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Infections caused by mycobacteria, including Mycobacterium tuberculosis complex (MTBC) and non-tuberculous mycobacteria (NTM), are a major public health issue worldwide. An accurate diagnosis of mycobacterial species is a challenge for surveillance and treatment, particularly in high-burden settings usually associated with low- and middle-income countries. In this study, we analyzed the clinical performance of two commercial PCR kits designed for the identification and differentiation of MTBC and NTM, available in a high-burden setting such as Ecuador. A total of 109 mycobacteria isolates were included in the study, 59 of which were previously characterized as M. tuberculosis and the other 59 as NTM. Both kits displayed great clinical performance for the identification of M. tuberculosis, with 100% sensitivity. On the other hand, for NTM, one of the kits displayed a good clinical performance with a sensitivity of 94.9% (CI 95%: 89-100%), while the second kit had a reduced sensitivity of 77.1% (CI 95%: 65-89%). In conclusion, one of the kits is a fast and reliable tool for the identification and discrimination of MTBC and NTM from clinical isolates.

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Severe pneumonia due to Candida tropicalis infection mainly occurs in immunosuppressed patients or those currently receiving broad-spectrum antibiotics. Herein, we report a case of severe pneumonia caused due to C tropicalis in an elderly patient. A 72-year-old man with a previous history of hypertension, ischemic stroke, and facial paralysis sequelae treated with the botulinic toxin, was admitted to the hospital for dyspnea. Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection was negative. Computed tomography of the chest revealed bilateral consolidation with left predominance. A bronchoalveolar lavage sample was sent to molecular biology, but no microorganisms were detected using a FilmArray respiratory panel. However, mamanocandidas test for candida was 166 pg/mL (positive), and fungal structures were identified by the MALDI-TOF Biotyper mass spectrometry and attributed to C tropicalis. Antifungal therapy was started using caspofungin 75 mg as the initial dose followed by 50 mg daily. After 10 days of treatment, ventilatory weaning was achieved. By day 14, the patient was decannulated from the tracheostomy. Oral antifungal treatment with voriconazole was continued, and he was discharged from intensive care in good clinical condition. Severe pneumonia due to C tropicalis might occur in specific cases, especially in those patients with risk factors, and must thus be considered when approaching such cases.

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Resumen Los objetivos de este estudio fueron determinar el desempeño del panel BCID de FilmArray® y establecer el impacto de estos resultados en el tratamiento antimicrobiano de pacientes con bacteriemia en 11 hospitales de Latinoamérica. Se incluyeron 397 episodios de bacteriemia y se documentaron 551 microorganismos aislados de hemocultivos. La identificación microbiana fue correcta en el 91,4% (504/551) de los aislados y en el 98,6% (504/511) si se consideran solo los microorganismos incluidos en el panel BCID. La sensibilidad en la detección de los genes mecA, vanA/B y blaKPC fue del 100% y la especificidad fue del 97%, 100% y 99,6% respectivamente. La notificación temprana del resultado permitió cambios terapéuticos en 242 episodios (60,9%). El panel BCID es un método confiable y rápido para la detección de mecanismos críticos de resistencia y de los microorganismos más frecuentemente aislados de bacteriemias y permite la optimización temprana del tratamiento antimicrobiano.

Abstract The objectives of this study were to determine the performance of the BCID panel and to establish the impact of these results on the antimicrobial treatment of patients with bacteremia in 11 hospitals in Latin America. Three hundred and ninety-seven episodes of bacteremia were included and 551 microorganisms isolated from blood cultures were documented. Microbial identification was correct in 91.4% (504/551) of the isolates and in 98.6% (504/511) if only the microorganisms included in the BCID panel are considered. The sensitivity in the detection of the genes mecA, vanA/B and blaKPC was 100% and the specificity was 97%, 100% and 99.6% respectively. Early notification of the outcome allowed therapeutic changes in 242 episodes (60.9%). The BCID panel is a reliable and rapid method for the detection of critical resistance mechanisms and of the microorganisms most frequently isolated from bacteremia and it enables early optimisation of antimicrobial treatment.

Resumo Os objetivos deste estudo foram determinar o desempenho do painel BCID do FilmArray® e estabelecer o impacto desses resultados no tratamento antimicrobiano de pacientes com bacteremia em 11 hospitais da América Latina. Trezentos e noventa e sete episódios de bacteremia foram incluídos e 551 microrganismos isolados de hemoculturas foram documentados. A identificação microbiana foi correta em 91,4% (504/551) dos isolados e em 98,6% (504/511) considerando apenas os microrganismos incluídos no painel BCID. A sensibilidade na detecção dos genes mecA, vanA/B e blaKPC foi de 100% e a especificidade foi de 97%, 100% e 99,6% respectivamente. A notificação precoce do desfecho permitiu mudanças terapêuticas em 242 episódios (60,9%). O painel BCID é um método confiável e rápido para a detecção de mecanismos críticos de resistência e dos microrganismos mais frequentemente isolados da bacteremia e permite a otimização precoce do tratamento antimicrobiano.

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We report the first identification in Ecuador of the microorganism Comamonas kerstersii, a strain isolates from a sample of fluid from the abdominal cavity and identified by the technique of mass spectrometry MALDITOF. It was obtained during the surgical act of a patient with the diagnosis of acute peritonitis, secondary to a perforated appendicitis. This microorganism is considered a rare pathogen. Even though the genus to which it belongs has a wide geographical distribution, this pathogen is considered an opportunistic agent.

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Resumen Comunicamos la primera identificación en Ecuador del microorganismo Comamonas kerstersii, cepa aislada a partir de una muestra de líquido de la cavidad abdominal e identificada mediante la técnica de espectrometría de masas MALDITOF. Fue obtenida durante el acto quirúrgico de un paciente con el diagnóstico de una peritonitis aguda, secundaria a una apendicitis perforada. Este microorganismo es considerado un patógeno poco común. Pese a que el género al que pertenece tiene una amplia distribución geográfica, es considerado un agente oportunista.

Abstract We report the first identification in Ecuador of the microorganism Comamonas kerstersii, a strain isolates from a sample of fluid from the abdominal cavity and identified by the technique of mass spectrometry MALDITOF. It was obtained during the surgical act of a patient with the diagnosis of acute peritonitis, secondary to a perforated appendicitis. This microorganism is considered a rare pathogen. Even though the genus to which it belongs has a wide geographical distribution, this pathogen is considered an opportunistic agent.

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El presente es el reporte de un caso de un paciente masculino de 37 años, con manifestaciones clínicas de aproximadamente 1 año de evolución caracterizadas por cefalea holocraneana de gran intensidad, fotofobia, diplopía, que se exacerban en los últimos tres meses con alucinaciones, pérdida de audición de oído izquierdo, refirió exposición de 4 años a heces de aves (palomas) por su trabajo en el puerto marítimo.Acudió por consulta privada a valoración y manejo, se le efectúa el diagnóstico de diabetes mellitus tipo 2, por lo cual se prescribió metformina oral, una vez iniciado el tratamiento presentó exacerbación de los síntomas neurológicos, por lo que se indicó internación hospitalaria y se sometió a investigación para diagnóstico de su enfermedad, con presunción de meningitis bacteriana, se le realizó punción lumbar para estudios microbiológicos y se inició tratamiento empírico con glucopeptido y carbapenemico. Con el esquema antimicrobiano presentó leve mejoría en la intensidad de sus síntomas, en el estudio microbiológico del líquido cefalorraquídeo se observaron estructuras micóticas compatibles con Cryptococcus, por lo cual se realizó una segunda punción lumbar para conseguir una muestra adecuada para cultivo y estudio con biología molecular, a fin de establecer el diagnóstico definitivo del microorganismo.

The present is a report of a 37-year-old male patient, who present clinical manifestations of approximately 1 year, by high-intensity holocranial headache, photophobia, diplopia, which were exacerbated in the last three months with hallucinations, loss of Hearing from the left ear, hereported exposure of 4 years to feces of birds (pigeons) for his work in the seaport.The patient was refer to a private consultation to assessment and management, he was diagnosed with type 2 diabetes mellitus, for which oral metformin was prescribed, once the treatment had begun, exacerbation of the neurological symptoms, so hospitalization was indicated, and He underwent research to diagnose his disease, with presumed bacterial meningitis, he underwent lumbar puncture for microbiological studies and began empirical treatment with glucopeptide and carbapenemic; With the antimicrobial scheme, there was a slight improvement in the intensity of its symptoms. In the microbiological study of the preliminary cerebrospinal fluid, fungal structures compatible with Cryptococcus were observe; a second lumbar puncture was performed to obtain an adequate sample for culture and study with molecular biology, in order to establish the definitive diagnosis of the microorganism.

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La principal enfermedad transmitida por alimentos en Venezuela es la intoxicación estafilocóccica y es el queso blanco el principal alimento involucrado. La nisina es una bacteriocina capaz de frenar el crecimiento de microorganismos Gram positivos, entre ellos Staphylococcus aureus. Una de las limitaciones de su uso es su alto costo. El empleo de cultivos iniciadores productores de bacteriocinas, representa una alternativapara elaboración de quesos con mejor calidad microbiológica. El objetivo del presente estudio fue evaluar el efecto biopreservador del Lactococcus lactis subsp. lactis (ATCC 11454) y compararlo con la adición de nisina a la leche. Para ello se elaboraron cinco tipos de quesos con leche pasteurizada: control; con L. lactis; con L. lactis y S. aureus; con S. aureus; con S. aureus y nisina. Las determinaciones microbiológicas y físico-químicas se realizaron de acuerdo a las normas COVENIN. La concentración de nisina se determinó mediante la técnica de difusión en agar. Los datos se analizaron utilizando el análisis de varianza y se probaron las medias por el método de losmínimos cuadrados. Se encontró producción de nisina por parte del cultivo iniciador, pero en bajas concentraciones. En los quesos elaborados con leche a la que se le inoculó S. aureus (103 ufc/mL) no se encontró efecto inhibidor del cultivo sobre este microorganismo patógeno. Sin embargo, los quesos elaborados con Lactococcus sin inoculación de Staphylococcus y los quesos elaborados con nisina, presentaron escaso crecimiento de estafilococos y de bacterias coliformes. La nisina resultó ser más eficiente para lograr biopreservación de los quesos blancos, aunque la utilización del cultivo iniciador productor de la bacteriocina, permitió obtener quesos con bajo conteo de patógenos, cuando la carga microbiana inicial en la leche era escasa.

The main disease transmitted by foods in Venezuela is the staphylococci poisoning, and it is white cheeses the most involved food. The nisin is a bacteriocin able to inhibit the growthof Gram positive microorganisms; among them, Staphylococcus aureus. One of the limitations of its use is its high cost. The use of bacteriocin producing starter cultures represents an alternative for milk industry. The objective of the present study was to evaluate the biopreservating effect of the Lactococcus lactis subsp. lactis (ATCC 11454) and to compare it with the addition of nisin to milk. Five types of cheese from pasteurized milk were elaborated: control; addition of L. lactis; addition of L. lactis and S. aureus; addition of S. aureus; addition of nisinaand S. aureus. Both, microbiological and physical-chemical determinations were made according to COVENIN. The nisinconcentration was measured using the agar diffusion technique. The data was analyzed with an analysis of variance and testing the means by the method of least squares means. The starter cultures produced nisin, but in low amounts. In cheeses elaborated with milk inoculated whit S. aureus (103 ufc/mL), no inhibiting effect of the culture on this pathogenic microorganismwas observed. Nevertheless, cheeses elaborated with both, Lactococcus without inoculation of Staphylococcus and with nisin, presented little growth of Staphylococcus and coliforms. Nisin was more efficient to obtain biopreservation of white cheeses, although the use of producing bacteriocin starter culture, allowed to obtain cheeses with low counts of pathogens, if the initial contamination of the milk was low.

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La microbiología predictiva es una herramienta útil para describir y predecir el crecimiento bacteriano en los alimentos. Para comparar la aplicación de diferentes modelos sigmoidales aplicados al crecimiento de Lactococcus lactis subsp. lactis, se analizaron muestras de leches tomadas del total del ordeño matutino de dos rebaños, bufalino (n=6) y vacuno (n=6), manejados bajo las mismas condiciones, ubicados en el municipio Mara del estado Zulia, Venezuela. Se determinaron algunos parámetros, tales como pH, acidez titulable y presencia de inhibidores. Se preparó una serie de tubos de ensayo con leche esterilizada a 110 ± 2°C por 10 min. y se inocularon con Lactococcus a 1 x 104 ufc/mL. Posteriormente, fueron incubados a 36 ± 0,5°C y cada dos horas se prepararon diluciones y siembra en placas con agar M-17. Se determinó el Log10 de ufc/mL para las 0; 2; 4; 6; 8 y 10 horas de incubación. Se realizó un análisis de regresión con los modelos de Gompertz, Logístico, Stannard y Richards, por medio del algoritmo de Marquardt. Se encontró similitud en el ajuste de los modelos aplicados. Los modelos de Stannard y Richards resultaron ser iguales en la estimación de los datos y fueron los que presentaron mayor dificultad para alcanzar el criterio de convergencia. El modelo de Gompertz de tres parámetros presentó diferencia significativa con los modelos de cuatro parámetros. Se considera los modelos de Gompertz y Logístico (con cuatro parámetros), modificados por Gibson, como los mejores para modelar y predecir el crecimiento del microorganismo en estudio.

Predictive Microbiology is a useful tool to describe and predict the bacterial growing in food. Milk samples from total morning milking of two herds, buffalo (n=6) and cattle (n=6), managed under similar conditions, located in Mara Municipality, Zulia State, Venezuela, were analyzed to compare the application of different sigmoid models to the growth of Lactococcus lactis subsp. lactis strain. Sanitary quality was determined by means of pH, acidity titration and detection of inhibitors. A series of assay tubes were prepared with sterilized milk at 110 ± 2°C for 10 min. The milk in the assay tubes was inoculated with Lactococcus at 1 x 104 ufc/mL. Then, the assay tubes were incubated at 36 ± 0.5°C and every two hours dilutions and culture were prepared in Petrie dishes with M-17 agar. Log10 of ufc/mL was determined for 0; 2; 4; 6; 8 y 10 hours post incubation. A regressions analysis with Gompertz, Logistic, Stannard and Richards models through Marquardt algorithm was used. Similarity was found when models were adjusted. The Stannard and Richards models were equal for the data estimation and they presented the greatest difficulty to reach the convergent criterion. The three parameters Gompertz model showed significant difference compare to the four parameters models. The Gompertz and Logistic models (with four parameters) modified by Gibson are considered the best to model and predict the growing of the microorganism under study.

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