RESUMO
The species included in the ESKAPE group (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and the genus Enterobacter) have a high capacity to develop antimicrobial resistance (AMR), a health problem that is already among the leading causes of death and could kill 10 million people a year by 2050. The generation of new potentially therapeutic molecules has been insufficient to combat the AMR "crisis", and the World Health Organization (WHO) has stated that it will seek to promote the development of rapid diagnostic strategies. The physicochemical properties of metallic nanoparticles (MNPs) have made it possible to design biosensors capable of identifying low concentrations of ESKAPE bacteria in the short term; other systems identify antimicrobial susceptibility, and some have been designed with dual activity in situ (bacterial detection and antimicrobial activity), which suggests that, in the near future, multifunctional biosensors could exist based on MNPs capable of quickly identifying bacterial pathogens in clinical niches might become commercially available. This review focuses on the use of MNP-based systems for the rapid and accurate identification of clinically important bacterial pathogens, exhibiting the necessity for exhaustive research to achieve these objectives. This review focuses on the use of metal nanoparticle-based systems for the rapid and accurate identification of clinically important bacterial pathogens.
Assuntos
Técnicas Biossensoriais , Klebsiella pneumoniae , Nanopartículas Metálicas , Staphylococcus aureus , Nanopartículas Metálicas/química , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Staphylococcus aureus/efeitos dos fármacos , Acinetobacter baumannii/efeitos dos fármacos , Pseudomonas aeruginosa/efeitos dos fármacos , Enterococcus faecium , Farmacorresistência Bacteriana , Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Diagnóstico Precoce , Enterobacter/efeitos dos fármacosRESUMO
Burkholderia cepacia complex (Bcc) is a bacterial group with 'natural' multi-antimicrobial resistance. This complex has generated epidemic outbreaks across the world. In people with cystic fibrosis (CF), Bcc can cause severe lung infections that lead to accelerated lung damage, which can be complicated by necrotizing pneumonia accompanied by high fevers, leucocytosis, and bacteraemia, which commonly causes fatal outcomes. Specifically, infection by Burkholderia cenocepacia is considered an exclusion criterion for lung transplantation. The species of Bcc exhibit both genetic and phenotypic hypervariability that complicate their accurate microbiological identification. Automated methods such as MALDI-TOF can err in the determination of species. Their slow growth even in selective agars and the absence of international consensuses on the optimal conditions for their isolation make early diagnosis a difficult challenge to overcome. The absence of correlations between antibiograms and clinical results has resulted in the absence of standardized cut-off values of antimicrobial susceptibility, a fact that brings a latent risk since incorrect antibiotic therapy can induce the selection of more aggressive variants that worsen the clinical picture of the host, added to the absence of a clear therapeutic guide for the eradication of pulmonary infections by Bcc in patients with CF, resulting in frequently ineffective treatments. There is an urgent need to standardize methods and diagnostic tools that would allow an early and accurate diagnosis, as well as to perform clinical studies of the effectiveness of available antibiotics to eradicate Bcc infections, which would allow us to establish standardized therapeutic schemes for Bcc-infected patients.
Assuntos
Bacteriemia , Complexo Burkholderia cepacia , Fibrose Cística , Transplante de Pulmão , Humanos , AntibacterianosRESUMO
BACKGROUND: Patients with cystic fibrosis (CF) have airway inflammation that contributes to symptoms and to pulmonary function derangement. Current drugs used to diminish airway inflammation improve the clinical and spirometric status of patients with CF, but their use is limited due to their undesired side effects, for example, glucose intolerance, growth retardation, and cataracts with corticosteroids, gastrointestinal toxicity with ibuprofen, and macrolide resistance with azythromycin. Glycine is known to decrease activation of inflammatory cells, including alveolar macrophages and neutrophils, and is relatively inexpensive, palatable, and virtually devoid of untoward effects. These features make glycine a good candidate for antiinflammatory treatment of CF. Thus, we aimed to explore whether glycine can exert a beneficial effect in a population of patients with CF. METHODS: This was a randomized, double blinded, cross-over pilot clinical trial. Subjects with CF received, in random order, oral glycine (0.5 g/kg/day, dissolved in any liquid) and placebo (glass sugar), each during 8 weeks with an intermediate 2-week wash-out period. RESULTS: Thirteen subjects aged 6-23 years, 8 females, completed the two arms of the study. As compared with placebo, after glycine intake patients had better symptom questionnaire scores (p = 0.02), mainly regarding sputum features and dyspnea. While spirometric variables tended to decline during placebo intake, they remained stable or even increased during glycine treatment (p = 0.04 to p = 0.003). In this context, FEV1 declined 8.6% after placebo and increased 9.7% at the end of the glycine period. Pulse oximetry improved after glycine intake (p = 0.04 vs. placebo). TNF-α in serum and IL-6 and G-CSF in sputum tended to decline at the end of the glycine period (p = 0.061, p = 0.068 and p = 0.04, respectively, vs placebo). Glycine was remarkably well tolerated. CONCLUSIONS: The clinical, spirometric and inflammatory status of subjects with CF improved after just 8 weeks of glycine intake, suggesting that this amino acid might constitute a novel therapeutic tool for these patients. Thus, further studies are warranted. TRIAL REGISTRATION: www.clinicaltrials.gov , registration number: NCT01417481 , date of registration: March 12, 2012.
Assuntos
Anti-Inflamatórios/farmacologia , Fibrose Cística/tratamento farmacológico , Fibrose Cística/fisiopatologia , Glicina/farmacologia , Pulmão/fisiopatologia , Administração Oral , Adolescente , Anti-Inflamatórios/administração & dosagem , Biomarcadores/sangue , Criança , Estudos Cross-Over , Método Duplo-Cego , Feminino , Volume Expiratório Forçado , Glicina/administração & dosagem , Humanos , Inflamação/tratamento farmacológico , Pulmão/efeitos dos fármacos , Masculino , Neutrófilos/efeitos dos fármacos , Projetos Piloto , Espirometria , Adulto JovemRESUMO
OBJECTIVES: This study was designed to explore whether parental activities such as repairing cars, welding, and rebuilding car batteries are risk factors for lead poisoning among Cuban refugee children in Miami-Dade County. METHODS: The authors performed a cross-sectional study of 479 children aged 12-83 months who had lived in Cuba during the six months prior to immigrating to the U.S. Lead levels were obtained, and parents provided information on demographics, home/neighborhood environment in Cuba prior to immigration, family/occupational factors prior to immigration, and child behavior factors. RESULTS: Of 479 children, 30 (6.3%) had elevated blood lead levels (EBLLs), defined as > or = 10 microg/dL, based on the Centers for Disease Control and Prevention action level. In multivariate analysis, racial/ethnic identification other than white, living in a home built after 1979, car repair in the home or yard, eating paint chips, and male sex were independently associated with EBLL. CONCLUSIONS: Risk factors for lead poisoning among immigrant children may differ from those among U.S.-born children. Screening of immigrant children who may have been exposed in their country of origin and education of immigrant parents about lead exposure hazards associated with activities such as car repair should be considered in the design of lead poisoning prevention and control programs.
Assuntos
Emigração e Imigração/estatística & dados numéricos , Intoxicação por Chumbo/etnologia , Refugiados/estatística & dados numéricos , Distribuição por Idade , Criança , Pré-Escolar , Estudos Transversais , Cuba/etnologia , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Exposição Ambiental/prevenção & controle , Feminino , Habitação/estatística & dados numéricos , Humanos , Incidência , Lactente , Intoxicação por Chumbo/sangue , Intoxicação por Chumbo/diagnóstico , Intoxicação por Chumbo/prevenção & controle , Modelos Logísticos , Masculino , Programas de Rastreamento , Análise Multivariada , Vigilância da População , Prevalência , Características de Residência , Medição de Risco , Fatores de Risco , Distribuição por Sexo , Inquéritos e Questionários , Estados Unidos/epidemiologia , Saúde da População Urbana/estatística & dados numéricosRESUMO
Presentamos el caso de un lactante con neumopatía crónica cuya madre tuvo leucorrea en último trimestre del embarazo y posteriormente al parto. El ejemplo de pruebas rápidas y específicas para la detección del antígeno mediante técnicas de ELISA e inmunofluorescencia directa, tanto de las secreciones bronquiales de la paciente como en las cervicovaginales de la madre, permitió diagnosticar neumonía por Chlamydia trachomatis adquirida al momento del nacimiento. Se empleó claritromicina durante 14 días consecutivos, y se obtuvo mejoría clínica con erradicación de la bacteria de la vía aérea de la paciente. Es el primer caso informado en México de neumonía por Chlamydia trachomatis tratado con éxito con claritromicina. El seguimiento de la paciente permitió documentar cuadros leves de hiperreactividad bronquial