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Recent evidence suggests that Pseudomonas aeruginosa, a bacterium that has the ability to cause deadly infections in hospitalized patients, could originate in the patient's own flora. We employed the Oxford Nanopore platform to obtain whole genome sequences (WGS) from clinical and rectal screen P. aeruginosa strains belonging to 15 patients from two hospitals. Our study found evidence that clinical and rectal isolates were clonal, with some evidence suggesting that the infecting strain was present in the patient's intestine at the time of admission, ruling out hospital acquisition. The use of WGS analysis is crucial to detect alternative sources of P. aeruginosa to develop new preventive measures against these serious infections.

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INTRODUCTION: The functional consequences of the bacterial gut microbiome for child health are not well understood. Characteristics of the early child gut microbiome may influence the course of enteric infections, and enteric infections may change the composition of the gut microbiome, all of which may have long-term implications for child growth and development. METHODS AND ANALYSIS: We are conducting a community-based birth cohort study to examine interactions between gut microbiome conditions and enteric infections, and how environmental conditions affect the development of the gut microbiome. We will follow 360 newborns from 3 sites along a rural-urban gradient in northern coastal Ecuador, characterising enteric infections and gut microbial communities in the children every 3 to 6 months over their first 2 years of life. We will use longitudinal regression models to assess the correlation between environmental conditions and gut microbiome diversity and presence of specific taxa, controlling for factors that are known to be associated with the gut microbiome, such as diet. From 6 to 12 months of age, we will collect weekly stool samples to compare microbiome conditions in diarrhoea stools versus stools from healthy children prior to, during and after acute enteric infections, using principal-coordinate analysis and other multivariate statistical methods. ETHICS AND DISSEMINATION: Ethics approvals have been obtained from Emory University and the Universidad San Francisco de Quito institutional review boards. The findings will be disseminated through conference presentations and peer-reviewed journals.

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Pregnancy outcomes and women's health are directly affected by vaginal microbiota. This microbiota consists of a dynamic ecosystem of various microbes in different ratios, which in healthy conditions protect the vaginal epithelium from infections. However, cases of vaginal infection are regularly diagnosed in women of reproductive age, contributing to more severe outcomes. Therefore, our main goal was to determine the prevalence of bacterial vaginosis (BV), aerobic vaginitis (AV), and vulvovaginal candidiasis (VVC) among Ecuadorian pregnant and non-pregnant women. A cross-sectional study was conducted among 217 women between 13 and 40 years old seeking primary healthcare in Carlos Andrade Marin Hospital (HCAM), Gynecological-Obstetric Hospital Isidro Ayora (HGOIA) and Center for Teaching Health Cipriana Dueñas during October 2018 to February 2019. The classical characterization of the vaginal microbiota was performed through microscopy by the Nugent criteria to evaluate the presence of BV, healthy and intermediate microbiota, by the criteria of Donders to determine the presence of AV and by the Marot-Leblond criteria to diagnose VVC. DNA extraction from vaginal samples and Polymerase Chain Reaction (PCR) analysis was performed to characterize the presence of Gardnerella spp., Mobiluncus mulieris, Escherichia coli, Enterococcus spp., and Lactobacillus spp. Finally, quantification of the lactobacilli was performed by quantitative real-time PCR (qPCR) for samples from women with normal vaginal microbiota and women with AV. Our results showed 52% of women with healthy microbiota, 7% with intermediate microbiota, and 41% with vaginal dysbiosis, comprising 27% with AV, 8% with BV and 4% with VVC and 2% with co-infections or co-dysbiosis. Additionally, a higher amount of lactobacilli were found in pregnant women when compared to non-pregnant women, while AV cases were characterized by a significant drop of Lactobacillus spp., more precisely, between 1E3 and 1E5 colony forming units (CFU)/ml. Finally, women with normal vaginal microbiota showed an average load of lactobacilli between 1E6 and 1E7 CFU/ml. This pilot study showed no statistically significant differences between pregnant and non-pregnant women, pointing to the possibility to use lactobacilli quantification for the prevention of future vaginal infections.

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Objetivo: determinar el valor diagnóstico de anticuerpos IgG anti-Helicobacter pylori ante sospecha clínica de enfermedad ácido-péptica en adultos jóvenes. Sujetos y métodos: estudiantes de la Carrera de Medicina de la Universidad Central del Ecuador que consintieron participar en una encuesta en línea y extracción de sangre venosa que fue sometida a una prueba inmunoenzimática para detección de anticuerpos. Resultados: se incluyeron 225 partícipes con un una edad promedio de 20 años; el estudio inmunoenzomático fue positivo en el 32,88% de muestras. La existencia de IgG anti-H. pylori no se relacionó estadísticamente a la presencia o ausencia de antecedentes patológicos personales, familiares o sociales. La acumulación de dos o tres síntomas no se relacionó con el hallazgo serológico. Conclusión: las pruebas serológicas para diagnóstico de gastritis o para tamizaje no son adecuadas para éste grupo de edad, toda vez que su positividad no se relaciona a síntomas, factores de riesgo conocidos de infección gástrica o desarrollo de patologías

Aims: to determine the diagnostic value of anti-Helicobacter pylori IgG antibodies in case of clinical suspicion of acid-peptic disease in young adults. Subjects and methods: students of the Medicine School of the Central University of Ecua- dor who agreed to participate in an online survey and venous blood collection that was sub- jected to an immunoenzymatic test for antibody detection. Results: 225 participants with an average age of 20 years were included; the immunoen- zomatic study was positive in 32.88% of samples. The existence of IgG anti H.pylori was not statistically related to the presence or absence of personal, family or social pathological his- tory. The accumulation of two or three symptoms was not related to the serological finding. Conclusion: serological tests for diagnosis of gastritis or screening are not suitable for this age group, since its positivity is not related to symptoms, known risk factors of gastric infec- tion or development of pathologies.

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BACKGROUND: Bacterial vaginosis (BV) is a microbial imbalance (i.e., dysbiosis) that can produce serious medical effects in women at childbearing age. Little is known, however, about the incidence of BV or vaginal microbiota dysbiosis in pregnant teenagers in low and middle-income countries such as Ecuador. The scope of this exploratory analysis was to study the relationship between epidemiologic and microbial risk factors. Among the microbiology risk factors this study investigated five Lactobacillus species, two of them know in preview studies as microbiology risk factors for BV development (Lactobacillus acidophilus and Lactobacillus iners), and the last three known for being associated with a healthy vaginal tract (Lactobacillus crispatus, Lactobacillus gasseri and Lactobacillus jensenii). In addition, fastidious anaerobes known to be microbial risk factors for BV development in pregnant teenagers were searched as well, more exactly, Gardnerella vaginalis, Atopobium vaginae and Mobiluncus mulieris. METHODS: Ninety-five healthy adolescent pregnant women, visiting a secondary level hospital in Quito, Ecuador, were enrolled into the study in 2015. The enrolled patients were between 10 to 13 weeks of pregnancy. Four epidemiological risk factors were collected in a survey: age, civil status, sexual partners and condom use. Also, vaginal pH was measured as a health risk factor. DNA was extracted from endocervical and exocervical epithelia from all the patients' samples. PCR analysis was performed in order to characterize the presence of the eight bacterial species known as risk factors for BV development, targeting three anaerobes and five Lactobacillus species. Univariate and multivariate analysis were performed to identify associated factors for the presence of anaerobic species using logistic regression. RESULTS: The 95 vaginal microflora samples of these teenagers were analyzed. Two of the bacterial species known to cause BV: A. vaginae (100%) and G. vaginalis (93.7%) were found in high prevalence. Moreover, the most predominant bacterial Lactobacillus species found in the pregnant teenagers' vaginal tract were L. crispatus (92.6%), L. iners (89.5%) and L. acidophilus (87.4%). In addition, the average vaginal pH measured in the study population was 5.2, and high pH was associated with the presence of the three-anaerobic species (p = 0.001). Finally, L. jensenii's presence in the study decreased in 72% the occupation of the three anaerobes. DISCUSSION: This work identified a high pH as a risk factor for BV anaerobes' presence in adolescent pregnant women. Moreover, this study identified L. crispatus, L. iners and L. acidophilus to be the most abundant species in our study population. From all fastidious anaerobes analyzed in this study, A. vaginae was present in all pregnant teenagers. To conclude, L. jensenii could be a potential healthy vaginal microbiota candidate in pregnant teenagers and should be further analyzed in future studies.

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Resumen Introducción. La Streptococcus pyogenes causa infecciones supurativas en la piel, en las mucosas y de carácter sistémico. Su detección oportuna es importante para evitar el desarrollo de complicaciones no supurativas. Además, el estado de portador puede ser una fuente potencial de autoinoculación o de brotes infecciosos. Objetivo. Determinar la presencia de estudiantes de medicina en estado de portador de S. pyogenes mediante dos métodos diagnósticos. Materiales y métodos. Se realizó un estudio de corte transversal con muestreo por conveniencia donde se analizaron muestras de orofaringe por inmunoensayo enzimático StrepA y cultivo bacteriano en agar base sangre de cordero al 5% más pruebas diferenciales con el objetivo de detectar la presencia de S. pyogenes. Resultados. De 77 muestras incluidas en el análisis, 3 (3.9%) fueron positivas por el cultivo microbiológico para S. pyogenes y ninguna por el método StrepA. Conclusión. El hallazgo de la bacteria S. pyogenes entre los estudiantes de medicina asintomáticos alerta de un potencial infeccioso. En la comparación de los métodos diagnósticos para su detección, los hallazgos validan el uso del cultivo sobre el del StrepA, en el caso de que se desee estimar la presencia de portadores de dicho agente.

Abstract Introduction: Streptococcus pyogenes causes suppurative skin, mucosal and systemic infections. Timely detection is important to avoid the development of nonsuppurative complications. In addition, carrier status can be a potential source of autoinoculation or infectious outbreaks. Objective: To establish the status as S. pyogenes carriers of medical students using two diagnostic methods. Materials and methods: A cross-sectional study was carried out with convenience sampling, in which samples from the oropharynx were analyzed by enzyme Strep-A immunoassay and bacterial culture on sheep blood agar at 5%, plus differential tests to detect the presence of S. pyogenes. Results: Out of 77 samples included in the analysis, 3 (3.9%) were positive for the microbiological culture for S. pyogenes and none for the Strep-A method. Conclusion: Finding the bacterium S. pyogenes among asymptomatic medical students is a warning sign of a potential infection. The comparison of the diagnostic methods for detection showed that the findings validate the use of the culture over Strep-A, if estimating the presence of carriers of said agent is desired.

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Continued success in decreasing diarrheal disease burden requires targeted interventions. To develop such interventions, it is crucial to understand which pathogens cause diarrhea. Using a case-control design we tested stool samples, collected in both rural and urban Ecuador, for 15 pathogenic microorganisms. Pathogens were present in 51% of case and 27% of control samples from the urban community, and 62% of case and 18% of control samples collected from the rural community. Rotavirus and Shigellae were associated with diarrhea in the urban community; co-infections were more pathogenic than single infection; Campylobacter and Entamoeba histolytica were found in large numbers in cases and controls; and non-typhi Salmonella and enteropathogenic Escherichia coli were not found in any samples. Consistent with the Global Enteric Multicenter Study, focused in south Asia and sub-Saharan Africa, we found that in Ecuador a small group of pathogens accounted for a significant amount of the diarrheal disease burden.

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