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Id: biblio-1008023
Autor: Cruz Camino, Cristina; Paredes, Patricio; Patiño Gualichico, Luis.
Título: Staphylococcus aureus meticilino resistente comunitario, Hospital de Niños Baca Ortiz / Community methicilin-resistant Staphylococcus aureus; Baca Ortiz Children´s Hospital
Fonte: Cambios rev. méd;14(24):82-85, abr. 2015. ilus.
Idioma: es.
Resumo: Introducción: las infecciones debidas a Staphylococcus aureus adquiridos en la comunidad (MRSA-AC) están aumentando significativamente a nivel mundial. Su virulencia se caracteriza principalmente por la presencia de la leucocidina Panton- Valentine. Caso: en la siguiente revisión presentamos dos casos clínicos en niños ecuatorianos que tuvieron cuadros infecciosos con las características de MRSA-AC con el objetivo de analizar la importancia del estudio de sensibilidad de los antibióticos para S. aureus adquiridas en la comunidad, lo que determina un manejo adecuado y temprano en la terapéutica de estas infecciones.

Introduction: infections due to community-acquired Staphylococcus aureus (MRSA -AC) are increasing signifcantly worldwide. Its virulence is mainly characterized by the presence of Panton- Valentine Leukocidin. This study pretends to analyze the importance of studying antibiotic sensitivity of community- acquired S. aureus, which determines appropriate management and early treatment of these infections. Case study: we present two cases in Ecuadorian children who had the characteristics of MRSA-AC.
Descritores: Virulência
Criança
Staphylococcus aureus Resistente à Meticilina
Infecções
Leucocidinas
Antibacterianos
-Características de Residência
América Latina
Meticilina
Limites: Humanos
Masculino
Criança
Tipo de Publ: Relatos de Casos
Responsável: EC162.1


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Texto completo SciELO Brasil
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Id: biblio-828162
Autor: Zurita, Jeannete; Barba, Pedro; Ortega-Paredes, David; Mora, Marcelo; Rivadeneira, Sebastián.
Título: Local circulating clones of Staphylococcus aureus in Ecuador
Fonte: Braz. j. infect. dis;20(6):525-533, Nov.-Dec. 2016. tab, graf.
Idioma: en.
Resumo: ABSTRACT The spread of pandemic Staphylococcus aureus clones, mainly methicillin-resistant S. aureus (MRSA), must be kept under surveillance to assemble an accurate, local epidemiological analysis. In Ecuador, the prevalence of the USA300 Latin American variant clone (USA300-LV) is well known; however, there is little information about other circulating clones. The aim of this work was to identify the sequence types (ST) using a Multiple-Locus Variable number tandem repeat Analysis 14-locus genotyping approach. We analyzed 132 S. aureus strains that were recovered from 2005 to 2013 and isolated in several clinical settings in Quito, Ecuador. MRSA isolates composed 46.97% (62/132) of the study population. Within MRSA, 37 isolates were related to the USA300-LV clone (ST8-MRSA-IV, Panton-Valentine Leukocidin [PVL] +) and 10 were related to the Brazilian clone (ST239-MRSA-III, PVL−). Additionally, two isolates (ST5-MRSA-II, PVL−) were related to the New York/Japan clone. One isolate was related to the Pediatric clone (ST5-MRSA-IV, PVL−), one isolate (ST45-MRSA-II, PVL−) was related to the USA600 clone, and one (ST22-MRSA-IV, PVL−) was related to the epidemic UK-EMRSA-15 clone. Moreover, the most prevalent MSSA sequence types were ST8 (11 isolates), ST45 (8 isolates), ST30 (8 isolates), ST5 (7 isolates) and ST22 (6 isolates). Additionally, we found one isolate that was related to the livestock associated S. aureus clone ST398. We conclude that in addition to the high prevalence of clone LV-ST8-MRSA-IV, other epidemic clones are circulating in Quito, such as the Brazilian, Pediatric and New York/Japan clones. The USA600 and UK-EMRSA-15 clones, which were not previously described in Ecuador, were also found. Moreover, we found evidence of the presence of the livestock associated clone ST398 in a hospital environment.
Descritores: Infecções Estafilocócicas/microbiologia
Staphylococcus aureus/genética
Toxinas Bacterianas/genética
Exotoxinas/genética
Leucocidinas/genética
Antibacterianos/farmacologia
-Staphylococcus aureus/isolamento & purificação
Staphylococcus aureus/classificação
DNA Bacteriano
Testes de Sensibilidade Microbiana
Prevalência
Fatores de Virulência/genética
Equador
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação
Staphylococcus aureus Resistente à Meticilina/classificação
Staphylococcus aureus Resistente à Meticilina/genética
Tipagem de Sequências Multilocus
Genótipo
Limites: Humanos
Masculino
Feminino
Recém-Nascido
Lactente
Pré-Escolar
Criança
Adolescente
Adulto
Pessoa de Meia-Idade
Idoso
Idoso de 80 Anos ou mais
Adulto Jovem
Responsável: BR1.1 - BIREME


  3 / 20 LILACS  
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Id: biblio-1038370
Autor: Gong, Zongrong; Shu, Min; Xia, Qing; Tan, Shan; Zhou, Wei; Zhu, Yu; Wan, Chaomin.
Título: Portación nasal deStaphylococcus aureus y sus perfiles de resistencia a antibióticos en niños que viven en zonas de gran altitud del sudoeste de China / Staphylococcus aureus nasal carriage and its antibiotic resistance profiles in children in high altitude areas of Southwestern China
Fonte: Arch. argent. pediatr;115(3):274-277, jun. 2017.
Idioma: en; es.
Resumo: Antecedentes/Objetivo. Describir el perfil epidemiológico de la portación nasal de cepas de Staphylococcus aureus (S. aureus), su resistencia a antibióticos y la presencia de los genes de leucocidina de Panton-Valentine (LPV) y mecA en niños en edad escolar que viven en zonas de gran altitud del sudoeste de China. Métodos. En el estudio transversal, se analizaron hisopados nasales de estudiantes a fin de detectar S. aureus. Se realizó la prueba de la reacción en cadena de la polimerasa (RCP) para identificar los genes de LPV y mecA. Resultados. Del total de 314 niños, se detectó S. aureus en el 5,10% (16/314). La resistencia de las cepas aisladas a la penicilina, eritromicina, clindamicina, rifampicina y cefoxitina fue del 100%, 81,3%, 81,3%, 0,0% y 6,3%, respectivamente. Ninguna de las cepas mostró resistencia a la vancomicina. Se detectó la expresión del gen mecA en 3 cepas aisladas, y 10 cepas aisladas dieron resultado positivo para el gen de LPV. Conclusión. Se detectó S. Aureus en el 5,10% (16/314) de la población del estudio; el 0,96% (3 /314) presentó S. Aureus resistente a la meticilina (SARM). Además, se detectó la expresión de los genes de LPV y mecA en 10 y 3 cepas aisladas, respectivamente.

Background/Aim. To describe the epidemiological profile of nasal carriage of Staphylococcus aureus (S. aureus) strains, its antibiotic resistance and mecA and Panton Valentine leukocidin (PVL) genes presence, in school children residing in high altitude areas of Southwestern China. Methods. The cross sectional study screened nasal swabs taken from students for S. aureus. PCR was performed to identify mecA and PVL genes. Results. Of the total 314 children 5.10% (16/314) was detected S. aureus. The resistance of isolated strains to penicillin, erythromycin, clindamycin, rifampicin and cefoxitin was 100%, 81.3%, 81.3%, 0.0%, and 6.3% respectively. No strains demonstrated resistance to vancomycin; expression of mecA gene was detected in 3 isolates and 10 isolates were PVL-positive. Conclusion. S. aureus was detected in 5.10% (16/314) of the study population; 0.96% (3/314) had methicillin resistant S. aureus (MRSA); expression of the mecA and PVL genes were detected in 3 and 10 isolates respectively.
Descritores: Staphylococcus aureus/efeitos dos fármacos
Portador Sadio/microbiologia
Nariz/microbiologia
Altitude
-Staphylococcus aureus/isolamento & purificação
Staphylococcus aureus/genética
Proteínas de Bactérias/genética
Toxinas Bacterianas/genética
China
Estudos Transversais
Farmacorresistência Bacteriana
Proteínas de Ligação às Penicilinas/genética
Exotoxinas/genética
Leucocidinas/genética
Limites: Humanos
Masculino
Feminino
Criança
Responsável: AR94.1 - Centro de Información Pediatrica


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Id: biblio-838248
Autor: Brizuela, Martín; Pérez, Guadalupe; Ruvinsky, Silvina; Sarkis, Claudia; Romero, Romina; Mastroianni, Alejandra; Casimir, Lidia; Venuta, María E; Gómez Bonduele, Verónica; Bologna, Rosa.
Título: Infección grave por Staphylococcus aureus meticilino sensible productor de leucocidina de Panton-Valentine: reportes de dos casos / Severe infection by methicillin sensitive Staphylococcus aureus producing Panton-Valentine leukocidin: reports of two cases
Fonte: Arch. argent. pediatr;114(4):e237-e240, ago. 2016. ilus.
Idioma: es.
Resumo: Staphylococcus aureus es uno de los principales agentes etiológicos de infecciones en niños provenientes de la comunidad y del ámbito hospitalario. La gravedad de estos cuadros se asocia a factores de virulencia, entre los que se encuentra la leucocidina de Panton-Valentine. Tanto Staphylococcus aureus resistente como sensible a la meticilina producen esta leucocidina, aunque con frecuencia variable. Presentamos a dos niños con infección grave por Staphylococcus aureus sensible a la meticilina productor de leucocidina de Panton-Valentine con complicaciones osteoarticulares y endovasculares. Es fundamental la sospecha diagnóstica, el tratamiento antibiótico adecuado y el manejo quirúrgico precoz para mejorar el abordaje de estas infecciones. Se debe mantener la vigilancia epidemiológica para detectar la frecuencia de las infecciones causadas por estas bacterias.

Staphylococcus aureus is a major etiologic agent of infections in children from the community and the hospital setting. The severity of these conditions is associated with virulence factors, including the Panton-Valentine leukocidin. Both methicillin resistant and sensitive Staphylococcus aureus produce this leukocidin although with varying frequency. We present two children with severe infection by sensitive Staphylococcus aureus producer of Panton-Valentine leukocidin with musculoskeletal and endovascular complications. It is essential the suspected diagnosis, appropriate antibiotic treatment and early surgical management to improve the approach of these infections. Epidemiological surveillance should be mantained to detect the frequency of infections caused by these bacteria.
Descritores: Infecções Estafilocócicas/diagnóstico
Infecções Estafilocócicas/microbiologia
Infecções Estafilocócicas/terapia
Staphylococcus aureus/efeitos dos fármacos
Staphylococcus aureus/metabolismo
Toxinas Bacterianas/biossíntese
Exotoxinas/biossíntese
Leucocidinas/biossíntese
Meticilina/farmacologia
Antibacterianos/farmacologia
-Índice de Gravidade de Doença
Testes de Sensibilidade Microbiana
Limites: Humanos
Masculino
Feminino
Criança
Tipo de Publ: Relatos de Casos
Responsável: AR94.1 - Centro de Información Pediatrica


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Id: biblio-838186
Autor: Karli, Arzu; Yanik, Keramettin; Paksu, Muhammet S; Sensoy, Gulnar; Aykanat, Alper; Yener, Nazik; Belet, Nursen; Ceyhan, Meltem.
Título: Infección diseminada por Staphylococcus aureus positivo para leucocidina de Panton-Valentine en un niño / Disseminated Panton-Valentine Leukocidin-Positive Staphylococcus aureus infection in a child
Fonte: Arch. argent. pediatr;114(2):e75-e77, abr. 2016. ilus.
Idioma: en; es.
Resumo: La leucocidina de Panton-Valentine (LPV) es una exotoxina producida por muchas cepas de Staphylococcus aureus, y un importante factor de virulencia. Una infección por S. aureus positivo para LPV deriva en infecciones rápidas y graves de partes blandas y neumonía necrosante en adolescentes sanos, y la tasa de mortalidad es elevada. Presentamos el caso de un paciente de 12 años hospitalizado por fiebre, dificultad respiratoria y coxalgia en el que se identificó neumonía necrosante con embolia pulmonar séptica, absceso del psoas, celulitis y osteomielitis. En el hemocultivo del paciente se aisló S. aureus sensible a la meticilina (SASM) positivo para LPV.

Panton-Valentine leukocidin (PVL) is an exotoxin that is produced by many strains of Staphylococcus aureus, and an important virulence factor. A PVL-positive S. aureus infection leads to rapid and severe infections of soft tissue and necrotizing pneumonia in healthy adolescents, and has a high mortality. This case report included a 12-year-old male patient who admitted for fever, respiratory distress and hip pain and was identified with necrotizing pneumonia with septic pulmonary embolism, psoas abscess, cellulitis and osteomyelitis. The PVL positive methicillin-sensitive S. aureus (MSSA) was isolated in the patient blood culture.
Descritores: Infecções Estafilocócicas/diagnóstico
Staphylococcus aureus
Toxinas Bacterianas/análise
Infecções Comunitárias Adquiridas
Exotoxinas/análise
Leucocidinas/análise
Limites: Humanos
Masculino
Criança
Tipo de Publ: Relatos de Casos
Responsável: AR94.1 - Centro de Información Pediatrica


  6 / 20 LILACS  
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Id: biblio-1025704
Autor: Al-Naaily, Dheaa Ghanim; Salim, Rana Masheel; Al-Zamily, Aqeel Meer.
Título: Detection of some virulence factors genes in Staphylococcus aureus isolated from different clinical cases
Fonte: Prensa méd. argent;105(2):82-91, apr 2019. tab, fig.
Idioma: en.
Resumo: Staphylococcus aureus is one of the most important pathogenic type to humans, and the most common species responsible for a wide range of diseases such as furuncles, various abscesses, wounds abscesses resulting from surgical operations, dermatitis, soft tissue inflammation, arthritis, bones inflammation, bronchial pneumonia, inflammation of internal parts of the heart and injuries caused by toxins such as toxic shock syndorome and staphylococcus aureus syndrome and food poisoning. The current study aimed by finding the genes responsible for the virulence factors in S. aureus isolates by using the Single and Multiplex PCR mechanism (technology). A total of 60 specimens (urine, burn swabs, wound swaabs) from different clinical cases were collected from patients (in different age groups) who admitted to several health centers in Al-Diwaniyah Teaching Hospital, Iraq, during a period extending from October 2016 to January 2017. Some virulence factors were investigated for 30 isolate only of MRSA using Single and Multiplex PCR for detection virulence factor genes which both coa gene encoding production of coagulase, clfA gene encoding for clumpting factor, spa gene encoding for protein A, fnbA gene encoding for fibronectin binding proteins, luks gene encoding prouction of Panton Valentine Leukocidin (PVL). Results 30 (100%) were possess coa, clfA, spa and fnbA genes, 13 (43.3%) were possess luks gene
Descritores: Manejo de Espécimes/instrumentação
Proteína Estafilocócica A
Staphylococcus aureus/patogenicidade
Registros Médicos/estatística & dados numéricos
Reação em Cadeia da Polimerase
Fibronectinas
Coagulase
Coenzima A/classificação
Fatores de Virulência/genética
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação
Leucocidinas
Limites: Humanos
Tipo de Publ: Estudo Observacional
Responsável: AR392.1 - Biblioteca


  7 / 20 LILACS  
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Id: biblio-996156
Autor: Martín Arsanios, Daniel; Bastidas, Rodrigo Alirio; Chaar Hernández, Aldair; Herazo Cubillos, Andrés; Beltrán Caro, Luis; Vesga Martín, Daniel.
Título: Neumonía adquirida en la comunidad por Staphylococcus aureus resistente a meticilina / Community-Acquired Pneumonia Due to Methicillin-Resistant Staphylococcus aureus
Fonte: Univ. med;58(3), 2017. ilus, tab.
Idioma: es.
Resumo: Los casos de infecciones causadas por Staphylococcus aureus resistente a meticilina han aumentado durante la última década. Dentro de ellas, la neumonía necrotizante (NN) adquirida en la comunidad se ha encontrado en pacientes jóvenes, sanos y sin factores de riesgo, lo que ha generado cuadros de evolución rápida y potencialmente mortales. En este artículo se discuten factores epidemiológicos, fisiopatológicos, de diagnóstico, tratamiento y pronóstico de la NN por Staphylococcus aureus resistente a meticilina adquirida en la comunidad.

The cases oí iníections caused by methicillirvresistant Stapkylococcus aureus have íncreased over the last decade, within them necrotizmg community'acquired pneumonía has been íound in healthy, young and with no risk factors patients, developing dínícal symptoms rapidly evolving and threatening. This artide discussed epidemiológica!, pathophysiological, diagnostic, treatment, and prognosis oí necrotizing pneumonía by Staphyiococcus aureus methicillin resistant communitV' acquired.
Descritores: Staphylococcus aureus
Pneumonia Necrosante/diagnóstico
-Leucocidinas
Tipo de Publ: Revisão
Responsável: CO185.1 - Biblioteca Alfonso Borrero Cabal, S. J.


  8 / 20 LILACS  
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Texto completo SciELO Brasil
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Id: lil-741293
Autor: Bonesso, Mariana Fávero; Marques, Silvio Alencar; Camargo, Carlos Henrique; Fortaleza, Carlos Magno Castelo Branco; Cunha, Maria de Lourdes Ribeiro de Souza da.
Título: Community-associated methicillin-resistant Staphylococcus aureus in non-outbreak skin infections
Fonte: Braz. j. microbiol;45(4):1401-1407, Oct.-Dec. 2014. ilus, tab.
Idioma: en.
Projeto: São Paulo Research Foundation; . CAPES.
Resumo: The aim of this study was to determine the prevalence of Staphylococcus aureus and risk factors for the acquisition of MRSA (Methicillin Resistant Staphylococcus aureus) as the main cause of skin and soft tissue infections. S. aureus were characterized for the presence of PVL, TSST-1 and mecA genes. SCCmec typing was carried out in mecA positive strains and PFGE was performed only in these strains. During the study period, 127 outpatients attending a dermatology clinical the Botucatu Medical School, a regional tertiary hospital in Botucatu, Sao Paulo, Brazil, were diagnosed with active skin infections. A total 66 (56.9%) S. aureus strains were isolated. The methicillin resistance gene mecA was detected in seven (10.6%) S. aureus strains. The SCCmec types detected in the seven mecA-positive S. aureus strains were type Ia in one, type II in three, and type IV in three. The PVL gene was detected in 10 (15.1%) in sensitive strains. Pulsed field gel electrophoresis revealed non-clonal diversity among the isolates. The risk factors associated with MRSA acquisition in this study were previous ciprofloxacin use and working in a healthcare environment. The risk factors indicate plausible routes of CA-MRSA transmission among the subjects studied.
Descritores: Infecções Comunitárias Adquiridas/epidemiologia
Infecções Comunitárias Adquiridas/microbiologia
Surtos de Doenças
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação
Infecções Cutâneas Estafilocócicas/epidemiologia
Infecções Cutâneas Estafilocócicas/microbiologia
-Brasil
Proteínas de Bactérias/genética
Toxinas Bacterianas/genética
Eletroforese em Gel de Campo Pulsado
Enterotoxinas/genética
Exotoxinas/genética
Variação Genética
Leucocidinas/genética
Epidemiologia Molecular
Tipagem Molecular
Staphylococcus aureus Resistente à Meticilina/genética
Prevalência
Fatores de Risco
Pele/microbiologia
Superantígenos/genética
Limites: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Criança
Pré-Escolar
Feminino
Humanos
Lactente
Masculino
Pessoa de Meia-Idade
Adulto Jovem
Tipo de Publ: Research Support, Non-U.S. Gov't
Responsável: BR1.1 - BIREME


  9 / 20 LILACS  
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Id: lil-725903
Autor: López, Nicolás; Orgaz, Cecilia Puig; Notario, Rodolfo; Gambandé, Telma; Luciano, María Isabel; Borda, Noemí.
Título: Portación nasal de staphylococcus aureus meticilino resistentes en poblaciones de la comunidad / Nasal colonization with methicillin-resistant staphylococcus aureus in the community
Fonte: Rev. med. Rosario;80(2):59-62, mayo-ago. 2014. tab.
Idioma: es.
Resumo: Staphylococcus aureus (SA) causa infecciones graves. Las debidas a cepas resistentes a meticilina representan undesafío terapéutico. Actualmente hay un aumento de casos de infecciones de piel y tejidos blandos con inusitadagravedad debidas a S. aureus meticilinorresistentes adquiridos en la comunidad (SAMR AC) pero se desconoce latasa de colonización de la población sana en nuestro medio. El propósito de este trabajo fue determinar la portación nasal en grupos de deportistas y personas que habitan en residencias de ancianos. Se tomaron hisopados nasales de 332 personas, 180 alojados en 4 residencias de ancianos y 152 de 7 grupos de deportistas, los cuales fueron extraídos, conservados y cultivados por los métodos convencionales. La caracterización molecular fue efectuada por PCR buscando el tipo de cassette cromosómico estafilocócico con el gen mecA (SCCmecA) y el gen que codifica la leucocidina de Panton-Valentine. Se asiló SA en 83 pacientes (25%), de los cuales 40 fueron SA meticilinosensibles (21,1%) y 13 SAMR (3,9%). Ocho casos fueron clasificados fenotípicamente y genotípicamente como SAMR AC (2,4%). Todos tenían SCCmecA tipo IV. Es necesaria una atenta vigilancia ya que las infecciones de piel y tejidos blandos de la comunidad no deberían ser tratadas con antibióticos betalactámicos

Staphylococcus aureus isolates are common causes of skin and soft tissue infections and other invasive infections. Those due to methicillin resistant strains represent a therapeutic challenge. Currently there is an increase in cases due to community-acquired methicillin-resistant S. aureus (CA-MRSA) but the rate of colonization of the healthy population is unknown in our country. The purpose of this study was to determine nasal carriage in sportsmen and people living in nursing homes in Rosario. Nasal swabs of 101 people staying in 4 nursing homes and of 98 from 7 groups of athletes were obtained. The samples were extracted, preserved, and cultured by conventional methods. PCR was performed in order to study the type of staphylococcal chromosome cassette mecA (SCCmecA) gene and the gene encoding the Panton-Valentine leukocidin. S. aureus was isolated in 48 patients (24.1%), of which 40 were methicillin-sensitive S. Aureus (20.1 %), and 8 methicillin resistant S. aureus (4.0%). Five cases were characterized phenotypically and genotypically as CA-MRSA (2.5%). All of them had type IV SCCmecA. Careful surveillance is required because skin and soft tissue infections in the community should not be treated with beta-lactam antibiotics
Descritores: Resistência a Meticilina
Staphylococcus aureus
-Resistência Microbiana a Medicamentos
Instituição de Longa Permanência para Idosos
Leucocidinas
Reação em Cadeia da Polimerase
Infecções dos Tecidos Moles
Infecções Cutâneas Estafilocócicas
População Urbana
Limites: Humanos
Masculino
Adolescente
Adulto
Feminino
Criança
Idoso
Idoso de 80 Anos ou mais
Responsável: AR16.1 - Biblioteca


  10 / 20 LILACS  
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Texto completo SciELO Brasil
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Id: lil-712957
Autor: Elisabeth, Paramythiotou; Maria, Souli; Irene, Galani; Helen, Giamarellou; Apostolos, Armaganidis.
Título: Success stories about severe pneumonia caused by Panton-Valentine leucocidin-producing Staphylococcus aureus
Fonte: Braz. j. infect. dis;18(3):341-345, May-June/2014. tab, graf.
Idioma: en.
Resumo: We describe three cases of community-acquired necrotizing pneumonia which were caused by Panton-Valentine leucocidin-producing strains of Staphylococcus aureus (one of them methicillin sensitive). All cases were successfully treated without any sequelae for the patients due to the prompt initiation of adequate antimicrobial therapy. High suspicion toward this fatal pathogen was the key to the successful outcome of the patients.
Descritores: Toxinas Bacterianas/biossíntese
Exotoxinas/biossíntese
Leucocidinas/biossíntese
Pneumonia Estafilocócica/diagnóstico
Staphylococcus aureus/metabolismo
-Infecções Comunitárias Adquiridas/diagnóstico
Infecções Comunitárias Adquiridas/microbiologia
Infecções Comunitárias Adquiridas/patologia
Necrose/microbiologia
Necrose/patologia
Pneumonia Estafilocócica/microbiologia
Pneumonia Estafilocócica/patologia
Índice de Gravidade de Doença
Limites: Adolescente
Adulto
Feminino
Humanos
Masculino
Tipo de Publ: Relatos de Casos
Responsável: BR1.1 - BIREME



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