Susceptibility to antifungal agents of Candida spp. from blood and feces collected in Novi Sad in 3-year period (2008-2010)

Candidemia is an important emerging nosocomial infection in patients with risk factors. Candida species from nonsterile sites can give insight into the characteristics of strains that may cause invasive disease. The aim of this study was to evaluate antifungal susceptibility of Candida blood and fecal isolates in Novi Sad, Vojvodina. During a 3-year period (2008 to 2010), 424 isolates of Candida spp. were collected, 30 bloodstream isolates and 394 strains from fecal samples. In vitro susceptibility of these isolates to five antifungal agents was established using commercial ATB FUNGUS 3 (Bio-Mérieux). Predominant species was Candida albicans (6 isolates from blood and 269 from feces). Resistance to one or more antifungal agents was less common in Candida albicans (3.63%) than in other species (24.83%). Resistance to itraconazole was the most commonly found in both groups of isolates, 9.64% strains from feces and 20% from blood samples. Twelve isolates were multiply resistant, usually to fluconazole, itraconazole, and voriconazole. Resistance to amphotericine B was extremely rare. Although resistance to antimycotics of Candida spp. is rare at present, continued surveillance of antifungal susceptibility is necessary in order to monitor trends, and to choose the right empiric therapy

Deficijencija B12 vitamina kod deteta majke na veganskoj ishrani

Vitamin B12 deficiency usually occurs in exclusively breastfed infants whose mothers have pernicious anaemia or are vegetarian. Early treatment of vitamin B12 deficiency in infants can prevent potentially neurologic sequelae. A male child aged 13 months has been hospitalized due to failure to thrive, feeding problems, pallor, weakness and hypotonia. During the pregnancy mother did not eat meat and during lactation she also excluded eggs and milk. The child was exclusively breastfed. Laboratory investigations showed a haemoglobin level of 3.5 g/dL, haematocrit 10%, red blood cell count of 0.99 × 1012/L, white blood cell count of 4.23 × 109 /L and platelet count of 55 × 109 /L. Vitamin B12 level was low. A bone marrow aspiration finding was consistent with megaloblastic anaemia. The magnetic resonance imaging showed brain atrophy. Vitamin B12 in a dose of 10µg per kg was applied intramuscularly daily for 2 weeks, then once weekly. Three days after initiating B12 vitamin therapy there was an improvement in the blood count with the gradual improvement of neurological state. Vitamin B12 deficiency is a treatable cause of pancytopenia and neurological dysfunction in children and should be considered as differential diagnosis in an infant with neurological symptoms.Deficijencija B12 vitamina se obično javlja kod odojčadi koja su na prirodnoj ishrani a čije majke imaju pernicioznu anemiju ili su vegetarijanci. Pravovremeno lečenje deficijencije B12 vitamina kod odojčadi može da prevenira potencijalne neurološke posledice. Malo muško dete uzrasta 13 meseci je hospitalizovano zbog nenapredovanja, problema sa hranjenjem, bledila, slabosti i hipotonije.Tokom trudnoće majka nije jela meso dok je tokom dojenja iz ishrane isključila i jaja i mleko. Dete je isključivo dojeno. U laboratorijskim nalazima nivo hemoglobina je iznosio 3,5 g/dl, hematokrit 10%, broj eritrocita je bio 0.99×1012/L, broj leukocita 4.23×109 /L i broj trombocita 55×109 /L. Nivo B12 vitamina je bio snižen. Nalaz biopsije kostne srži ukazivao je na megaloblastnu anemiju. Na magnetnoj rezonanci endokranijuma viđena je atrofija mozga. Vitamin B12 u dozi od 10 mikrograma/kg primenjen je intramuskularno svakodnevno tokom 2 nedelje, potom jednom nedeljno.Tri dana od započinjanja terapije zabeleženo je poboljšanje hematoloških vrednosti uz postepeno poboljšanje neurološkog statusa. Deficijencija B12 vitamina je uzrok pancitopenije i neurološke disfuncije kod dece koju je moguće lečiti. Kod odojčeta sa neurološkim simptomima ova deficijencija treba da bude razmotrena kao diferencijalna dijagnoza

First Isolation of Exiguobacterium aurantiacum in Serbia

Exiguobacterium aurantiacum is isolated from a variety of environmental samples but rarely from patients. The aim of the study was to represent isolation of unusual bacterial strains that could cause infection in patients. Final identification was performed using matrix-assisted description/ionization time-of-flight mass spectrometry (MALDI-TOF). Two isolates strains of E. aurantiacum were isolated, one isolate from distilled water used during surgical treatment and the second one from a patient with bacteremia after radical prostatectomy, both sensitive to all tested antimicrobials. Environmental strains could cause infection, especially in immunocompromised patients; therefore, rare bacteria testing is required, in which identification special assistance is provided by an automated system MALDI-TOF

Purple Urine Bag Syndrome in a Home-Dwelling Elderly Female with Lumbar Compression Fracture: A Case Report

Purple urine bag syndrome (PUBS) is an uncommon, but usually benign, underrecognized clinical condition with the distressing presentation of purple, blue or reddish discoloration of a patient’s catheter bag and tubing in the setting of catheter-associated urinary tract infections (UTIs). PUBS is the result of the complex metabolic pathway of the dietary essential amino acid tryptophan. Its urinary metabolite, indoxyl sulfate, is converted into red and blue byproducts (indirubin and indigo) in the presence of the bacterial enzymes indoxyl sulfatase and phosphatase. The typical predisposing factors are numerous and include the following: female gender, advanced age, long-term catheterization and immobilization, constipation, institutionalization, dementia, increased dietary intake of tryptophan, chronic kidney disease, alkaline urine, and spinal cord injury (SCI). Here, we present a case of PUBS in a home-dwelling elderly female patient with a history of long-term immobility after a pathological spinal fracture, long-term catheterization, constipation, and malignant disease in remission. Urine culture was positive for Proteus mirabilis. This state can be alarming to both patients and physicians, even if the patient is asymptomatic. Healthcare professionals and caregivers need to be aware of this unusual syndrome as an indicator of bacteriuria in order to initiate proper diagnostics and treatment