RESUMO
We subtyped Brazilian Yersinia pestis strains by pulsed-field gel electrophoresis (PFGE). This was done with 22 Brazilian Y. pestis strains: 17 from an outbreak and 5 from endemic routine surveillance. The strains were divided into 2 groups (I and II), 8 subgroups (A-H) and 19 PFGE profiles or pulsotypes. PFGE did not separate outbreak from non-outbreak strains, as identical pulsotype patterns were found among outbreak strains and strains obtained from surveillance. However, it was able to detect intraspecific genetic diversity among Brazilian strains. This PFGE technique was able to differentiate a homogeneous group of Brazilian Y. pestis strains.
Assuntos
Yersinia pestis/classificação , Técnicas de Tipagem Bacteriana , Brasil , Análise por Conglomerados , Eletroforese em Gel de Campo Pulsado , Geografia , Reprodutibilidade dos Testes , Yersinia pestis/genéticaRESUMO
A review is presented of 20 patients consecutively operated on for acute valvular endocarditis. The diagnosis was established from at least two of the criteria: (a) typical clinical features, (b) two blood cultures positive for the same causal microorganism, and (c) echocardiographic evidence of vegetations. In all cases there was histologic evidence of active infection in the surgical specimen. Only three of the 20 patients had no previous cardiac disease. The most common causal agent was Staphylococcus aureus. The indications for surgery were refractory cardiac failure or infection (18 and 2 cases, respectively). Aortic valve replacement was performed in 16 of the 20 cases, suggesting that aortic valvulopathy aggravates the course of infective endocarditis and increases the risk of heart failure. The overall mortality rate was 30%. All surviving patients were infection-free at postoperative bacteriologic follow-up. Surgery is considered to be the management of choice in active valvular, therapy-resistant bacterial endocarditis with or without cardiac failure.