RESUMO
Polymorphisms in the CAMP gene (cathelicidin) have not been tested in tuberculosis susceptibility. We tested polymorphisms rs9844812 (HIF-1α::ARNT binding site) and rs56122065 (CAMP) plus rs1800972 (DEFB1). SNP rs1800972 was associated with extrapulmonary tuberculosis (EPTB) in a codominant model (genotype CG, P = 0.037, OR 4.82; 95% CI: 0.92-47.42; statistical power, 82%), but not PTB (P = 0.101) in a Mexican population.
Assuntos
Peptídeos Catiônicos Antimicrobianos/genética , Predisposição Genética para Doença , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Polimorfismo Genético , Tuberculose/genética , Regiões 5' não Traduzidas , Alelos , Sequência de Aminoácidos , Peptídeos Catiônicos Antimicrobianos/química , Translocador Nuclear Receptor Aril Hidrocarboneto/genética , Translocador Nuclear Receptor Aril Hidrocarboneto/metabolismo , Sequência de Bases , Sítios de Ligação , Estudos de Casos e Controles , Éxons , Frequência do Gene , Genótipo , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Dados de Sequência Molecular , Motivos de Nucleotídeos , Polimorfismo de Nucleotídeo Único , Matrizes de Pontuação de Posição Específica , Regiões Promotoras Genéticas , Ligação Proteica , Tuberculose/metabolismo , Tuberculose Pulmonar/genética , Tuberculose Pulmonar/metabolismo , beta-Defensinas/genética , CatelicidinasRESUMO
OBJECTIVES: To describe the prevalence of baseline drug-resistance mutations, resistance to antiretroviral drugs, and the subsequent virological response to therapy in treatment-naïve patients from Mexico with established HIV-1 infection. METHODS: Resistance testing was performed on plasma samples from antiretroviral-naïve patients. Data on mutations associated with antiretroviral drug resistance were obtained using Stanford software (http://hivdb.stanford.edu). RESULTS: Ninety-six treatment-naïve individuals were enrolled in the study during 2002-2003. Of these, 83 patients (86%) had at least one resistance mutation and 15 (16%) had drug resistance. At baseline, the mean plasma viral load was 299 834 HIV-1 RNA copies/mL, and at follow-up it was 37 620 copies/mL (P<0.0001). Primary mutations in the reverse transcriptase region were observed in 15% of patients. For nucleoside inhibitors, mutations T215Y/C and F77L (3%) and D67N/S, T69N and M184V (2%), were detected. For nonnucleoside inhibitors, mutations K103N/R (6%), Y181C (3%) and G190A (2%) were detected. Overall, 6% of patients showed resistance to delavirdine and nevirapine, 4% to efavirenz, and 2% to lamivudine and nelfinavir. Twelve patients showed no response to treatment and three of these patients had antiretroviral drug resistance. CONCLUSIONS: The prevalence of baseline drug-resistance mutations found in this study was similar to that found in previous reports for newly HIV-infected individuals, although access to and management of antiretrovirals in Mexico are different.
Assuntos
Farmacorresistência Viral/genética , Infecções por HIV/virologia , HIV-1/genética , Mutação , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Feminino , Seguimentos , Infecções por HIV/tratamento farmacológico , Protease de HIV/genética , Transcriptase Reversa do HIV/antagonistas & inibidores , Transcriptase Reversa do HIV/genética , HIV-1/efeitos dos fármacos , HIV-1/isolamento & purificação , Humanos , Masculino , Estudos Prospectivos , RNA Viral/sangue , Inibidores da Transcriptase Reversa/uso terapêutico , Resultado do Tratamento , Carga ViralRESUMO
Resistance of Mycobacterium tuberculosis to antimycobacterial agents is a worldwide problem. The proposite of this study was to analyze the current resistance patterns of patients with initial episodes, as well as relapses, due to M. tuberculosis in western Mexico. From January 1993 to February 1999 a total of 237 strains of M. tuberculosis (120 from initial cases and 117 from relapse cases) were analyzed. Two hundred and four (86%) strains were isolated from the lower respiratory tract, and 33 strains (14%) from extrapulmonary sites. Twenty-three percent of M. tuberculosis isolated from patients with initial episodes were resistant to both isoniazid and rifampin, and 52% of M. tuberculosis isolated from relapse cases were also resistant to both isoniazid and rifampin.
Assuntos
Antituberculosos/farmacologia , Isoniazida/farmacologia , Mycobacterium tuberculosis/efeitos dos fármacos , Rifampina/farmacologia , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose/microbiologia , Resistência Microbiana a Medicamentos , Resistência a Múltiplos Medicamentos , Humanos , México/epidemiologia , Testes de Sensibilidade Microbiana/métodos , Mycobacterium tuberculosis/isolamento & purificação , Recidiva , Tuberculose/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/microbiologiaRESUMO
BACKGROUND: Bacteriuria > or = 10(5) CFU/ml is evidence of urinary tract infection in the absence of associated signs or symptoms. The presence of pyuria with asymptomatic bacteriuria established the response of elderly women against microorganisms capable of causing invasiveness or tissue injury of the urinary tract. METHODS: The association between bacteriuria and pyuria was determined in 178 elderly, ambulatory women without symptoms of urinary tract infection in seven nursing homes. Urine culture results were subsequently analyzed in conjunction with absolute leukocyte count in urine. In this cross-sectional study, asymptomatic bacteriuria in elderly women was classified with and without pyuria. RESULTS: The prevalence of asymptomatic bacteriuria was found in 44 (24.7%) elderly women. The presence of pyuria had a sensitivity of 63.6% for bacteriuria and a specificity of 91%. The positive predictive value for the presence of pyuria predicting those with bacteriuria was 70%, and the negative predictive value for the absence of pyuria predicting those without bacteriuria was 88.4%. Escherichia coli was the most common organism isolated in 81.8% of the women. CONCLUSIONS: Bacteriuria > or 10(5) CFU/ml associated with pyuria was detected in 77% of elderly women with asymptomatic urinary tract infections. Bacteriuria of < 10(5) CFU/ml with pyuria proves less sensitive as an indicator of urinary tract infection. Elderly women with pyuria but without bacteriuria should be studied for other causes of urinary tract inflammation.
Assuntos
Bacteriúria/epidemiologia , Piúria/epidemiologia , Infecções Urinárias/diagnóstico , Idoso , Bacteriúria/etiologia , Bacteriúria/microbiologia , Estudos Transversais , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/epidemiologia , Feminino , Humanos , México/epidemiologia , Casas de Saúde , Valor Preditivo dos Testes , Piúria/etiologia , Piúria/microbiologia , Infecções Urinárias/complicações , Infecções Urinárias/microbiologiaRESUMO
The aim of this study was to compare the safety and efficacy of lomefloxacin, a new difluornated quinolone, with those of amoxicillin in the treatment of acute exacerbations of chronic bronchitis caused by Gram-negative bacteria. The study was conducted as a multicenter, randomized, single-blind comparison in four countries (Argentina, Colombia, Mexico and Venezuela). In total, 163 evaluable patients were assessed-82 in the lomefloxacin group and 81 in the amoxicillin group. Patients received oral therapy with either 40 mg lomefloxacin once daily or 500 mg amoxicillin three times daily for 10 days. The most frequent bacterial pathogens isolated included: Haemophilus influenzae, Moraxella catarrhalis, Pseudomonas aeruginosa and Klebsiella pneumoniae. The overall clinical success rates (cure plus improvement) were 93.9% in the lomefloxacin group and 81.5% in the amoxicillin group. The eradication rate was 81.7% in the lomefloxacin group and 75.3% in the amoxicillin group. Most of the clinical and bacteriological failures in both groups were associated with P. aeruginosa in baseline sputum cultures. In conclusion, once-daily lomefloxacin is a safe and effective treatment for acute exacerbations of chronic bronchitis caused by Gram-negative pathogens.
RESUMO
The purpose of this study was to compare the safety and efficacy of lomefloxacin with that of cefaclor in the treatment of adult secondary bacterial skin and skin structure infections. The study was conducted as a randomized, single-blind comparison. Eighty patients enrolled in the study, of which 74 were evaluable: 37 patients in the lomefloxacin group and 37 in the cefaclor group. Patients received either 400 mg of lomefloxacin orally once daily or 250 mg of cefaclor orally three times daily for 12 days. The most frequent pathogens isolated included Staphylococcus aureus, Streptococcus pyogenes, coagulase-negative staphylococci, and Escherichia coli. The clinical response was similar in both groups (89.1%). The bacteriologic eradication rate was 100% in the lomefloxacin group and 94.5% in the cefaclor group. Adverse events were minimal. Once-daily lomefloxacin is a safe and effective treatment for secondary bacterial skin and skin structure infections caused by susceptible pathogens.
RESUMO
Infections caused by Salmonella typhi are commonly followed by a chronic carrier state despite positive clinical and initial bacteriologic responses. The use of primary antibiotics like chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole has several major drawbacks, including in some instances the failure to prevent the carrier state. The appearance worldwide of strains with multiple resistance to the most commonly used regimens has prompted the search for new forms of therapy. Among the agents studied have been third-generation cephalosporins and quinolones, which are active in vitro against bacterial enteropathogens like S. typhi. Resolution of chronic carriage of S. typhi and other salmonellae is difficult, and regimens commonly fail (including those that combine antibiotic administration with removal of the gallbladder). In addition to being active in vitro against Salmonella species, the newer quinolones adequately penetrate the intestinal lumen, liver, bile, and gallbladder. Initial experience with norfloxacin and ciprofloxacin in oral treatment of the chronic S. typhi carrier state in adults has been promising.