Cinquenta e nove pacientes chagásicos crônicos foram submetidos a xenodiagnósticos e hemocultura concomitantes para isolamento de amostras de Trypanosoma cruzi. O xenodiagnóstico foi composto de 40 ...ninfas de Panstrongylus megistrus, Triatoma infestans e Dipetalogylus megistus, Triatoma infestans e Dipetalogaster maximus num total de 120 triatomíneos. Os insetos foram dissecados em grupo de 10 por espécie e o conteúdo intestinal, agrupado, examinado após prévia trituração e homogeneização. O material negativo ao microscópio foi semeado em meio LIT e examinado após 20 dias. Vinte e nove pacientes foram parasitologicamente comprovados, sendo 15 apenas no xenodiagnóstico, quatro apenas com a hemocultura e 10 por ambos os métodos. Discutem-se as dificuldades para a comprovação parasitológica dos pacientes chagásicos crônicos, o valor da utilização simultânea de diferentes espécies de triatomíneos no xenodiagnóstico e a hemocultura, numa associação positiva favorável ao aumento da sensibilidade para o diagnóstico da doença de Chagas. A positividade de 49,2% obtida neste grupo de pacientes visualiza abordagens do tipo ensaio clínico-terapêutico e/ou epidemiológico (tipo caso-controle) com a finalidade de investigar uma possível associação entre amostras do T. cruzi e diferentes formas clínicas da doença de Chagas.Fifty nine chronic chagasic patients were simultaneously submitted to xenodiagnosis and hemoculture for Trypanosoma cruzi sampels isolations. The xenodiagnosis was done with 40 Panstrongylus megistus, Triatoma infestans and Dipetalogaster maximus nymphs, performing 120 triatomines. Groups of 10 insects per specie were dissecated and the intestinal content pooled and examine, after previous trituration and homogenization. The microscopically negative material was seed into LIT medium and examined after 20 days. Twenty nine patients were parasitologically proved, being 15 only by senoxiagnosis, 4 only by hemoculture and 10 by both methods. It was discussed the parasitological comprovation difficulties in chronic chagastic patients, the value of the simultaneous utilization of different triatomine species in xenodiagnosis and the hemoculture, in a favorable positive association to the sensistivity increase in the diagnosis' disease. The 49,2% of posistivity obtained in this group, visualize approaches like clinic-therapeutic assay and or epidemiological (case-control) with the purpose to investigate a possible association with T. cruzi sampels and different clinic forms in Chagas' disease.
Com o objetivo de se isolar amostras do Trypanosoma cruzi de chagásicos crônicos, foram submetidos a xenodiagnóstico e hemocultura, 59 pacientes provenientes do ambulatório de um dos Hospitais de ...Belo Horizonte. Esses pacientes informaram, em entrevista prévia, serem ou terem sido doadores de sangue ou candidatos à uma primeira doação. 44 deles (74,6%) já haviam doado sangue de la mais de 20 vezes em diferentes bancos de sangue de Belo Horizonte. O resultado conferido através da realização concomitante de apenas 1 xenodiagnóstico e 1 hemocultura, revelou, no grupo de doadores, 47,7% depositividade parasitológica. Considerando todos os doadores chagásicos crônicos, parasitologicamente comprovados ou não, ocorreram mais de 112 doações. Esse é um dado altamente significativo em relação ao problema de transmissão transfusional da doença de Chagas em bancos de sangue de Belo Horizonte, MG.
Fifty nine chronic chagasic individuals from a out-patient clinics in Belo Horizonte, who use to act as blood donors were submitted to xenodiagnosis and hemocultures for isolating Trypanosoma cruzi. Forty four of them (74.5%) had already given blood 1 to 20 times. The results, based on only one xenodiagnosis and one blood culture per patient revealed 47. 7% of parasitological positivity. The whole population studied wes responsible for 112 donations. These data stress the importance of transmission of Chagas disease through blood transfusion in Belo Horizonte.
With the purpose of standardization of an hemoculture technique presenting a higher positive rate in the parasitological diagnosis of chronic Chagas' disease in patients with reactive serology (IFT, ...HA, CFT) the following schedule was used. Thirty ml of venous blood was collected with heparin and the plasma was separated by centrifugation (2.000 rpm/30'). The packed cells were washed with LIT medium or PBS which was then removed by centrifugation (2.000 rpm/15'). This material was sampled in 6 screw-tubes 18x200 with 6 ml of LIT medium and incubated at 28°C. These incubated cultures at 28°C were examined after 15, 30, 45 and 60 days. When the hemoculture was not immediately processed after blood collection, the plasma was removed and the sediment enriched with LIT medium and preserved at 4°C. The Xenodiagnosis was performed according to Schenones method used here as a reference technique. Among the various groups of patients examined by both techniques the best results obtained were: 55.08% ofpositivity for hemocultures against 27.5% forxenodiagnosis (X² = 4.54, p = 0.05), with a tubepositivity of 26.6%. Recommendation for screening trials of drug assays is the repetition of method on a same patient 2 or more times in different occasions, as used in xenodiagnosis.Objetivando a padronização de uma técnica de hemoculturas que apresente maior taxa de positividade no diagnóstico da fase crônica da doença de Chagas em pacientes com sorologia reativa (TIF, HA, RFC) utilizamos o seguinte esquema: o volume de 30ml de sangue foi colhido heparinizado e o plasma separado por centrifugaçao (200 rpm/30'); o sedimento foi lavado com meio LIT ou salina fisiológica tamponada e removido por nova centrifugação (2000 rpm/15); as células sedimentadas foram distribuídas em 6 tubos tipo "screw" 18 x 200 contendo 6,0 ml de meio LIT; as culturas incubadas a 28°C, foram examinadas após 15, 30, 45 e 60 dias; quando a hemocultura não foi processada imediatamente após a colheita de sangue, o plasma foi removido e o sedimento, adicionado de meio LIT, conservado a 4°C; o xenodiagnóstico (Schenone) realizado no mesmo dia da colheita do sangue foi utilizado como técnica de referência. Entre os vários grupos de pacientes examinados, os melhores resultados forneceram uma positividade de 55,0%para hemocultura contra 27,5% de xenodiagnósticos positivos (X² = 4,54; p = 0,05), com positividade/tubo de 26,6%. A conservação do material a 4°C durante 48-72 horas não alterou o percentual de positividade. A positividade dos tubos de hemoculturas mostrou uma redução de 18,0para 7,2% quando o plasma não foi removido logo após a colheita do sangue, e mantidas por 24-48 horas a 4°C antes da técnica ser processada. É provável que isto se deva à ação lítica de imunoglobulinaspresentes no plasma, ou ao potencial macrofágico dos linfócitos. Recomendamos: (a) a realização de duas ou mais hemoculturas do mesmo paciente com a finalidade de aumentar a positividade, principalmente em condições de campo e em áreas onde os pacientes crônicos apresentam baixos níveis de parasitemia; (a) o emprego desta técnica na triagem de pacientes e no controle parasitológico de cura, em ensaios clínico-terapéuticos; (c) a execução deste método em outros laboratórios com a finalidade de comprovara viabilidade de seu emprego no diagnóstico de rotina utilizando o meio LIT ou Warren.
Leyişmaniyoz etkenlerine moleküler yöntemlerin uygulanabilmesi eldeki hücre sayısı ile yakından ilgilidir. Bu çalışmada, bilinen populasyon taşıma kapasitesinin arttırılması ve maksimum hücre ...sayısına erişme süresinin kısaltılması hedeflendi. Modifiye Evans bifazik besiyerine ek olarak yalın 1x RPMI-1640 besiyerine çeşitli kan ve kan ürünleri katılarak elde edilen yeni modifiye monofazik besiyerleri hazırlandı. Bu besiyerlerine belirli sayıda L.tropica (K-27) ve L.donovani (DD-8) parazitleri ekildi.
İnkübasyon sonrası hem yalın 1x RPMI-1640 besiyerinde hem de kan ve kan ürünlerinin ilavesi ile elde edilen yeni modifiye besiyerlerinde, birim hacme düşen parazit sayılarının, daha önce yapılan çalışmalardan elde edilen düzeyi aşamadıkları tespit edildi. Buna karşılık, maksimum hücre sayısına erişme süreleri arasında farklılıklar belirlendi. Buna göre; L.tropica (K-27) ve L.donovani (DD-8) hücreleri modifiye Evans besiyerinde 14., yalın 1x RPMI-1640 besiyerinde 12. ve insan tam kan lizatının eklendiği 1x RPMI-1640 besiyerinde ise dördüncü günde maksimum hücre sayısına eriştiği gözlendi.
Ayrıca, mitotik indeksi arttırarak taşıma kapasitesine daha kısa zamanda erişmek amacıyla fitohemaglütinin (PHA) denemesi yapıldı. Farklı derişimlerde fitohemaglütinin, yalın 1x RPMI-1640 besiyerlerine eklendikten sonra L.major (5-ASKH) ekildi ve belirli zaman aralıklarıyla birim hacme düşen hücre sayıları belirlendi. Yapılan çalışmaya göre, besiyerine eklenen mitojen maddenin (PHA) populasyon taşıma kapasitesini ve ikilenme süresini etkilemediği tespit edildi.
The molecular methods that can be applied to Leishmania parasites are directly related with the cell number that is present. In this study, it was aimed to increase conventional carrying capacity of culture and to decrease the period to reach the maximum cell number. The medium was prepared as modified Evans' biphasic medium and as monophasic RPMI-1640 with blood or blood products. The determined cell numbers of L.tropica (K-27) and L.donovani (DD-8) were inoculated into these media, seperately.
The 1x RPMI-1640 media of both type, simple and modified ones did not show any positiveness comparing with the preliminary studies performed with traditional media. However, the reaching periods to full capacity happened to be different. L.tropica (K-27) and L.donovani (DD-8) cells in Evans' modified medium and simple 1x RPMI-1640 were highest in 14th, and enriched 1x RPMI-1640 medium with human whole blood lysate reached almost the same level after only four days.
In order to reach the full capacity in minimum period of time, we tried to have the advantage of higher mitotic index with phytohaemagglutinin (PHA). The PHA in different concentrations were added into simple 1x RPMI 1640 media, then the media were inoculated with L.major (5-ASKH). Following the cell numbers throughout the cultivation no positive effect was detected at all.
Orientia tsutsugamushi, which requires specialized facilities for culture, is a substantial cause of disease in Asia. We demonstrate that O. tsutsugamushi numbers increased for up to 5 days in ...conventional hemocultures. Performing such a culture step before molecular testing could increase the sensitivity of O. tsutsugamushi molecular diagnosis.
Aim:
To observe bacteremia following closed and open dental extraction.
Material and methods:
The study included two subject groups each comprising 29 participants. Group I patients received a single ...closed dental extraction, and group II patients - a single open extraction. Venous blood from the cubital vein of each patient was collected in three samples - preoperatively, 30 seconds after surgery, and 15 minutes after surgery. Anaerobic and aerobic hemocultures (Bact/ALERT, BioMerieux, Inc., Durhamn, N.C.) were used to study the bacteremia process.
Results:
Preoperatively, bacteremia was confirmed in 4 patients (6.9%) undergoing closed extraction and in 1 patient (1.7%) undergoing open extraction. Additionally, we found statistically significant relation between bacteremia and age (
p
=0.002). Thirty seconds after surgery bacteriemia was evident in 6 patients (10.3%) from group I and in 3 (5.2%) from group II. Fifteen minutes following surgery bacteremia was evident in 4 patients (6.9%) undergoing typical extraction and in one patient (1.7%) undergoing surgical extraction. No statistically significant relation between type of extraction and presence of bacteria in the bloodstream at 30 seconds (
p
=0.285) and at 15 minutes (
p
=0.166) was found. Coagulase-negative
Staphylococcus
was the most frequently found microorganism (22.2% of aerobic and 11.1% of anaerobic hemocultures). The results show greater significance of bacteremia at 30 seconds, compared to preoperative samples for both subject groups (
p
=0.03).
Conclusions:
Bacteremia following dental extraction is unaffected by duration of intervention, type of extraction and gender.
Introduction : La septicémie est une affection grave et fréquente dans le monde avec une mortalité élevée elle est considéré par l’OMS comme une priorité de santé publique. En outre la mortalité ...attribuable à la résistance est estimée plus élevée en Afrique subsaharienne occidentale soit 27,3 décès pour 100 000 infections. La présente étude visait á identifier les bactéries responsables des septicémies aux Mali de 2000-2020 et leur sensibilité aux antibiotiques. Méthodologie : Une métaanalyse a été conduite à partir des données recueillies dans les bibliothèques numériques de certaines universités d’Afrique de l’Ouest, sur Pub Med et Medline. Résultats : sept études sur les hémocultures ont été retenues. La positivité des hémocultures variait entre 7% à 38% (taux combiné = 22%). Les bactéries fréquemment isolées étaient Streptococcus pneumoniae (18%), Salmonella enterica (11,5%) et Haemophilus influenza B (10,1%). Chez les enfants, la fréquence de Salmonella enterica est passée de 14% à 0% et celle de Haemophilus influenza B de 12,8% à 3,2% entre 2008 et 2020. S. pneumoniae étaient plus sensible à l’ampicilline, la ceftriaxone et l’érythromycine. S. enterica était plus sensible à l’amikacine, la ceftazidime, la cefotaxime, à la ceftriaxone, l’acide nalidixique, la ciprofloxacine et l’Imipénème. H. influenza B était plus sensible à l’ampicilline, la ceftriaxone, chloramphénicol et la ciprofloxacine. Conclusion : les données de cette étude permettent une meilleure compréhension, une prise en charge adéquate des septicémies et des résistances aux antibiotiques au Mali
L’endocardite infectieuse est une maladie grevée d’une lourde morbi-mortalité. Nous avons mené une analyse rétrospective sur 100 patients hospitalisés pour endocardite infectieuse de janvier ...2009 jusqu’à décembre 2015. L’âge moyen de ce patients était de 41 ans avec une prédominance masculine. L’endocardite infectieuse survient sur valve native (77 patients), sur prothèse valvulaire (12 patients), sur Pacemaker (7 patients) et sur cardiopathie congénitale (4 patients). Le délai diagnostique était de 77jours en moyenne. La fièvre était présente chez 85 patients. Les hémocultures étaient négatives chez 54 patients. L’échocardiographie a permis de visualiser les végétations chez 95 patients. Dans les cas d’EI sur prothèse valvulaire, une fuite paraprothétique a été diagnostiquée chez 54 % de nos patients et une végétation a été visualisée dans 18 % des cas. Les principales complications sont l’insuffisance cardiaque (42), les complications neurologiques (19), spléniques (10) et rénales (23). L’évolution sous traitement médical était marquée par l’amélioration clinico-biologique dans (57), l’absence d’amélioration avec persistance de la fièvre (21). Le taux de mortalité de notre série est de 23 %. Sept patients seulement ont bénéficié d’une chirurgie urgente pour des indications hémodynamiques et infectieuses. Au terme de ce travail, on souligne que le profil épidémiologique de l’endocardite infectieuse n’obéit pas aux modifications que connaît le monde. Dans notre contexte, sa prise en charge reste difficile (retard diagnostique important, hémocultures souvent négatives, niveau de morbidité élevé, manque de recours à la chirurgie précoce). L’amélioration de celle-ci consiste sur le renforcement de la prévention du rhumatisme articulaire aigu et l’instauration d’un « heart team endocarditis » pour adapter les recommandations internationnales au contexte national.
Infective endocarditis is a grave disease because of a high level of morbidity and mortality. We conducted a retrospective analysis of 100 patients hospitalized for infective endocarditis from January 2009 until December 2015. The mean age was 41 years with a male predominance. Infective endocarditis occurs on a native valve (77 patients), prosthetic valves (12 patients), Pacemaker (7 patients) and congenital heart disease (4 patients). The diagnostic delay was 77 days on average. The fever was present in 85 patients. Blood cultures were negative in 54 patients. Echocardiography allowed visualizing the vegetations in 95 patients. In patients with prosthetics valves, a paraprosthetic regurgitation was diagnosed in 54 % of these patients and vegetation in 18 %. The main complications are heart failure (42), neurological (19), spleen (10) and renal (23) complications. The evolution under medical treatment was marked by the clinical-laboratory improvement in 57 patients, the lack of improvement with persistent fever in 21 patients. The mortality rate of our series is 23 %. Only seven patients underwent urgent surgery for hemodynamic and infectious indications. At the end of this work, it is emphasized that the epidemiological profile of infective endocarditis does not follow the changes of Wold. Its management is difficult in our context (significant diagnostic delay, often negative blood cultures, high level of morbidity, lack of recourse to early surgery). The improvement of this disease consistes of the prevention of acute articular rhumatism and the establishment of an heart team endocarditis to adapt international recommendations to our context.
Évaluer, d’une part, l’intérêt de réaliser une deuxième ponction biopsie disco-vertébrale chez les patients présentant une spondylodiscite primitive à hémocultures négatives et ayant eu une première ...ponction négative et, d’autre part la sensibilité d’une première ponction et l’intérêt des hémocultures post-ponction.
Recueil rétrospectif multicentrique de 2004 à 2014. Les spondylodiscites postopératoires ont été exclues.
De 2004 à 2014, 63 spondylodiscites primitives avec hémocultures stériles ayant eu au moins une ponction biopsie disco-vertébrale par voie radiologique ont été recensées. La première ponction a permis un diagnostic dans 52 % des cas (33/63). Parmi les 30 patients ayant eu une première ponction négative, 33 % (10/30) ont eu une deuxième ponction et 67 % (20/30) ont eu une antibiothérapie probabiliste. La deuxième ponction était positive dans 60 % (6/10) des cas. Huit hémocultures post-première PBDV étaient positives, mais 7 d’entre elles étaient associées à une ponction également positive. La rentabilité des prélèvements était dépendante de la technique (logiciel de guidage versus TDM et/ou scopie) et de l’opérateur. Le recours à une antibiothérapie dans les 6 mois précédant la première PBDV était significativement associé à une première ponction négative (15/30 versus 7/33 ; OR 3,13, IC 95 % 1,07–9,13, p<0,05).
Notre étude montre l’intérêt de réaliser une deuxième ponction biopsie disco-vertébrale, qui permet un diagnostic bactériologique dans 60 % des cas, chez les patients présentant une spondylodiscite primitive à hémocultures négatives, et en cas de négativité de la première ponction.
IntroductionLa réalisation des hémocultures est le meilleur moyen de diagnostic des bactériémies, cependant les résultats faussement positifs peuvent entraîner une confusion concernant les schémas ...thérapeutiques antibiotiques, mettant ainsi en danger la sécurité des patients. L'objectif principal de ce travail est d'évaluer la prévalence des Staphylocoques à coagulase négative (SCN) ainsi que Corynebacterium spp et Bacillus spp dans les ballons d'hémoculture analysés au laboratoire de microbiologie du Centre Hospitalier Universitaire (CHU) Ibn Rochd de Casablanca. Cette prévalence a été aussi évaluée en fonction de différents services hospitaliers sur l'année 2016.MéthodesIl s'agit d'une étude rétrospective descriptive basée sur une analyse de la base de données informatisée du laboratoire de bactériologie-virologie du CHU Ibn Rochd de Casablanca sur une période de 12 mois allant du 1er janvier au 31 décembre 2016, Ont été inclus dans notre étude les bactéries faisant partie de la flore commensale (staphylocoque à coagulase négative,corynébactéries spp et Bacillus spp) Les ballons d'hémoculture ont été incubés sur automate Bactec FX. L'identification des germes à partir d'une culture positive a été réalisée selon les techniques standards de bactériologie et l'antibiogramme selon EUCAST 2015. L'étude est basée sur une analyse de la base de données informatisée du système KALISIL (Netika) version (2.2.10.) du Laboratoire de Microbiologie du CHU Ibn Rochd-Casablanca Maroc.RésultatsSur 7959 demandes d'hémocultures adressées au laboratoire de bactériologie provenant de 5801 patients, 2491 étaient positifs dont 848, soit 34% des ballons positifs ou 10,6% de l'ensemble des ballons reçus durant l'année 2016, ont été représentées par staphylocoque à coagulase négative, 56 soit (2,2%) ballons des hémocultures par corrynébacteruim SP, suivi par 60 soit (2,4%) ballons par bacillus sp. La fréquence d'isolement du SCN par rapport aux autres bactéries en fonction des services cliniques a montré une fréquence plus élevée dans les services de pédiatrie avec 47,2% suivie des services de médecine avec 44,1%.ConclusionCette étude montre que, Les staphylocoques à coagulase négative sont les organismes les plus fréquemment isolés des hémocultures, ils constituent une cause non négligeable d'infections nosocomiales mais, ils sont également les contaminants les plus courants des hémocultures.
PDF
