venezuelan endemic areas, with one group of patients with schistosomiasis and the other one of non-infected people, that were evaluated clinically and by abdominal ultrasound using the Cairo classification. Schistosomiasis diagnosis was established based on parasitologic and serological tests. The increase of the hepatic size at midclavicular and midsternal lines (in hepatometry and the hard liver consistency were the clinical parameters able to differentiate infected persons from non infected ones, as well as the presence of left lobe hepatomegaly detected by abdominal ultrasound. The periportal thickening, especially the mild form, was frequent in all age groups in both infected and uninfected patients. There was not correlation between the intensity of infection and ultrasound under the current circumstances. Our data suggest that in Venezuela, a low endemic area of transmission of schistosomiasis, the hepatic morbidity is mild and uncommon. The Cairo classification seems to overestimate the prevalence of periportal pathology. The specificity of the method must be improved, especially for the recognition of precocious pathology. Other causes of hepatopathies must be investigated.

  3. Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis

    Edivaldo Massazo Utiyama

    Full Text Available OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years; 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

  4. [Abdominal pregnancy care. Case report].

    Morales Hernández, Sara; Díaz Velázquez, Mary Flor; Puello Tamara, Edgardo; Morales Hernández, Jorge; Basavilvazo Rodríguez, Maria Antonia; Cruz Cruz, Polita del Rocío; Hernández Valencia, Marcelino


    Abdominal pregnancies are the implantation of gestation in some of the abdominal structures. This kind of pregnancies represents sevenfold maternal death risk than tubarian ectopic pregnancies, and 90-fold death risk than normal ones. Previous cases have erroneously reported as abscess in Douglas punch, and frequently result in obitus or postnatal deaths. We report a case of a patient with 27 years old, and diagnosis of 25.2 weeks of pregnancy, prior placenta and anhidramnios, referred due to difficult in uterine contour delimitation, easy palpation of fetal parts, cephalic pole in left hypochondrious and presence of mass in hypogastria, no delimitations, pain with mobilization, no transvaginal bleed and fetal movements. Interruption of pregnancy is decided by virtue of severe oligohidramnios, retardation in fetal intrabdominal growth, and recurrent maternal abdominal pain. Surgical intervention was carried out for resolution of the obstetrical event, in which was found ectopic abdominal pregnancy with bed placental in right uterine horn that corresponded to a pregnancy of 30 weeks of gestation. Abdominal pregnancy is still a challenge for obstetrics due to its diagnosis and treatment. Early diagnosis is oriented to prevent an intrabdominal hemorrhage that is the main maternal cause of mortality.

  5. Pancreatic and biliary drainage for the treatment of bile leakage and severe intra-abdominal infection after pancreatiduodenectomy due to severe trauma%急诊胰十二指肠切除术后并发胆胰漏的处理



    目的 探讨因腹部外伤行急诊胰十二指肠切除术( pancreaticoduodenectomy,PD)后胆胰漏的发生及并发严重腹腔感染需再次手术时的处理策略.方法 回顾分析10年来因腹部外伤而急诊行PD手术病人共35例,术后发生胆胰漏12例,发生率为34.3%.经保守治疗、调整腹腔引流管或穿刺引流后治愈3例,另9例发生严重腹腔感染,再次手术行腹腔清洗和置管引流.结果 再手术者中8例未行胆胰管支撑引流,其中6例术后胆胰漏之积液区未有效局限,腹腔感染持续并加重,3例并发腹腔出血;均行第3次手术,于胰管和(或)胆管内置管外引流,感染区留置双套管术后冲洗腹腔并负压引流;6例均存活,6个月后行决定性手术.结论 胰十二指肠外伤行PD术后胆胰漏发生率高,再次手术时行胰管和(或)胆管内置支撑管外引流,可迅速有效地控制腹腔感染,降低死亡率.%Objective The objective of this study was to investigate the incidence and the operation strategy of biliary and pancreatic leakage and related severe intra-abdominal infection after pancre-aticoduodenectomy (PD) due to abdominal trauma. Methods A total of 35 patients who underwent e-mergent PD in our department due to severe abdominal trauma during past ten years were retrospectively analyzed. Results Postoperative biliary and pancreatic leakages developed in 12 cases with an incidence of 34.3 %, in which 3 patients were cured by non-operating treatment, including peritoneal drainage tube,and other 9 patients had severe abdominal infectious complications and needed re-operation. In these patients who required re-operations without biliary and pancreatic drainage, bile and pancreatic secreting fluid were not limited effectively, resulting in severe intraperitoneal infection in 6 cases, in which 3 patients needed to be re-operated for the third time due to a massive bleeding. Other 6 patients were treated with effectively drainage by

  6. Abdominal wall hernia and pregnancy

    Jensen, K K; Henriksen, N A; Jorgensen, L N


    PURPOSE: There is no consensus as to the treatment strategy for abdominal wall hernias in fertile women. This study was undertaken to review the current literature on treatment of abdominal wall hernias in fertile women before or during pregnancy. METHODS: A literature search was undertaken in Pub......Med and Embase in combination with a cross-reference search of eligible papers. RESULTS: We included 31 papers of which 23 were case reports. In fertile women undergoing sutured or mesh repair, pain was described in a few patients during the last trimester of a subsequent pregnancy. Emergency surgery...... of incarcerated hernias in pregnant women, as well as combined hernia repair and cesarean section appears as safe procedures. No major complications were reported following hernia repair before or during pregnancy. The combined procedure of elective cesarean section and abdominal wall hernia repair was reported...

  7. Abdominal actinomycosis mimicking acute appendicitis.

    Conrad, Robert Joseph; Riela, Steven; Patel, Ravi; Misra, Subhasis


    A 52-year-old Hispanic woman presented to the emergency department, reporting worsening sharp lower right quadrant abdominal pain for 3 days. CT of the abdomen and pelvis showed evidence of inflammation in the peritoneal soft tissues adjacent to an enlarged and thick-walled appendix, an appendicolith, no abscess formation and a slightly thickened caecum consistent with acute appendicitis. During laparoscopic appendectomy, the caecum was noted to be firm, raising suspicion of malignancy. Surgical oncology team was consulted and open laparotomy with right hemicolectomy was performed. Pathology reported that the ileocaecal mass was not a malignancy but was, rather, actinomycosis. The patient was discharged after 10 days of intravenous antibiotics in the hospital, with the diagnosis of abdominal actinomycosis. Although the original clinical and radiological findings in this case were highly suggestive of acute appendicitis, abdominal actinomycosis should be in the differential for right lower quadrant pain as it may be treated non-operatively.

  8. Direct comparison of Xpert MTB/RIF assay with liquid and solid mycobacterial culture for quantification of early bactericidal activity

    Kayigire, X.A.; Friedrich, S.O.; Venter, A.; Dawson, R.; Gillespie, S.H.; Boeree, M.J.; Heinrich, N.; Hoelscher, M.; Diacon, A.H.; Aarnoutse, R.


    The early bactericidal activity of antituberculosis agents is usually determined by measuring the reduction of the sputum mycobacterial load over time on solid agar medium or in liquid culture. This study investigated the value of a quantitative PCR assay for early bactericidal activity determinatio

  9. 濒海战创伤动物模型腹腔感染细菌学特点及药敏试验研究%Experimental study on the characteristics of bacteriology and drug sensitivity test of naval warfare injury animal model with abdominal infection

    王代勇; 徐先锋; 唐玉娟; 王瑜; 王烈; 张再重


    目的 探讨濒海实地海水中动物模型腹部火器伤后腹腔感染的细菌学特点及其药敏试验研究.方法 将小型猪分为海水中腹部火器伤组(n=8)和陆地腹部火器伤组(n=8).海水中腹部火器伤组浸泡于海水中,在距离10 m处步枪射击左麦氏点处,继续浸泡30 min,陆地腹部火器伤组固定于陆地支架上,相同方法射击后于陆地观察30 min;之后两组行剖腹探查术,术中取腹腔液5 ml行细菌检测.细菌鉴定分析仪进行细菌学鉴定,抗菌药物敏感试验使用K-B 纸片琼脂扩散法.同时采集8份海水进行细菌鉴定.结果 两组共同检测出表皮葡萄球菌、奇异变形杆菌、大肠埃希菌等内源性肠道菌群,其中海水中腹部火器伤组检测出特有的副溶血弧菌(4%)、溶藻弧菌(8%).细菌药敏实验结果显示,对革兰阴性菌敏感率大于70%的抗菌药物包括亚胺培南、阿莫西林/克拉维酸、替卡西林/克拉维酸妥布霉素等.对革兰阳性菌敏感率大于70%的抗菌药物包括环丙沙星、达托霉素、呋喃妥因等.结论 濒海实地海水中腹部火器伤后腹腔感染为内源性肠道菌群、皮肤表面菌群和海水中特有弧菌的混合感染,故提倡早期联合使用广谱抗生素控制感染.%Objective To investigate the bacteriological characteristics and drug sensitivity test for abdominal infection of animal model after abdominal firearm injury in littoral seawater.Methods Mini-pigs were randomly divided into two groups, the group of abdominal firearm injury in littoral seawater(n=8) and the group on land (n=8).The pigs of abdominal firearm injury in littoral seawater group were soaked in sea water, and were shot from a distance of 10 m, hitting the left mcburney point, finally immersed into seawater for 30 min. Pigs in another group were fixed on fixator on land and were shot in the same way, finally observed on land for 30 min. The animals in two groups underwent exploratory

  10. CT appearances of abdominal tuberculosis

    Lee, W.-K., E-mail: [Department of Medical Imaging, St Vincent' s Hospital, University of Melbourne, Fitzroy, Victoria (Australia); Van Tonder, F.; Tartaglia, C.J.; Dagia, C. [Department of Medical Imaging, St Vincent' s Hospital, University of Melbourne, Fitzroy, Victoria (Australia); Cazzato, R.L. [Department of Radiology, Universita Campus Bio-Medico di Roma, Rome (Italy); Duddalwar, V.A. [Department of Radiology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California (United States); Chang, S.D. [Department of Medical Imaging, Vancouver General Hospital, University of British Columbia, British Columbia (Canada)


    The purpose of this article is to review and illustrate the spectrum of computed tomography (CT) appearances of abdominal tuberculosis. Tuberculosis can affect any organ or tissue in the abdomen, and can be mistaken for other inflammatory or neoplastic conditions. The most common sites of tuberculosis in the abdomen include lymph nodes, genitourinary tract, peritoneal cavity and gastrointestinal tract. The liver, spleen, biliary tract, pancreas and adrenals are rarely affected, but are more likely in HIV-seropositive patients and in miliary tuberculosis. This article should alert the radiologist to consider abdominal tuberculosis in the correct clinical setting to ensure timely diagnosis and enable appropriate treatment.

  11. Blunt abdominal trauma in sports.

    Rifat, Sami F; Gilvydis, Rimas P


    Abdominal injuries are rare in sports, but when they do occur it is important that the physician recognize the warning signs of potentially life-threatening injury to the liver, spleen, or hollow abdominal viscera. Though the sports medicine physician may not always provide definitive treatment of many of these conditions, he or she should be familiar with the preferred diagnostic modalities and latest treatment options. This information is not only essential to appropriately participate in treatment decisions, but is also important in order to make return-to-play determinations.

  12. [Gallstone ileus. Abdominal CT usefulness].

    Sukkarieh, F; Brasseur, P; Bissen, L


    The authors report the case of a 93-year old woman referred to the emergency department and presenting with an intestinal obstruction. Abdominal CT reveals a biliary ileus caused by the migration and the impaction of a 3 cm gallstone in the small bowel. Surgical treatment by enterolithotomy was successful. In over 90% of cases, gallstone ileus is a complication of cholelithiasis and accounts for 25% of intestinal obstruction in patients over 65 years. To reduce morbidity and mortality, early diagnosis and prompt treatment are essential. Abdominal CT-scan is the gold standard technique.

  13. Diagnosis in acute abdominal pain and ongoing abdominal sepsis

    Kiewiet, J.J.S.


    Acute abdominal pain is a common reason for presentation at the emergency department. To establish a timely and adequate diagnosis, doctors use the pattern of complaints and physical examination as the basis for the evaluation of a patient. In this thesis we conducted a study that showed that surgeo

  14. A randomised controlled trial of the effects of albendazole in pregnancy on maternal responses to mycobacterial antigens and infant responses to bacille Calmette-Guérin (BCG immunisation [ISRCTN32849447

    Nampijja Margaret


    Full Text Available Abstract Background Maternal schistosomiasis and filariasis have been shown to influence infant responses to neonatal bacille Calmette-Guérin (BCG immunisation but the effects of maternal hookworm, and of de-worming in pregnancy, are unknown. Methods In Entebbe, Uganda, we conducted a randomised, double-blind, placebo-controlled trial of a single dose of 400 mg of albendazole in the second trimester of pregnancy. Neonates received BCG. Interferon-gamma (IFN-γ and interleukin (IL-5 responses to a mycobacterial antigen (crude culture filtrate proteins (CFP of Mycobacterium tuberculosis were measured in a whole blood assay. We analysed results for binary variables using χ2 tests and logistic regression. We analysed continuous variables using Wilcoxon's tests. Results Maternal hookworm was associated with reduced maternal IFN-γ responses to CFP (adjusted odds ratio for IFN-γ > median response: 0.14 (95% confidence interval 0.02–0.83, p = 0.021. Conversely, maternal hookworm was associated with subsequent increased IFN-γ responses in their one-year-old infants (adjusted OR 17.65 (1.20–258.66; p = 0.013. Maternal albendazole tended to reduce these effects. Conclusion Untreated hookworm infection in pregnancy was associated with reduced maternal IFN-γ responses to mycobacterial antigens, but increased responses in their infants one year after BCG immunisation. The mechanisms of these effects, and their implications for protective immunity remain, to be determined.

  15. Aneurisma de aorta abdominal na infância Abdominal aortic aneurism in childhood

    Abdo Farret Neto


    Full Text Available The authors report a case of an abdominal aortic aneurism involving all visceral branches minus the Inferior Mesenteric artery in a 4-year-old girl. There was sugestive evidence that the arterial disease had an inflamatory or infectious etiologic factor. The most probable etiological factors could be salmonelas infection of the arterial wall or Takayasu's disease secondary to tuberculosis. The treatment with antibiotic to salmonelas infection during ten days, followed by tuberculostatic therapy for six months was chosen. Concerning the age, the arteries involved and the inflamatory aspect of the aneurysm, the surgical option became an alternative to the clinic treatment in case of any future evidence of the aneurysm enlargement. The patient became asymptomatic as soon as the antibiotic has been started. The control of the aneurysm evolution will be made by ecography each three months.

  16. Support Vector Machine-based method for predicting subcellular localization of mycobacterial proteins using evolutionary information and motifs

    Raghava Gajendra PS


    Full Text Available Abstract Background In past number of methods have been developed for predicting subcellular location of eukaryotic, prokaryotic (Gram-negative and Gram-positive bacteria and human proteins but no method has been developed for mycobacterial proteins which may represent repertoire of potent immunogens of this dreaded pathogen. In this study, attempt has been made to develop method for predicting subcellular location of mycobacterial proteins. Results The models were trained and tested on 852 mycobacterial proteins and evaluated using five-fold cross-validation technique. First SVM (Support Vector Machine model was developed using amino acid composition and overall accuracy of 82.51% was achieved with average accuracy (mean of class-wise accuracy of 68.47%. In order to utilize evolutionary information, a SVM model was developed using PSSM (Position-Specific Scoring Matrix profiles obtained from PSI-BLAST (Position-Specific Iterated BLAST and overall accuracy achieved was of 86.62% with average accuracy of 73.71%. In addition, HMM (Hidden Markov Model, MEME/MAST (Multiple Em for Motif Elicitation/Motif Alignment and Search Tool and hybrid model that combined two or more models were also developed. We achieved maximum overall accuracy of 86.8% with average accuracy of 89.00% using combination of PSSM based SVM model and MEME/MAST. Performance of our method was compared with that of the existing methods developed for predicting subcellular locations of Gram-positive bacterial proteins. Conclusion A highly accurate method has been developed for predicting subcellular location of mycobacterial proteins. This method also predicts very important class of proteins that is membrane-attached proteins. This method will be useful in annotating newly sequenced or hypothetical mycobacterial proteins. Based on above study, a freely accessible web server TBpred has been developed.

  17. Engineering Mycobacteria for the Production of Self-Assembling Biopolyesters Displaying Mycobacterial Antigens for Use as a Tuberculosis Vaccine

    Lee, Jason W.; Parlane, Natalie A.; Rehm, Bernd H. A.; Buddle, Bryce M.


    ABSTRACT Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis or Mycobacterium bovis and still remains one of the world's biggest global health burdens. Recently, engineered polyhydroxyalkanoate (PHA) biobeads that were produced in both Escherichia coli and Lactococcus lactis and displayed mycobacterial antigens were found to induce significant cell-mediated immune responses in mice. We observed that such PHA beads contained host cell proteins as impurities, which we hypothesized to have the potential to induce immunity. In this study, we aimed to develop PHA beads produced in mycobacteria (mycobacterial PHA biobeads [MBB]) and test their potential as a TB vaccine in a mouse model. As a model organism, nonpathogenic Mycobacterium smegmatis was engineered to produce MBB or MBB with immobilized mycobacterial antigens Ag85A and ESAT-6 on their surface (A:E-MBB). Three key enzymes involved in the poly(3-hydroxybutyric acid) pathway, namely, β-ketothiolase (PhaA), acetoacetyl-coenzyme A reductase (PhaB), and PHA synthase (PhaC), were engineered into E. coli-Mycobacterium shuttle plasmids and expressed in trans. Immobilization of specific antigens to the surface of the MBB was achieved by creating a fusion with the PHA synthase which remains covalently attached to the polyester core, resulting in PHA biobeads displaying covalently immobilized antigens. MBB, A:E-MBB, and an M. smegmatis vector control (MVC) were used in a mouse immunology trial, with comparison to phosphate-buffered saline (PBS)-vaccinated and Mycobacterium bovis BCG-vaccinated groups. We successfully produced MBB and A:E-MBB and used them as vaccines to induce a cellular immune response to mycobacterial antigens. IMPORTANCE Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis or Mycobacterium bovis and still remains one of the world's biggest global health burdens. In this study, we produced polyhydroxyalkanoate (PHA) biobeads in mycobacteria and used them as vaccines to

  18. Wrist Tenosynovitis due to Mycobacterium bovis Infection: Case Series and Review of the Literature

    Mehmet Derviş Güner, MD


    Full Text Available Summary: Tuberculosis infections are still one of the most important public health problems among developing countries. Musculoskeletal involvement represents 10–15% of all extrapulmonary cases. Tuberculosis tenosynovitis is usually misdiagnosed as nonspecific tenosynovitis. To avoid misdiagnosis and mistreatment, it is important to be alert for mycobacterial infections. This article presents 3 patients with wrist tenosynovitis, which was caused by Mycobacterium bovis infection. The article also includes review of the literature.

  19. Tuberculosis and non-tuberculous mycobacteria among HIV-infected individuals in Ghana

    Bjerrrum, Stephanie; Oliver-Commey, Joseph; Kenu, Ernest


    OBJECTIVES: To assess the prevalence and clinical importance of previously unrecognised tuberculosis (TB) and isolation of non-tuberculous mycobacteria (NTM) among HIV-infected individuals in a teaching hospital in Ghana. METHODS: Intensified mycobacterial case finding was conducted among HIV...

  20. The tip of the iceberg: Post caesarean wound dehiscence presenting as abdominal wound sepsis

    Kaundinya Kiran Bharatam


    Conclusion: Uterine scar dehiscence with infection requires high index of suspicion as rare cause for post partum localized/generalized peritonitis with sepsis. Severe abdominal wound infection after caesarean section may be associated with uterine wound dehiscence, which poses a grave risk to the mother in a future pregnancy.