O uso da adenosina deaminase no diagnóstico da tuberculose pericárdica

The objective of this study was to evaluate the adenosine deaminase (ADA) activity usefulness in the diagnosis of tuberculous pericarditis (TP), comparing its value with pericardial effusions (PE) caused by other pericardial diseases. A retrospective case-control study was conducted with nine cases of TP and 39 other than TP diseases (12 neoplastic, 11 septic and 16 unknown origin). Every patient included in this study had PE samples submitted to ADA activity measures and microbiological analysis, and then had pericardial tissue samples submitted to microbiological and histopathological examination. Considering the value of 40 U/L as the cut-off for the diagnosis of TP, the specificity and sensitivity were respectively of 72% and 89%. The specificity of ADA activity for the TP was best applied in the differential diagnosis from PE of unknown origin. The present study demonstrates the clinical value of the measurement of ADA activity in PE in the diagnosis of TP.O objetivo deste estudo foi avaliar a atividade da adenosina deaminase (ADA) como auxiliar no diagnóstico da tuberculose pericárdica (TP), comparando o seu valor no derrame pericárdico com outras doenças pericárdicas. Um estudo retrospectivo tipo caso-controle foi conduzido com nove casos de TP e 39 pacientes com outras doenças pericárdicas (12 neoplasias, 11 pericardites bacterianas e 16 pericardites de etiologia indeterminada). Cada paciente incluído no estudo teve sua amostra de tecido pericárdico encaminhada para estudo microbiológico e histopatológico. Considerando o valor de 40 U/L como corte para o diagnóstico de TP, a especificidade e sensibilidade foram respectivamente 72 e 89%. A especificidade da atividade de ADA para a TP foi melhor aplicada no diagnóstico diferencial entre derrame pericárdico de origem indeterminada. O presente estudo demonstrou o valor clínico da mensuração da atividade de ADA no diagnóstico de TP

Peritonite bacteriana espontânea causada por Listeria monocytogenes em pacientes com cirrose: primeiro relato de caso no Brasil

Two cases of spontaneous bacterial peritonitis (SBP) caused by Listeria monocytogenes in cirrhotic patients are reported. In one of the cases, the microorganism was isolated from pleural effusion and ascites. SBP is a serious and common complication of patients with ascites caused by hepatic cirrhosis and the culture of the ascitic fluid is an important tool for the diagnosis and for the more appropriate treatment. Although a third generation cephalosporin has usually been employed for empiric treatment of SBP, it does not provide adequate coverage against Listeria spp. In such cases the use of ampicillin (with or without sulbactam) or sulfamethoxazole-trimethoprim is recommended. The last one is used for secondary prophylaxis, instead of norfloxacin. To summarize, Listeria monocytogenes infection is a rare cause of SBP, whose treatment should be specific for the bacteria.Foram relatados dois casos de peritonite bacteriana espontânea (PBE) por Listeria monocytogenes em pacientes com cirrose. Em um dos casos isolamos também o agente no líquido pleural. A PBE é uma complicação comum e grave de pacientes com ascite por cirrose e a cultura do líquido ascítico é de grande importância para o diagnóstico e para o tratamento mais adequado. Embora uma cefalosporina de terceira geração seja geralmente utilizada para o tratamento empírico da PBE, ela não oferece cobertura adequada contra a Listeria spp. Nesses casos, recomenda-se o uso de ampicilina (com ou sem sulbactam) ou sulfametoxazol-trimetoprim. Para a profilaxia secundária indica-se o uso deste último, ao invés da norfloxacina. Em resumo, a infecção por Listeria monocytogenes é uma causa rara de PBE e o tratamento específico deve ser administrado

Comparison of disc diffusion, Etest and broth microdilution for testing susceptibility of carbapenem-resistant P. aeruginosa to polymyxins

Abstract\ud \ud \ud \ud Background\ud \ud Considering the increasing use of polymyxins to treat infections due to multidrug resistant Gram-negative in many countries, it is important to evaluate different susceptibility testing methods to this class of antibiotic.\ud \ud \ud \ud Methods\ud \ud Susceptibility of 109 carbapenem-resistant P. aeruginosa to polymyxins was tested comparing broth microdilution (reference method), disc diffusion, and Etest using the new interpretative breakpoints of Clinical and Laboratory Standards Institute.\ud \ud \ud \ud Results\ud \ud Twenty-nine percent of isolates belonged to endemic clone and thus, these strains were excluded of analysis. Among 78 strains evaluated, only one isolate was resistant to polymyxin B by the reference method (MIC: 8.0 μg/mL). Very major and major error rates of 1.2% and 11.5% were detected comparing polymyxin B disc diffusion with the broth microdilution (reference method). Agreement within 1 twofold dilution between Etest and the broth microdilution were 33% for polymyxin B and 79.5% for colistin. One major error and 48.7% minor errors were found comparing polymyxin B Etest with broth microdilution and only 6.4% minor errors with colistin. The concordance between Etest and the broth microdilution (reference method) was respectively 100% for colistin and 90% for polymyxin B.\ud \ud \ud \ud Conclusion\ud \ud Resistance to polymyxins seems to be rare among hospital carbapenem-resistant P. aeruginosa isolates over a six-year period. Our results showed, using the new CLSI criteria, that the disc diffusion susceptibility does not report major errors (false-resistant results) for colistin. On the other hand, showed a high frequency of minor errors and 1 very major error for polymyxin B. Etest presented better results for colistin than polymyxin B. Until these results are reproduced with a large number of polymyxins-resistant P. aeruginosa isolates, susceptibility to polymyxins should be confirmed by a reference method.Financial support: Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP).Financial support: Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Antifungal drug susceptibility profile of Pichia anomala isolates from patients presenting with nosocomial fungemia

In vitro susceptibility of 58 isolates of Pichia anomala to five antifungal drugs using two broth microdilution methods (CLSI and EUCAST) was analyzed. Low susceptibility to itraconazole was observed. Fluconazole, voriconazole, amphotericin B, and caspofungin showed good antifungal activity, although relatively high drug concentrations were necessary to inhibit the isolates.Inst Adolfo Lutz Registro, São Paulo, BrazilUniversidade Federal de São Paulo, Div Infect Dis, São Paulo, BrazilUniv Estadual Campinas, Fac Med Sci, Div Infect Dis, Campinas, SP, BrazilUniv Catolica Argentina, Fac Med, Buenos Aires, DF, ArgentinaUniv São Paulo, Hosp Clin, Lab Clin Micorbiol, São Paulo, BrazilUniv São Paulo, Hosp Clin, Hosp Infect Control Dept, LIM 54, São Paulo, BrazilHosp Sirio Libanes, São Paulo, BrazilUniv Fed Rio de Janeiro, Dept Internal Med, Rio de Janeiro, BrazilUniv São Paulo, Hosp Clin, Dept Infect Dis, São Paulo, BrazilUniversidade Federal de São Paulo, Div Infect Dis, São Paulo, BrazilWeb of Scienc

Use of hepatitis C-positive donors in transplantation

We thank the Clinical Directors from the Hospital das Clínicas da Faculdade\ud de Medicina da USP for their support: Prof. Jose Otávio Costa Auler Junior, Prof. Tarcísio Eloi Pessoa de Barros Filho and Prof. Eloísa Bonf

Prophylaxis of fungal infections in transplant patients

We thank the Clinical Directors from the Hospital das Clínicas da Faculdade\ud de Medicina da USP for their support: Prof. Jose Otávio Costa Auler Junior, Prof. Tarcísio Eloi Pessoa de Barros Filho and Prof. Eloísa Bonf

Rhodotorula spp. isolated from blood cultures in Hospital das Clínicas School of Medicine University of São Paulo: clinical and microbiological aspects

Foi realizado um estudo para verificar a ocorrência de leveduras do gênero Rhodotorula, em hemocultura por um período de 8 anos. Os pacientes identificados foram descritos clinicamente segundo variáveis de interesse incluindo dados sobre terapêutica e desfecho. Determinou-se também as concentrações inibitórias mínimas de 20 cepas frente a diferentes antifúngicos de acordo com NCCLS e EUCAST. Realizou-se tipagem molecular através da cariotipagem eletroforética em campo pulsátilA study was conducted to verify the frequency of occurrence of Rhodotorula spp. from blood cultures over an 8-year period, clinically and microbiologically characterizing patients affected, including data regarding antifungal treatment and outcome. The minimal inhibitory concentrations of antifungal agents were determined against 20 isolates. Molecular typing of the strains were performed using pulsed field gel electrophoresis metho