संक्रामक रोग और चिकित्सा जर्नल

Children with urinary tract infection present with vague clinical features and candiduria in such patients signifies pyelonephritis/cystitis, disseminated candidiasis, contamination or colonisation. This study was aimed to determine the prevalence of candiduria in paediatric patients, their speciation, associated risk factors and antifungal susceptibility of these isolates which will help the clinicians in the better management of candiduria. In our study, the isolation rate for candiduria was 24.3%, more common in males (63%) compared to females (37%) and infants were most commonly involved. Colony count of ≥105 cfu/ml seen in 53% of the isolates and pus cells were seen in 84% cases. Among candiduria cases, 87% received broad spectrum antibiotics for more than 7 days, while 57% were catheterized, and 19% of the patients were on fluconazole therapy. In the present study, non-albicans candida species emerged as the predominant pathogen and was found in 57% cases while Candida albicans was found in 43% cases of candiduria. Antifungal susceptibility testing revealed that all the isolates were sensitive to voriconazole and ketoconazole while 95% of the isolates were sensitive to fluconazole and 92% were sensitive to itraconazole. Resistance to fluconazole was found in 5% of isolates while 8% isolates were resistant to itraconazole. Identification of candida species along with antifungal susceptibility is important in patients with UTI and will help the clinician in selecting the appropriate antifungal agent for better management of such cases.

Background: PRES is an increasingly recognized cliniconeuroradiological disorder, presenting with headache, nausea, vomiting, seizures, altered consciousness and visual disturbances. It is mainly associated with kidney disease, organ transplantation, immunosuppressives, autoimmune diseases and eclampsia. Typical MRI findings include white matter vasogenic edema predominantly affecting the posterior parietaloccipital lobes of the brain. The symptoms may persist for several days and the radiological findings resolve within few weeks. Case-diagnosis/treatment: We report a previously healthy 7-year old patient, who presented with status epilepticus, following a 2-day history of nausea, vomiting and headache. The patient was apyrexial and had no history of epilepsy or recent history of head trauma or ingestion of toxic substances. During the seizures, raised systolic blood pressure was recorded. Periorbital edema and proteinuria were noted for 24 hours post-seizure. Persistent microscopic hematuria and hypertension were also recognized. Based on a positive personal history of tonsillitis 2 weeks before the onset of the seizures, persistent microscopic hematuria, raised blood pressure for one week, low C3 and C4 levels, raised Antistreptolysin O titer and typical MRI findings that resolved 4 weeks later, PRES was diagnosed in the context of post-streptococcal glomerulonephritis. Conclusions: PRES should always be considered in patients with glomerulonephritis presenting with acute hypertension and rapidly progressive neurological manifestations. Since it is often unsuspected, prompt recognition and treatment is important for the resolution of the symptoms and radiological features, as well as for preventing unnecessary investigations and therapies.

Objective: To describe treatment strategies employed in hospitalized patients at the “General Hospital Dr. Manuel Gea González” with infection by Extensively Drug-Resistant (XDR) Acinetobacter baumannii. Methodology: A retrospective analysis was carried out from January 1st 2012 to December 31st, 2014. Clinical data were collected, as well as group and doses of antimicrobial agents administered. Results: 39 patients were enrolled, the main infectious diagnosis was hospital acquired pneumonia (HAP) in 64%, followed by skin and soft-tissue infections (SSTI) in 23%. Thirty patients (77%) received tigecycline, while 83% of these received high doses. Thirty three percent of patients receiving meropenem had high dose. Twenty-nine patients (74.3%) received colistin and, from these, 61.5% was given a loading dose. Concerning the combined therapy, the following distribution was observed: 19 patients (48.7%) had triple therapy: meropenem, colistin and tigecycline (MCT), and 20 patients (51.3%) had double therapy including combinations of meropenem-colistin (MC), meropenem-tigecycline (MT) and tigecycline-colistin (TC). The sole adverse effect with the use of tigecycline was nausea in 20%. Twenty five percent of patients receiving colistin required dose adjustment after 5 days due to acute kidney injury (AKI). Outcomes: overall mortality was 33.3%, the mean of hospital stay at the intensive care unit (ICU) was 12.8 days (SD ± 16.2), while the total days of stay were 41 (SD ± 25.9). The lowest mortality (25.3%) was observed in the group receiving triple therapy (MCT), although this was no statistically significant. Conclusions: Triple combination therapy showed a trend to decreased mortality. The use of tigecycline at high doses and colistin at loading dose did not determine unfavorable clinical outcomes. It is necessary to perform randomized studies comparing different therapeutic strategies.

Post kala-azar dermal leishmaniasis is a dermal complication occurring months after treatment of visceral leishmaniasis. A 10 year old boy, resident of kalaazar endemic area presented with multiple hypopigmented macules over both legs and abdomen for 3 years. Child had splenomegaly. Splenic puncture revealed LD bodies and RK 39 antibody positivity. Skin revealed unremarkable epidermis and dermal perivascular inflammation in 100 X magnification. Leishmania donovani body was seen 1000X magnification. Presentation of PKDL with VL is rare. Child was treated with liposomal amphotericin B. Skin lesions decreased and spleen size regressed after treatment.