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Complementary feeding (CF) is defined as the feeding of infants that complements breastfeeding, or alternatively, feeding with a breast milk substitute, and is a process that is more than simply a guide as to what and how to introduce foods. The information provided by healthcare professionals must be up-to-date and evidence-based. Most of the recommendations that appear in the different international guidelines and position papers are widely applicable, but some must be regionalized or adapted to fit the conditions and reality of each geographic zone. The Nutrition Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) summoned a group of experts from each of the society's member countries, to develop a consensus on CF, incorporating, whenever possible, local information adapted to the reality of the region. The aim of the present document is to show the results of that endeavor. Utilizing the Delphi method, a total of 34 statements on relevant aspects of CF were evaluated, discussed, and voted upon.
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Gastroenterologia , Lactente , Criança , Feminino , Humanos , Cocos , Consenso , América Latina , Fenômenos Fisiológicos da Nutrição do LactenteRESUMO
BACKGROUND: The outbreak of SARS-CoV-2 abruptly disseminated in early 2020, overcoming the capacity of health systems to respond the pandemic. It was not until the vaccines were launched worldwide that an increase in survival was observed. The objectives of this study were to analyse the characteristics of survivors and their relationship with comorbidities. We had access to a database containing information on 16,747 hospitalized patients from Mexico, all infected with SARS-CoV-2, as part of a regular follow-up. The descriptive analysis looked for clusters of either success or failure. We categorized the samples into no comorbidities, or one and up to five coexisting with the infection. We performed a logistic regression test to ascertain what factors were more influential in survival. The main variable of interest was survival associated with multimorbidity factors. The database hosted information on hospitalized patients from Mexico between March 2020 through to April 2021. Categories 2 and 3 had the largest number of patients. Survival rates were higher in categories 0 (64.8%), 1 (57.5%) and 2 (51.6%). In total, 1741 (10.5%) patients were allocated to an ICU unit. Mechanical ventilators were used on 1415 patients, corresponding to 8.76%. Survival was recorded in 9575 patients, accounting for 57.2% of the sample population. Patients without comorbidities, younger people and women were more likely to survive.
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Objectives: Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major public health concerns globally. Enhanced AMR surveillance for gonococci is essential worldwide; however, recent quality-assured gonococcal AMR surveillance in Latin America, including Brazil, has been limited. Our aims were to (i) establish the first nationwide gonococcal AMR surveillance, quality assured according to WHO standards, in Brazil, and (ii) describe the antimicrobial susceptibility of clinical gonococcal isolates collected from 2015 to 2016 in all five main regions (seven sentinel sites) of Brazil. Methods: Gonococcal isolates from 550 men with urethral discharge were examined for susceptibility to ceftriaxone, cefixime, azithromycin, ciprofloxacin, benzylpenicillin and tetracycline using the agar dilution method, according to CLSI recommendations and quality assured according to WHO standards. Results: The levels of resistance (intermediate susceptibility) to tetracycline, ciprofloxacin, benzylpenicillin and azithromycin were 61.6% (34.2%), 55.6% (0.5%), 37.1% (60.4%) and 6.9% (8.9%), respectively. All isolates were susceptible to ceftriaxone and cefixime using the US CLSI breakpoints. However, according to the European EUCAST cefixime breakpoints, 0.2% (n = 1) of isolates were cefixime resistant and 6.9% (n = 38) of isolates had a cefixime MIC bordering on resistance. Conclusions: This study describes the first national surveillance of gonococcal AMR in Brazil, which was quality assured according to WHO standards. The high resistance to ciprofloxacin (which promptly informed a revision of the Brazilian sexually transmitted infection treatment guideline), emerging resistance to azithromycin and decreasing susceptibility to extended-spectrum cephalosporins necessitate continuous surveillance of gonococcal AMR and ideally treatment failures, and increased awareness when prescribing treatment in Brazil.
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Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla , Gonorreia/epidemiologia , Testes de Sensibilidade Microbiana , Neisseria gonorrhoeae/efeitos dos fármacos , Vigilância de Evento Sentinela , Adulto , Azitromicina/farmacologia , Brasil/epidemiologia , Ceftriaxona/farmacologia , Ciprofloxacina/farmacologia , Gonorreia/urina , Humanos , Masculino , Neisseria gonorrhoeae/isolamento & purificação , Adulto JovemRESUMO
Leishmania spp. are distributed throughout the world, and different species are associated with varying degrees of disease severity. In Brazil, Leishmania transmission involves several species of phlebotomine sand flies that are closely associated with different parasites and reservoirs, and thereby giving rise to different transmission cycles. Infection occurs during the bloodmeals of sand flies obtained from a variety of wild and domestic animals, and sometimes from humans. The present study focused on detection of Leishmania DNA in phlebotomine sand flies from a cave in the state of Minas Gerais. Detection of Leishmania in female sand flies was performed with ITS1 PCR-RFLP (internal transcribed spacer 1) using HaeIII enzyme and genetic sequencing for SSUrRNA target. The survey of Leishmania DNA was carried out on 232 pools and the parasite DNA was detected in four: one pool of Lutzomyia cavernicola (Costa Lima, 1932), infected with Le. infantum (ITS1 PCR-RFLP), two pools of Evandromyia sallesi (Galvão & Coutinho, 1939), both infected with Leishmania braziliensis complex (SSUrRNA genetic sequencing analysis), and one pool of Sciopemyia sordellii (Shannon & Del Ponte, 1927), infected with subgenus Leishmania (SSUrRNA genetic sequencing analysis). The present study identified the species for Leishmania DNA detected in four pools of sand flies, all of which were captured inside the cave. These results represent the first molecular detection of Lu cavernicola with Le infantum DNA, Sc sordellii with subgenus Leishmania DNA, and Ev sallesi with Leishmania braziliensis complex DNA. The infection rate in females captured for this study was 0.17%.
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Leishmania/isolamento & purificação , Psychodidae/parasitologia , Animais , Brasil , Cavernas , DNA de Protozoário/genética , DNA Espaçador Ribossômico/genética , Feminino , Leishmania/genética , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Análise de Sequência de DNA , Especificidade da EspécieRESUMO
INTRODUCTION: Probiotics are frequently prescribed in clinical practice. Their efficacy in treating gastrointestinal disorders is supported by a significant number of clinical trials. However, the correct prescription of these agents is hampered due to a lack of knowledge of the scientific evidence and to the different presentations and microbial compositions of the probiotics that are currently available. AIM: To provide the clinician with a consensus review of probiotics and recommendations for their use in gastroenterology. MATERIALS AND METHODS: Controlled clinical trials, meta-analyses, and systematic reviews published up to 2015 were selected, using the MESH terms: probiotics, gastrointestinal diseases, humans, adults, AND children. The Delphi method was employed. Eighteen gastroenterologists treating adult patients and 14 pediatric gastroenterologists formulated statements that were voted on until agreement>70% was reached. The level of evidence based on the GRADE system was evaluated for each statement. RESULTS AND CONCLUSIONS: Eleven statements on the general concepts of probiotics and 27 statements on the use of probiotics in gastrointestinal diseases in both adults and children were formulated. The consensus group recommends the use of probiotics under the following clinical conditions: the prevention of diarrhea associated with antibiotics, the treatment of acute infectious diarrhea, the prevention of Clostridium difficile infection and necrotizing enterocolitis, the reduction of adverse events from Helicobacter pylori eradication therapy, relief from irritable bowel syndrome symptoms, the treatment of functional constipation in the adult, and the induction and maintenance of remission in patients with ulcerative colitis and pouchitis, and the treatment of covert and overt hepatic encephalopathy.
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Gastroenterologia , Probióticos/uso terapêutico , Adulto , Criança , Consenso , Técnica Delphi , Guias como Assunto , Humanos , MéxicoRESUMO
SETTING: Human immunodeficiency virus (HIV) infection may impact tuberculosis (TB) diagnosis, clinical presentation and treatment outcomes in children as the signs and symptoms of both diseases overlap. OBJECTIVE: To compare the sociodemographic and clinical profiles of childhood TB according to HIV status in Brazil. METHODS: This was a cross-sectional study of data on subjects aged <15 years retrieved from the Brazilian National Electronic Disease Registry (Sistema de Informação de Agravos de Notificação) database on TB to compare TB-HIV coinfected patients and patients with TB only registered between 2007 and 2011. A hierarchical logistic regression model was applied. RESULTS: Of 6091 cases analysed, 780 (12%) were TB-HIV patients, while 5311 (87%) presented with TB only. TB-HIV patients were more likely to be institutionalised (OR 2.22, 95%CI 1.43-3.46), to present with relapsed TB (OR 5.03, 95%CI 2.02-12.5) and be readmitted after treatment default (OR 16.7, 95%CI 4.34-64.46). They were also more likely to have unfavourable outcomes, including default (OR 2.85, 95%CI 1.81-4.49), death due to TB (OR 2.76, 95%CI 1.27-6.03) and death from other causes (OR 5.59, 95%CI 2.63-11.8). CONCLUSION: Our study highlights the challenges of using national registers for research into childhood TB.
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Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Tuberculose/epidemiologia , Adolescente , Brasil/epidemiologia , Criança , Saúde da Criança , Pré-Escolar , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , Estudos Transversais , Bases de Dados Factuais , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Análise Multivariada , Fatores de Risco , Resultado do Tratamento , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológicoRESUMO
INTRODUCTION: Conservative treatment with intralesional interferon (IFN) is a therapeutic option for cervical intraepithelial neoplasia (CIN) patients of childbearing age. MATERIALS AND METHODS: The study group was made up of patients diagnosed with a high-grade lesion and treated with intralesional human recombinant IFNalpha-2b. Vaginal secretion was collected during IFNalpha-2b treatment for analysis of cytokines and viral load. RESULTS: The initial histology diagnostic was 62.5% (n = 5) with CIN 2 and 37.5% (n = 3) with CIN 3. In terms of clinical evaluation and anatomopathology, 6.5% (n = 5) had a good clinical response, while 37.5% (n = 3) had therapeutic failure. All the patients with therapeutic failure were smokers. Interleukin 6 and tumor necrosis factor-alpha concentrations were raised at the sixth application for the patient group who failed to respond to therapy compared to the responsive group (p = 0.0357). Patients with a good response exhibited a reduction in human papillomavirus viral load (p = 0.03). CONCLUSIONS: Patients that had a good response had lower concentrations of inflammatory cytokines than did non-responders.
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Antineoplásicos/uso terapêutico , Interferon-alfa/uso terapêutico , Displasia do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/tratamento farmacológico , Vagina/metabolismo , Adulto , Citocinas/metabolismo , DNA Viral/análise , Feminino , Citometria de Fluxo , Humanos , Interferon alfa-2 , Interferon-alfa/administração & dosagem , Pessoa de Meia-Idade , Papillomaviridae/genética , Estudos Prospectivos , Proteínas Recombinantes , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia , Vagina/patologia , Vagina/virologia , Esfregaço Vaginal , Displasia do Colo do Útero/patologia , Displasia do Colo do Útero/virologiaRESUMO
Pseudomonas aeruginosa infections cause significant mortality and morbidity in health care settings. Strategies to prevent and control the emergence and spread of P. aeruginosa within hospitals involve implementation of barrier methods and antimicrobial stewardship programs. However, there is still much debate over which of these measures holds the utmost importance. Molecular strain typing may help elucidate this issue. In our study, 71 nosocomial isolates from 41 patients and 23 community-acquired isolates from 21 patients were genotyped. Enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) was performed. Band patterns were compared using similarity coefficients of Dice, Jaccard and simple matching. Strain similarity for nosocomial strains varied from 0.14 to 1.00 (Dice); 0.08 to 1.00 (Jaccard) and 0.58 to 1.00 (simple matching). Forty patterns were identified. In most units, several clones coexisted. However, there was evidence of clonal dissemination in the high risk nursery, neurology and two surgical units. Each and every community-acquired strain produced a unique distinct pattern. Results suggest that cross transmission of P. aeruginosa was an uncommon event in our hospital. This points out to a minor role for barrier methods in the control of P. aeruginosa spread.
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Humanos , Infecção Hospitalar , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/isolamento & purificação , Reação em Cadeia da Polimerase/métodosRESUMO
Pseudomonas aeruginosa infections cause significant mortality and morbidity in health care settings. Strategies to prevent and control the emergence and spread of P. aeruginosa within hospitals involve implementation of barrier methods and antimicrobial stewardship programs. However, there is still much debate over which of these measures holds the utmost importance. Molecular strain typing may help elucidate this issue. In our study, 71 nosocomial isolates from 41 patients and 23 community-acquired isolates from 21 patients were genotyped. Enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) was performed. Band patterns were compared using similarity coefficients of Dice, Jaccard and simple matching. Strain similarity for nosocomial strains varied from 0.14 to 1.00 (Dice); 0.08 to 1.00 (Jaccard) and 0.58 to 1.00 (simple matching). Forty patterns were identified. In most units, several clones coexisted. However, there was evidence of clonal dissemination in the high risk nursery, neurology and two surgical units. Each and every community-acquired strain produced a unique distinct pattern. Results suggest that cross transmission of P. aeruginosa was an uncommon event in our hospital. This points out to a minor role for barrier methods in the control of P. aeruginosa spread.(AU)
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Humanos , Pseudomonas aeruginosa , Doenças Endêmicas , Infecção Hospitalar/complicaçõesRESUMO
Foram avaliados os achados microbiológicos do lavado traqueobrônquico, obtido por coleta transtraqueal, de 65 equinos com sintomas de alteração do sistema respiratório e de 25 equinos assintomáticos (grupo controle) encaminhados ao HOVET - USP. No grupo controle somente oito dos 25 animais não apresentaram crescimento de patógenos nas amostras obtidas, enquanto que no grupo que incluiu oito equinos portadores de broncopneumonia bacteriana (12,3%dos animais estudados) houve crescimento em 100% das amostras, destacando-se Streptococcus alfa-hemolítico. A técnica mostrou-se eficiente, porém mais estudos precisam ser conduzidos tanto em equinos saudáveis como naqueles portadores de afecções do sistema respiratório com o propósito de aperfeiçoar o uso de tal exame complementar no diagnóstico definitivo de doenças respiratórias em equinos.SummaryThis study evaluated the microbiological aspects of tracheobronchial washes obtained through tracheal puncture of 25 healthy horses and 65 horses with respiratory distress admitted to the Hospital Veterinario (HOVET, USP). In the control group, only 8 of the 25 animals did not present bacterial growth in the obtained samples. F
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This study evaluated the microbiological aspects of tracheobronchial washes obtained through tracheal puncture of 25 healthy horses and 65 horses with respiratory distress admitted to the Hospital Veterinario (HOVET, USP). In the control group, only 8 of the 25 animals did not present bacterial growth in the obtained samples. Furthermore, the group that included eight horses with bacterial bronchopneumonia (12.3% of the animals studied) presented bacterial growth in 100% of the samples, with special attention to Streptococcus alpha-hemolyticus. The technique proved to be efficient, but more research is needed to improve its use as a complementary exam on the diagnosis of equine respiratory disorders.
Foram avaliados os achados microbiológicos do lavado traqueobrônquico, obtido por coleta transtraqueal, de 65 equinos com sintomas de alteração do sistema respiratório e de 25 equinos assintomáticos (grupo controle) encaminhados ao HOVET - USP. No grupo controle somente oito dos 25 animais não apresentaram crescimento de patógenos nas amostras obtidas, enquanto que no grupo que incluiu oito equinos portadores de broncopneumonia bacteriana (12,3%dos animais estudados) houve crescimento em 100% das amostras, destacando-se Streptococcus alfa-hemolítico. A técnica mostrou-se eficiente, porém mais estudos precisam ser conduzidos tanto em equinos saudáveis como naqueles portadores de afecções do sistema respiratório com o propósito de aperfeiçoar o uso de tal exame complementar no diagnóstico definitivo de doenças respiratórias em equinos.
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Animais , Infecções Respiratórias/microbiologia , Streptococcus/isolamento & purificação , Traqueia/microbiologia , Brônquios/microbiologia , Broncopneumonia/veterinária , Cavalos/microbiologiaRESUMO
Conservative treatment with interferons (IFNs) has the advantage of preserving reproductive capacity in patients with grade 2 or 3 cervical intraepithelial neoplasia (CIN). The objective of this work was to study patients with high-grade CIN treated with intralesional IFN alpha-2b and to analyze the expression of Th1, Th2 and Th3 cytokines in cervical stroma. We observed that patients with a satisfactory response (60%) to treatment with IFN alpha-2b expressed more Th1 (IFN-gamma TNF-alpha, IL-2) cytokines, with a significant reduction in the viral load of high-risk human papillomavirus (p = 0.0313). All patients with therapeutic failure were smokers and had higher expression of cytokines Th2 (IL-4) or Th3 (TGF-beta2 and TGF-beta3).
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Antivirais/administração & dosagem , Citocinas/metabolismo , Interferon-alfa/administração & dosagem , Displasia do Colo do Útero/tratamento farmacológico , Displasia do Colo do Útero/metabolismo , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/metabolismo , Adolescente , Adulto , Feminino , Humanos , Injeções Intralesionais , Interferon alfa-2 , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Proteínas Recombinantes , Falha de Tratamento , Neoplasias do Colo do Útero/patologia , Adulto Jovem , Displasia do Colo do Útero/patologiaRESUMO
Interferons were initially described in terms of their role in blocking viral replication. They are important cytokines that act on various aspects of cell physiology. Importantly, they can affect cell proliferation or induce the differentiation of neoplastic cells. The exact way in which the interferon complex (IFN) acts on tumours is still unknown, although their use in clinical practice has been widely recommended, especially with tumours that are resistant to conventional treatments, or in situations where surgical removal might lead to a loss of organ function. IFN can be employed as a treatment for various chronic diseases, including tumours. Indeed interferon cytokines are the therapy of choice in certain situations. However, one of the difficulties yet to be overcome is the need for frequent administrations of the drug. We believe that the development of new formulations is needed to match the demand for its use in oncology treatment.
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Neoplasias da Mama/tratamento farmacológico , Interferon Tipo I/uso terapêutico , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias da Mama/imunologia , Feminino , Humanos , Imunidade Humoral/imunologia , Transdução de Sinais/imunologia , Neoplasias do Colo do Útero/imunologiaRESUMO
Although effective strategies for preventing cancer of the uterine cervix exist, this disease continues to be a serious health problem worldwide, especially in developing countries. Today, the role of human papillomavirus (HPV) as a causal factor for the emergence of cervical cancer and its precursor lesions is well established, and prevention programs against cervical cancer are based on detecting cervical intraepithelial neoplasia (CIN). HPV present immunological evasion mechanisms that inhibit detection of the virus by the host, which may result in persistent chronic infection and irrevocably comprise the host defenses. Conization is the surgical technique most used for treating high-grade CIN, since it makes it possible to exclude invasive neoplasia, evaluate resection margins and preserve fertility. However, several factors have been considered to be indicators for residual disease. This review had the aim of covering some factors relating to persistence and recurrence of high-grade CIN following conization.
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Recidiva Local de Neoplasia/virologia , Infecções por Papillomavirus/complicações , Displasia do Colo do Útero/virologia , Neoplasias do Colo do Útero/virologia , Conização , Feminino , Infecções por HIV/complicações , Humanos , Recidiva Local de Neoplasia/cirurgia , Neoplasias do Colo do Útero/cirurgia , Displasia do Colo do Útero/cirurgiaRESUMO
A 7-year-old Mexican boy with end-stage cirrhosis underwent liver transplantation and was maintained with cyclosporine and prednisolone. No specific data about Toxoplasma gondii or cytomegalovirus (CMV) infections in the cadaver donor were available. The recipient was seronegative for Toxoplasma, but CMV-IgG positive before transplantation. Ganciclovir was administered for prophylaxis during 3 months, but 5 months later he presented with icterus and increased transaminases. Acute transplant rejection was ruled out by biopsy. A seroconversion for T. gondii IgM and IgG and a small increase in CMV-IgM antibodies were observed, although the CMV-polymerase chain reaction (PCR) was negative. Ganciclovir was re-started, and the patient improved, but 6 months later he relapsed, and chorioretinitis lesions compatible both with T. gondii and CMV infections appeared. Pyrimethamine, sulfadiazine, folinic acid, and ganciclovir were administered. The boy showed favorable clinical improvement and remained stable for 12 months. Then, new retinal CMV lesions appeared in both eyes and the PCR for CMV became positive; therefore, the patient received a new regimen of ganciclovir, and clinically improved. From these data we concluded that the child presented a reactivation of CMV and a primary infection with T. gondii after transplantation.
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Infecções por Citomegalovirus/parasitologia , Citomegalovirus/isolamento & purificação , Transplante de Fígado , Complicações Pós-Operatórias/parasitologia , Complicações Pós-Operatórias/virologia , Toxoplasma/isolamento & purificação , Toxoplasmose/virologia , Animais , Antivirais/uso terapêutico , Criança , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/virologia , Ganciclovir/uso terapêutico , Humanos , Masculino , Toxoplasmose/parasitologiaRESUMO
SETTING: Four hundred and sixty-eight isoniazid (INH) resistant Mycobacterium tuberculosis isolates recovered from a selected Brazilian population. OBJECTIVE: To check for susceptibility to other chemotherapeutic drugs used in TB treatment, and to ascertain mutations involved in INH and rifampicin (RMP) resistance. DESIGN: Antimicrobial susceptibility to RMP, streptomycin and ethambutol (EMB) was evaluated by the resistance ratio method and pyrazinamide (PZA) by activity assay. Single strand conformation polymorphism (SSCP) and sequence analysis were performed in samples from this panel to confirm mutations in codon 315 of the katG and in a 69-bp region of the rpoB gene. RESULTS: Combined resistance to INH+RMP, INH+ PZA, INH+EMB, and INH+RMP+PZA was shown in respectively 272 (58.1%), 126 (26.9%), 47 (10%), 116 (24.8%) isolates. No katG mutation was found in 19 (39.6%) of 48 strains tested. Ser315Thr substitution was found in 29 (60.4%). All RMP-resistant strains tested (n = 25) showed rpoB mutations. S531L substitution was found in 15 (60%). CONCLUSION: INH-resistant strains isolated from selected Brazilian populations frequently show resistance to other first-line anti-tuberculosis drugs. rpoB mutation was responsible for RMP resistance in all strains. Among INHr strains, katG mutations were shown in only 60.4%. Genetic approaches targeting the rpoB gene but not the katG gene have a high sensitivity to detect resistance among Brazilian M. tuberculosis strains.
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Antituberculosos/farmacologia , Isoniazida/farmacologia , Mycobacterium tuberculosis/genética , Rifampina/farmacologia , Proteínas de Bactérias/genética , Brasil , Catalase/genética , Análise Mutacional de DNA , RNA Polimerases Dirigidas por DNA/genética , Resistência Microbiana a Medicamentos , Humanos , Mycobacterium tuberculosis/patogenicidade , Polimorfismo Conformacional de Fita Simples , Prevalência , Análise de Sequência de DNA , Tuberculose Resistente a Múltiplos MedicamentosRESUMO
Mycobacterium avium is an important pathogen among immunodeficient patients, especially patients with AIDS. The natural history of this disease is unclear. Several environmental sources have been implicated as the origin of this infection. Polyclonal infection with this species is observed, challenging the understanding of its pathogenesis and treatment. In the present study 45 M. avium strains were recovered from 39 patients admitted to a reference hospital between 1996 and 1998. Species identification was performed using a species-specific nucleic acid hybridization test (AccuProbe«) from Gen-Probe«. Strains were genotyped using IS1245 restriction fragment length polymorphism typing. Blood was the main source of the organism. In one patient with disseminated disease, M. avium could be recovered more than once from potentially sterile sites. Strains isolated from this patient had different genotypes, indicating that the infection was polyclonal. Four patient clones were characterized in this population, the largest clone being detected in eight patients. This finding points to a common-source transmission of the organism
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Humanos , Infecções Oportunistas Relacionadas com a AIDS , Técnicas de Tipagem Bacteriana , Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare , Polimorfismo de Fragmento de RestriçãoRESUMO
Mycobacterium avium is an important pathogen among immunodeficient patients, especially patients with AIDS. The natural history of this disease is unclear. Several environmental sources have been implicated as the origin of this infection. Polyclonal infection with this species is observed, challenging the understanding of its pathogenesis and treatment. In the present study 45 M. avium strains were recovered from 39 patients admitted to a reference hospital between 1996 and 1998. Species identification was performed using a species-specific nucleic acid hybridization test (AccuProbe) from Gen-Probe. Strains were genotyped using IS1245 restriction fragment length polymorphism typing. Blood was the main source of the organism. In one patient with disseminated disease, M. avium could be recovered more than once from potentially sterile sites. Strains isolated from this patient had different genotypes, indicating that the infection was polyclonal. Four patient clones were characterized in this population, the largest clone being detected in eight patients. This finding points to a common-source transmission of the organism.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Técnicas de Tipagem Bacteriana , Complexo Mycobacterium avium/genética , Humanos , Complexo Mycobacterium avium/classificação , Infecção por Mycobacterium avium-intracellulare/microbiologia , Polimorfismo de Fragmento de RestriçãoRESUMO
O objetivo deste trabalho foi estudar a presença de bactérias aeróbias em 20 cäes com osteomielite, decorrente de exposiçäo óssea. Na identificaçäo das bactérias utilizou-se o sistema API-Bio Mérieux e testou-se a sensibilidade dos microrganismos in vitro, pelo método de difusäo em ágar, frente a 14 diferentes antibacterianos. O osso mais acometido pela infecçäo foi a tíbia (35 por cento). Isolaram-se 68,3 por cento de bactérias Gram positivas e 31,7 por cento de Gram negativas. Staphylococcus spp, Streptococcus spp e Enterococcus spp foram os gêneros mais freqüentes, representando respectivamente 34,1 por cento, 14,6 por cento e 14,6 por cento do total de bactérias (41 cepas). Enterobactérias foram isoladas em 26,8 por cento das amostras. Os cocos Gram positivos apresentaram maior sensibilidade à amoxicilina associada ao ácido clavulânico. Os microrganismos Gram negativos, tanto as bactérias da família Enterobacteriaceae como as do gênero Pseudomonas, apresentaram altos índices de resistência