Among 800 stool specimens from patients with diarrhea submitted by Primary Care Centers for routine analysis to the Hospital of León (NW Spain) Microbiology and Parasitology Service, 32 (4%) were tested positive for Aeromonas spp. Mixed infections with other enteric pathogens occurred in 12 patients. A. caviae was isolated from 23 clinical specimens. There were also patients infected with A. media, A. hydrophila, A. bestiarum, and A. veronii biovar veronii. All but three isolates carried one or more of the virulence genes. The incidence of the alt, hlyA, aerA, ast, and laf genes was 71.9, 28.1, 25.0, 18.8, and 9.4%, respectively. The alt(+)/ast(+) combination was detected in four isolates and the aerA(+)/hlyA(+) combination was detected in the two A. hydrophila isolates. None of the strains harbored the TTSS, stx1, or stx2 genes and nine bore plasmids. Thirty clinical isolates and a collection of 12 A. caviae and A. media strains obtained from León municipal drinking water over the study period were typed by pulsed-field gel electrophoresis (PFGE). PFGE patterns revealed genetic relatedness and persistence over time among water isolates and some clinical isolates. Interestingly, one A. caviae (aerA(-)/hlyA(-)/alt(+)/ast(-)/laf(+)) human isolate and two A. caviae (aerA(-)/hlyA(-)/alt(+)/ast(-)/laf(+)) drinking water isolates had indistinguishable PFGE patterns, suggesting waterborne infection.
We identified the mucus-activatable Shiga toxin genotype stx2d in the most common hemolytic uremic syndrome–associated Escherichia coli serotype, O157:H7. stx2d was detected in a strain isolated from a 2-year-old boy with bloody diarrhea in Spain, and whole-genome sequencing was used to confirm and fully characterize the strain.
The incidence of tuberculosis in humans due to Mycobacterium caprae is very low and is almost confined to Europe. We report a case of a previously healthy 41-year-old Moroccan with a 6 month history of abdominal pain, weight loss, fatigue and diarrhea. A diagnosis of peritoneal tuberculosis due to M. caprae was made.
In children, cervical lymphadenitis is the most common type of infection caused by non-tuberculous mycobacteria. The isolated species are frequently identified as M. avium, M. scrofulaceum, and M. malmoense; they often cause indolent cervical adenitis and the treatment of choice is radical excision. [1][2][3][4] In recent times, new mycobacteria species have been described: M. lentiflavum, M. interjectum, which cause lymphadenitis in children as in the case presented here. [1][2][3][4][5][6] A 2-year-old boy presented with a 3-month history of a 2 Â 2 cm submandibular adenopathy in the right cervical area, which did not remit with antibiotic treatment (amoxicillin-clavulanate). On examination, a tumor was found in the right submandibular region, which was indolent, fluctuant, inflamed and with a high temperature.The patient had not received a BCG vaccination and tested positive (14 mm) on the PPD RT-23 2 TU Mantoux tuberculin test. In blood screening most noteworthy was: Leucocytes 9500 (37% neutrophyles, 49% lymphocytes, and 10% monocytes) and a globular sedimentation rate of 62.In the neck ultrasound examination, in the right submandibular region, a small irregular lump was appreciated, which went from the adenopathy with necrosis to the surface of the skin.Due to suspicion of tuberculous adenopathy, treatment was initiated with rifampicin, isoniazid, and pyrazinamide for 9 months.The drainage liquid of the adenopathy was sent to the laboratory resulting in negative staining and cultures. The remitted sample was decontaminated using the N-acetyl-L-cysteine-NaOH method, it was cultured in a Löwenstein-Jensen medium and inoculated in a liquid medium BACTEC MGIT 960 System (Mycobacteria growth indicator tube: Becton Dickinson, Heidelberg, Germany). After 4 weeks of incubation in the liquid medium, a scotochromogenic mycobacteria grew which was sent to the National Microbiology Centre of Majadahonda for its molecular typing and antimicrobial sensibility.The isolate was identified by phenotipic and genotypic methods. We performed a subculture on Löwenstein-Jensen and observed smooth colonies of about 1-2 mm in diameter, with bright yellow pigmentation after 3 weeks of incubation at 378C. The growing was inhibited at 22 and 428C. The majority of the biochemical tests were negative (niacin production, Tween-80 hydrolysis, tolerance for NaCl 5%, nitrate reductase, arylsulfatase, and urease). Only two tests were positive, the tellurite reduction and weakly the heat-stable catalase test. The genetic studies were performed by PCR-RFLP of hsp65 gene. 7 The analyzed strain showed two fragments (sized 240 and 210 bp) and two fragments (sized 130 and 110 bp) by BstEll and Haell restriction enzyme digestion, respectively. The size of the fragments corresponds to M. Interjectum.The identification was confirmed by sequencing of 16S rRNA gen. The DNA sequence of the 1,514 bp 16S rRNA region was amplified using the primer described by Springer et al. 8 The PCR conditions were those described previously by Kirschner et al. 9 The se...
Fascioliasis is a parasitic zoonosis caused by Fasciola flukes. Humans are accidental hosts that become infected via the consumption of aquatic vegetables or water with metacercariae (1). The clinical manifestations in the chronic phase are colicky pain, jaundice, cholecystitis, cholangitis and biliary obstruction (1-3).
BackgroundEnteroaggregative Escherichia coli (EAEC) is increasingly associated with domestically acquired diarrheal episodes in high-income countries, particularly among children. However, its specific role in endemic diarrhea in this setting remains under-recognized and information on molecular characteristics of such EAEC strains is limited. We aimed to investigate the occurrence of EAEC in patients with non-travel related diarrhea in Spain and molecularly characterize EAEC strains associated with illness acquired in this high-income setting.MethodsIn a prospective multicenter study, stool samples from diarrheal patients with no history of recent travel abroad (n = 1,769) were collected and processed for detection of EAEC and other diarrheagenic E. coli (DEC) pathotypes by PCR. An additional case–control study was conducted among children ≤5 years old. Whole-genome sequences (WGS) of the resulting EAEC isolates were obtained.ResultsDetection of DEC in the study population. DEC was detected in 23.2% of patients aged from 0 to 102 years, with EAEC being one of the most prevalent pathotypes (7.8%) and found in significantly more patients ≤5 years old (9.8% vs. 3.4%, p < 0.001). Although not statistically significant, EAEC was more frequent in cases than in controls. WGS-derived characterization of EAEC isolates. Sequence type (ST) 34, ST200, ST40, and ST10 were the predominant STs. O126:H27, O111:H21, and O92:H33 were the predominant serogenotypes. Evidence of a known variant of aggregative adherence fimbriae (AAF) was found in 89.2% of isolates, with AAF/V being the most frequent. Ten percent of isolates were additionally classified as presumptive extraintestinal pathogenic E. coli (ExPEC), uropathogenic E. coli (UPEC), or both, and belonged to clonal lineages that could be specifically associated with extraintestinal infections.ConclusionEAEC was the only bacterial enteric pathogen detected in a significant proportion of cases of endemic diarrhea in Spain, especially in children ≤5 years old. In particular, O126:H27-ST200, O111:H21-ST40, and O92:H33-ST34 were the most important subtypes, with all of them infecting both patients and asymptomatic individuals. Apart from this role as an enteric pathogen, a subset of these domestically acquired EAEC strains revealed an additional urinary/systemic pathogenic potential.
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