Vol. 13. Núm. 53.
Páginas 3100-3110 (Abril 2022)

Actualización en otras infecciones bacterianas crónicas: actinomicosis y brucelosis

Update on other chronic bacterial infections: actinomycosis and brucellosis

S. Pascual PérezaI. Tinoco RaceroaE. López TinocoaM.L. Piñero Fernández-Reyesb
Doi : https://10.1016/j.med.2022.03.021
Opciones
Resumen

La actinomicosis es una rara infección granulomatosa producida por bacterias del género Actinomyces. Su diagnóstico, con frecuencia insospechado, se basa en la visualización del germen o de los denominados «gránulos de azufre» en muestras histológicas y/o su aislamiento e identificación microbiológica. Su clínica no es específica y depende de la localización, debiéndose sospechar en infecciones crónicas e indolentes que forman masas o fístulas y simulan neoplasias, ausencia de curación o recidiva tras la administración de antibióticos. De buen pronóstico, el tratamiento es antibiótico, sobre todo penicilinas, en altas dosis y durante tiempo prolongado.

La brucelosis es una zoonosis producida por Brucella spp. La mayor parte de las infecciones ocurren por contacto con ganado o ingestión de lácteos no pasteurizados. Se debe sospechar en un entorno epidemiológico adecuado en pacientes con fiebre prolongada, espondilodiscitis, sacroilitis, orquiepidedimitis, endocarditis con cultivo negativo y meningitis linfocitaria. El diagnóstico depende de la fase de la enfermedad en la que nos encontremos y se basa en métodos directos e indirectos. Para el tratamiento usamos biterapia con tetracicilinas y aminoglucósidos.

Palabras clave
Actinomyces
Brucella
Fiebre de origen indeterminado
Abstract

Actinomycosis is a rare granulomatous infection caused by bacteria of the Actinomyces genus. Its diagnosis, which is often not suspected, is based on visualization of the germ or of the so-called «sulfur granules» in histological samples and/or its isolation and microbiological identification. It produces nonspecific symptoms that depend on its location. It should be suspected in chronic and indolent infections that form masses or fistulas and appear to be neoplasms, lack of a cure, or relapse following the administration of antibiotics. Actinomycosis has a good prognosis. Treatment with antibiotics, especially penicillin, is given at high doses and for a long period of time.

Brucellosis is a zoonosis produced by Brucella spp. Most infections occur due to contact with livestock or intake of non-pasteurized dairy products. It should be suspected in epidemiologically suitable environments in patients with prolonged fever, spondylodiscitis, sacroiliitis, orchiepididymitis, endocarditis with a negative culture, or lymphocytic meningitis. Its diagnosis depends on the disease stage and is based on direct and indirect methods. Combination therapy with tetracyclines and aminoglycosides are used to treat it.

Keywords
Actinomyces
Brucella
Fever of unknown origin

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