RESUMO
Introducción: las infecciones estreptocócicas pueden presentarse con fiebre, inflamación faringoamigdalina con o sin exudados, petequias en el paladar, adenitis cervical, exantema escarlatiniforme y / o dolor abdominal. Resulta útil en área de urgencia disponer de pruebas de detección rápida de antígenos de S. pyogenes (DRASP) de alta especificidad y sensibilidad algo menor. Objetivos: conocer la utilidad de un test de DRASP en 2 servicios de Urgencia Pediátrica, describiendo las características clínicas y epidemiológicas de los pacientes estudiados durante el período de la investigación y su correlación con el cultivo de exudado faríngeo mediante el cálculo de sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Material y métodos: estudio prospectivo, observacional, transversal en dos servicios de emergencia pediátrica. Se incluyeron niños a los que se les realizó DRASP y exudado faríngeo (EF) entre el 14 de febrero y el 13 de abril de 2018. Se registró: sexo, edad, motivo de consulta, diagnóstico, tratamiento, destino, resultado del test y de cultivo faríngeo. Se calcularon S, E, VPP y VPN. Resultados: n=241 niños. Rango 8 meses - 14 años, media 6 años. Consultaron por fiebre 103 niños (42,7%); por odinofagia 48, por erupción 11 y 47 por otros síntomas. Al 95% de los niños se le otorgó el alta. DRASP negativos 87,6% (N: 211) y positivos 12,9% (N: 31). EF negativos 80,1% (n: 193) y positivos para SßHGA en 13,7% (n: 33). La sensibilidad de la prueba fue del 52% y su especificidad del 93%. El VPP 55% y el negativo 92%. El diagnóstico más frecuente fue faringitis viral 132 (54,7%). Conclusiones: el test se aplicó fundamentalmente a escolares febriles, algunos con odinofagia. Contribuye a diferenciar en forma rápida la etiología y habilita a no usar antibióticos en caso de resultado negativo. Estos resultados avalan el uso de DRASP en la urgencia pediátrica.
Introduction: streptococcal infections can show fever, pharyngotonsillar inflammation with or without swabs, palatal petechiae, cervical adenitis, scarlatiniform rash and/or abdominal pain. Rapid detection tests for S. pyogenes antigens (DRASP) with high specificity and somewhat lower sensitivity are a useful at the Emergency Ward. Objectives: know the usefulness of a DRASP test in 2 Pediatric Emergency, describe the clinical and epidemiological characteristics of the patients studied during the research period and its correlation with the culture of pharyngeal exudates by calculating sensitivity (S) , specificity (S), positive predictive value (PPV), and negative predictive value (NPV). Material and Methods: prospective, observational, cross-sectional study carried out in two pediatric emergency wards. We included children who underwent DRASP and pharyngeal swab (PS) between February 14 and April 13, 2018. The following data were recorded: sex, age, reason for consultation, diagnosis, treatment, destination, test results and throat cultures. S, S, PPV and NPV were calculated. Results: n=241 children. Range 8 months - 14 years, average 6 years. 103 children (42.7%) consulted due to fever; 48 due to sore throat, 11 due to rash and 47 due to other symptoms. 95% of children were discharged. DRASP negative 87.6% (N: 211) and positive 12.9% (N: 31). Negative EP 80.1% (n: 193) and positive for SßHGA in 13.7% (n: 33). The test sensitivity was 52% and specificity 93%. The PPV 55% and the negative 92%. The most frequent diagnosis was viral pharyngitis 132 (54.7%). Conclusions: the test was applied mainly to febrile schoolchildren, some with odynophagia. A quick etiology differentiation is helpful, since it prevents antibiotics from being used in the event of a negative result. These results support the use of DRASP in pediatric emergency wards.
Introdução: as infecções estreptocócicas manifestam-se com febre, inflamação faringotonsilar com ou sem exsudado, petéquias palatinas, adenite cervical, erupção cutânea escarlatiniforme e/ou dor abdominal. Nos serviços de emergência é útil realizar testes de detecção rápida para antígenos de S. pyogenes (DRASP) com alta especificidade e sensibilidade um pouco mais baixa Objetivos: conhecer a utilidade do teste DRASP em 2 Emergências Pediátricas, descrever as características clínicas e epidemiológicas dos pacientes estudados durante o período da pesquisa e sua correlação com a cultura de exsudatos faríngeos por meio do cálculo de sensibilidade (S) , especificidade (S), positivo valor preditivo (VPP) e valor preditivo negativo (VPN). Material e métodos: estudo prospectivo, observacional, transversal, realizado em duas unidades de emergência pediátrica. Foram incluídas crianças que realizaram DRASP e swab faríngeo (PS) entre 14 de fevereiro e 13 de abril de 2018. Foram registrados os seguintes dados: sexo, idade, motivo da consulta, diagnóstico, tratamento, destino, resultados de exames e culturas de garganta. S, S, VPP e VPN foram calculados. Resultados: n=241 crianças. Faixa 8 meses - 14 anos, média 6 anos. 103 crianças (42,7%) consultadas por febre; 48 por dor de garganta, 11 por erupção cutânea e 47 por outros sintomas. 95% das crianças receberam alta. DRASP negativo 87,6% (N: 211) e positivo 12,9% (N: 31). EP negativo 80,1% (n: 193) e positivo para SßHGA em 13,7% (n: 33). A sensibilidade do teste foi de 52% e a especificidade de 93%. O PPV 55% e o negativo 92%. O diagnóstico mais frequente foi faringite viral 132 (54,7%). Conclusões: o teste foi aplicado principalmente em escolares febris, alguns com odinofagia. A rápida diferenciação etiológica é útil, pois evita o uso de antibióticos em caso de resultado negativo. Esses resultados apoiam o uso do DRASP em enfermarias de emergência pediátrica.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes/isolamento & purificação , Transtornos de Deglutição/diagnóstico , Faringite/diagnóstico , Infecções Estreptocócicas/microbiologia , Transtornos de Deglutição/microbiologia , Faringite/microbiologia , Estudos Transversais , Valor Preditivo dos Testes , Estudos Prospectivos , Serviço Hospitalar de Emergência , Exsudatos e Transudatos/microbiologiaRESUMO
Pressure injuries are a common kind of skin lesion that may be difficult to treat. The objective of this study was to analyze the effect of hydrogel enriched with alginate, fatty acids, and vitamins A and E in the treatment of pressure injuries. This case series with 12-week follow-up included applying daily dressings with hydrogel, maintaining a photographic record, using planimetry to calculate the lesion area, and classifying the healing process using the Pressure Ulcer Scale for Healing (PUSH). In addition, exudate collection from the ulcers was performed in the beginning and after 12 weeks of treatment to determine the dosage of metalloproteinase 9 (MMP9) and tissue inhibitor of metalloproteinase 1 (TIMP1). Of the 13 patients included in the study, 2 died and 11 were monitored for 12 weeks. Only 1 patient showed full wound healing, but all patients showed a significant 12.19% (p = .023) reduction in the lesion area. The PUSH score was also significantly reduced from 15.9 to 10.54 (p = .0052). Relative to the dosage of metalloproteinase and its inhibitor, there was a reduction in the level of MMP9 and there was no change in the level of TIMP1. This study showed that hydrogel enriched with alginate, fatty acids, and vitamins A and E provided promising results for the treatment of pressure injuries by reducing the lesion area, the general PUSH score, and the amount of MMP9 in the wounds' microenvironment.
Assuntos
Alginatos/farmacologia , Ácidos Graxos/farmacologia , Úlcera por Pressão/tratamento farmacológico , Vitamina A/farmacologia , Vitamina E/farmacologia , Idoso , Alginatos/uso terapêutico , Exsudatos e Transudatos/microbiologia , Ácidos Graxos/uso terapêutico , Feminino , Seguimentos , Humanos , Hidrogéis/farmacologia , Hidrogéis/uso terapêutico , Masculino , Metaloproteinase 9 da Matriz/análise , Pessoa de Meia-Idade , Úlcera por Pressão/fisiopatologia , Inibidor Tecidual de Metaloproteinase-1/análise , Vitamina A/uso terapêutico , Vitamina E/uso terapêutico , Cicatrização/efeitos dos fármacosRESUMO
Chronic venous leg ulcer (CVLU) arises as a chronic venous insufficiency complication and is a major cause of morbidity throughout the world. Our hypothesis is that the CVLU exudate composition is a biochemical representation of the wound clinical state. Then, Fourier Transform Infrared (FTIR) spectroscopy could be a useful and less-invasive technique to study the clinical state of the ulcer. For this, the aim of this work was to perform a spectral characterization of the exudate from CVLU using FTIR spectroscopy to identify potential healing markers. 45 exudate samples from CVLU, 95% of the strains isolated from CVLU in planktonic and biofilm phenotypes and other related biological samples such as human plasma, serum, urine, blood cells, urea, creatinine, glucose and albumin were studied by FTIR spectroscopy. According to the vibration frequency of biomolecules' (lipids, proteins, nucleic acids and carbohydrates) characteristic bonds in the infrared region, different spectral windows were selected and spectral areas of each window were measured. Besides, Savitzky-Golay second derivatives were obtained for all spectra and peaks from each standardized window were detected. FTIR spectroscopy allowed identification of sample types (exudate, plasma, serum, urine) as each one presents a unique relative composition and ratios range. Also, this technique could be useful to identify bacteria in the phenotypic-ulcer state and allows differentiation of whether bacteria are in the biofilm or planktonic form which is unlikely by conventional methods. In this work we found some spectral markers (areas, peaks) that allow identification of several parameters in the exudate such as (a) total cellularity, (b) inflammatory cell load, (c) bacterial load, (d) fibrin amount, and (e) inflammatory proteins. Because the measured areas or founded peaks are concentration-dependent this method could also serve to measure them. Therefore, FTIR spectroscopy could be useful to evaluate patient evolution as all these exudate parameters represent critical negative markers for wound healing.
Assuntos
Bactérias/isolamento & purificação , Exsudatos e Transudatos/microbiologia , Úlcera da Perna/diagnóstico , Espectroscopia de Infravermelho com Transformada de Fourier , Biofilmes , Biomarcadores , Humanos , Úlcera da Perna/microbiologiaAssuntos
Alcoolismo/complicações , Pelagra/complicações , Pelagra/dietoterapia , Diarreia/etiologia , Exsudatos e Transudatos/microbiologia , Infecções por HIV/sangue , Infecções por HIV/complicações , Pessoas Mal Alojadas , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/etiologia , Niacina/análise , Niacina/sangue , Niacina/uso terapêutico , Avaliação Nutricional , Pelagra/diagnósticoRESUMO
We previously reported 10-valent pneumococcal non-typeable Haemophilus influenzae (NTHi) protein D conjugate vaccine (PHiD-CV) efficacy in a double-blind randomized trial (ClinicalTrials.gov: NCT00466947) against various diseases, including acute otitis media (AOM). Here, we provide further analyses. In the Panamanian subset, 7,359 children were randomized (1:1) to receive PHiD-CV or control vaccine at age 2/4/6 and 15-18 months. Of these, 2,000 had nasopharyngeal swabs collected. AOM cases were captured when parents sought medical attention for children with AOM symptoms; surveillance was enhanced approximately 2 y into the study through regular telephone calls or home visits by study personnel, who advised parents to visit the clinic if their child had AOM symptoms. Mean follow-up was 31.4 months. Clinical AOM (C-AOM) cases were assessed by physicians and confirmed by otorhinolaryngologists. Middle ear fluid samples, taken from children with C-AOM after specific informed consent, and nasopharyngeal samples were cultured for pathogen identification. For 7,359 children, 2,574 suspected AOM cases were assessed by a primary healthcare physician; 649 cases were C-AOM cases as per protocol definition. From the 503 MEF samples collected, 158 resulted in a positive culture. In the intent-to-treat cohort (7,214 children), PHiD-CV showed VE against first C-AOM (24.0% [95% CI: 8.7, 36.7]) and bacterial (B-AOM) episodes (48.0% [20.3, 66.1]) in children <24 months, which declined thereafter with age. Pre-booster VE against C-AOM was 30.7% [12.9, 44.9]; post-booster, -6.7% [-36.4, 16.6]. PHiD-CV VE was 17.7% [-6.1, 36.2] against moderate and 32.7% [-20.5, 62.4] against severe C-AOM. VE against vaccine-serotype pneumococcal NPC was 31.2% [5.3, 50.3] 3 months post-booster, and 25.6% [12.7, 36.7] across all visits. NTHi colonization rates were low and no significant reduction was observed. PHiD-CV showed efficacy against C-AOM and B-AOM in children younger than 24 months, and reduced vaccine-serotype NPC.
Assuntos
Proteínas de Bactérias/imunologia , Proteínas de Transporte/imunologia , Portador Sadio/prevenção & controle , Infecções por Haemophilus/prevenção & controle , Vacinas Anti-Haemophilus/imunologia , Imunoglobulina D/imunologia , Lipoproteínas/imunologia , Otite Média/prevenção & controle , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Método Duplo-Cego , Orelha Média/microbiologia , Exsudatos e Transudatos/microbiologia , Feminino , Seguimentos , Vacinas Anti-Haemophilus/administração & dosagem , Humanos , Lactente , Masculino , Nasofaringe/microbiologia , Panamá , Vacinas Pneumocócicas/administração & dosagem , Resultado do TratamentoRESUMO
INTRODUCTION: The etiological diagnosis of pleural effusion is a difficult task because the diagnostic tools can only establish a definitive etiological diagnosis in at most 76% of cases. OBJECTIVES: To verify the diagnostic accuracy of the latex agglutination test (LAT) for the etiological diagnosis of pleural effusions caused by Streptococcus pneumoniae and Haemophilus influenzae type b. METHODS: After thoracocentesis, paired fresh samples of pleural fluid from 418 children and adolescents were included in this investigation. They were tested blindly and simultaneously through counterimmunoelectrophoresis (CIE) and LAT for both bacteria. Sensitivity, specificity, predictive values and likelihood ratios (LR) were calculated taking CIE as a reference standard. RESULTS: The sensitivity and specificity of LAT was 100% (95% confidence interval, 94.4%-100%) and 83.3% (95% confidence interval, 79.0%-87.0%), respectively, whereas the positive (calculated from Bayes' theorem) and negative predictive values were, respectively, lower than 1% and 100% (95% confidence interval, 98.8%-100%). Positive and negative LR were 6.0 (95% confidence interval, 4.7-7.6) and zero, respectively. CONCLUSIONS: Our results suggest that LAT is a useful tool for the etiological diagnosis of pleural effusion. It is a reliable, rapid, simple to perform and shows an excellent yield in our studied population, helping to prescribe appropriate antibiotics for this clinical condition.
Assuntos
Contraimunoeletroforese/métodos , Exsudatos e Transudatos/imunologia , Testes de Fixação do Látex/métodos , Derrame Pleural/diagnóstico , Adolescente , Brasil/epidemiologia , Criança , Pré-Escolar , Exsudatos e Transudatos/microbiologia , Feminino , Haemophilus influenzae tipo b/isolamento & purificação , Humanos , Lactente , Recém-Nascido , Masculino , Derrame Pleural/etiologia , Derrame Pleural/microbiologia , Derrame Pleural/virologia , Valor Preditivo dos Testes , Estudos Prospectivos , Streptococcus pneumoniae/isolamento & purificação , Toracentese/métodosRESUMO
OBJECTIVES: The study aimed to demonstrate Helicobacter pylori presence in otitis media with effusion (OME) and its association with symptomatology of gastroesophageal reflux disease (GERD). METHODS: In a cohort study, 69 effusions were collected during tympanostomy tube insertion for H. pylori detection using PCR and ELISA. Validated questionnaires were performed according to age for clinical diagnosis of GERD; chi-square ×2 statistical analysis was made. RESULTS: Eight of the 69 ear effusions (5.7%) were positive for H. pylori detection using ELISA. Two patients (2.9%) had positive results for H. pylori detection using ELISA and PCR. These eight patients had positive results too in GERD questionnaires. None of the patients with negative/suspect questionnaires had positive results for H. pylori. We found statistical association between the results of ELISA, PCR and questionnaires (×2, p = 0.001). CONCLUSIONS: The H. pylori presence in effusions varies widely, in our population the frequency was lower than other reports. We found strong association between H. pylori in effusions and positive GERD questionnaires. The bacterium role in OME chronicity is not clear, but this study supports the GERD participation in OME pathogenesis.
Assuntos
Exsudatos e Transudatos/microbiologia , Refluxo Gastroesofágico/epidemiologia , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Otite Média com Derrame/epidemiologia , Adolescente , Criança , Pré-Escolar , Doença Crônica , Estudos de Coortes , Ensaio de Imunoadsorção Enzimática , Feminino , Helicobacter pylori/genética , Helicobacter pylori/metabolismo , Humanos , Lactente , Masculino , México/epidemiologia , Ventilação da Orelha Média , Otite Média com Derrame/microbiologia , Otite Média com Derrame/cirurgia , Reação em Cadeia da Polimerase , Estudos ProspectivosRESUMO
INTRODUCTION: Macrophages are highly activated by endodontic contents. This study investigated the correlation between different clinical signs/symptoms and radiographic features according to the levels of interleukin (IL)-1ß, tumor necrosis factor α (TNF-α), IL-6, IL-10, prostaglandin E(2) (PGE(2)), and their networks produced by endodontic content-stimulated macrophages collected from primary endodontic infection with apical periodontitis (PEIAP). METHODS: Samples were taken from 21 root canals with PEIAP by using paper points. The presence of exudate (EX), pain on palpation (POP), tenderness to percussion (TTP), and the size of the radiographic lesion (SRL) were recorded. Polymerase chain reaction (16S rDNA) was used for bacterial detection and limulus amebocyte lysate (LAL) assay for endotoxin measurement. Raw 264.7 macrophages were stimulated with bacterial contents during 24 hs. The amounts of IL-1ß, TNF-α, IL-6, IL-10 and PGE(2) were measured by enzyme-linked immunosorbent assay. Log-based data were correlated by multiple logistic regression (P < .05). RESULTS: Bacteria and endotoxin were detected in 100% of the samples. IL-6 and TNF-α were positively correlated with SRL and EX, respectively (P < .05). Clinical signs/symptoms and radiographic findings were set as dependent variables for EX-positive correlations between PGE(2), IL-1ß, and TNF-α (P < .05), whereas IL-6 and PGE(2) were positively correlated to each other in POP but negatively correlated in SRL (P < .05). When POP and TTP-POP were set as dependent variables, different cytokine networks were found. CONCLUSIONS: Our findings suggest different roles for each cytokine in the development of apical periodontitis, whose effects of overlapping networks depend on the signs/symptoms and radiographic features found in endodontic infection.
Assuntos
Citocinas/biossíntese , Cavidade Pulpar/microbiologia , Endotoxinas/fisiologia , Macrófagos/metabolismo , Periodontite Periapical/microbiologia , Adolescente , Adulto , Idoso , Animais , Células Cultivadas , DNA Bacteriano/genética , Dinoprostona/biossíntese , Exsudatos e Transudatos/microbiologia , Humanos , Interleucina-10/biossíntese , Interleucina-1beta/biossíntese , Interleucina-6/biossíntese , Teste do Limulus , Camundongos , Pessoa de Meia-Idade , RNA Mensageiro/biossíntese , Odontalgia/microbiologia , Fator de Necrose Tumoral alfa/biossíntese , Adulto JovemRESUMO
Vaginitis is a common gynecologic disorder. It is due to several causes, some even unknown. Bacteroides fragilis is the most important anaerobe in clinical bacteriology, some strains of this group are notable for being enterotoxigenic and they have been associated with intestinal and extraintestinal syndromes. They have recently been isolated from patients with vaginitis. The purpose of this study was to investigate a possible association of enterotoxigenic B. fragilis with infectious vaginitis. 265 samples of vaginal exudate were processed, 202 from symptomatic patients and 63 healthy women. The identification of the microorganisms was carried out by conventional methods. In 31.2% of symptomatic patients were identified: Gardnerella vaginalis, Mobiluncus, Candida albicans, Mycoplasma hominis, Ureaplasma urealyticum and Streptococcus agalactiae. B. fragilis was identified in 27 symptomatic patients and 5 healthy women. These strains were cultivated in liquid medium and incubated during 48 h at 36 degrees C in anaerobe chambers. Supernatant activity was assayed in HT-29 cells. Eighteen B. fragilis strains isolated from symptomatic patients were enterotoxigenic, because induced alterations in target cell morphology. It was not identified in healthy women (P < 0.05). 77.7% of enterotoxigenic B. fragilis strains were not associated with other specific pathogens. This fact suggests that enterotoxigenic B. fragilis could be a cause for vaginitis. The effect of enterotoxin on E-cadherin of vaginal epithelium could facilitate invasion and its possible pathogenic role in the vagina. This is the first report that associates enterotoxigenic Bacteroides fragilis as a possible cause of infectious vaginitis.
Assuntos
Bacteroides fragilis/patogenicidade , Enterotoxinas/análise , Vaginose Bacteriana/microbiologia , Adolescente , Adulto , Toxinas Bacterianas/análise , Bacteroides fragilis/isolamento & purificação , Bacteroides fragilis/metabolismo , Candida albicans/isolamento & purificação , Candidíase Vulvovaginal/microbiologia , Coinfecção , Exsudatos e Transudatos/microbiologia , Feminino , Gardnerella vaginalis/isolamento & purificação , Humanos , Metaloendopeptidases/análise , Pessoa de Meia-Idade , Infecções por Mycoplasma/microbiologia , Mycoplasma hominis/isolamento & purificação , Infecções Estafilocócicas/microbiologia , Vagina/microbiologia , Adulto JovemRESUMO
La vaginitis es un trastorno ginecológico frecuente producido por distintas causas, algunas de las cuales permanecen desconocidas. Bacteroides fragilis es el anaerobio más importante en bacteriología clínica. Algunas cepas son enterotoxigénicas y se asocian con síndromes intestinales y extraintestinales. Recientemente han sido aisladas de pacientes con vaginitis. En este trabajo se planteó investigar la posible asociación de B. fragilis enterotoxigénico con la vaginitis infecciosa. Fueron procesadas 265 muestras de exudado vaginal. 202 de mujeres sintomáticas y 63 mujeres sanas. La identificación de los microorganismos se realizó por métodos convencionales. En 31,2% de las pacientes sintomáticas se identificaron: Gardnerella vaginalis, Candida albicans, Mobiluncus, Mycoplasma hominis, Ureaplasma urealyticum y Streptococcus agalactiae. En 27 pacientes sintomáticas y en 5 mujeres sanas se identificó B. fragilis. Estas cepas fueron cultivadas en medio líquido e incubadas durante 48 h a 36° C en anaerobiosis. La toxicidad en los sobrenadantes se ensayó en células HT-29. 18 cepas de B. fragilis aisladas de pacientes sintomáticas fueron enterotoxigénicas, ya que indujeron alteraciones en la monocapa celular y en las células. No se identificó en mujeres sanas (P<0,05). 77,7% de las cepas de B. fragilis enterotoxigénicas no se encontraron asociadas con otros patógenos específicos. Este hecho sugiere que pudiera ser un agente causante de vaginitis, ya que el efecto de la enterotoxina sobre la E-cadherina del epitelio vaginal podría facilitar la invasión y su posible papel patógeno en la vagina. Esta es la primera investigación que asocia a Bacteroides fragilis enterotoxigénico como posible causa de vaginitis infecciosa.
Vaginitis is a common gynecologic disorder. It is due to several causes, some even unknown. Bacteroides fragilis is the most important anaerobe in clinical bacteriology, some strains of this group are notable for being enterotoxigenic and they have been associated with intestinal and extraintestinal syndromes. They have recently been isolated from patients with vaginitis. The purpose of this study was to investigate a possible association of enterotoxigenic B. fragilis with infectious vaginitis. 265 samples of vaginal exudate were processed, 202 from symptomatic patients and 63 healthy women. The identification of the microorganisms was carried out by conventional methods. In 31.2% of symptomatic patients were identified: Gardnerella vaginalis, Mobiluncus, Candida albicans, Mycoplasma hominis, Ureaplasma urealyticum and Streptococcus agalactiae. B. fragilis was identified in 27 symptomatic patients and 5 healthy women. These strains were cultivated in liquid medium and incubated during 48 h at 36°C in anaerobe chambers. Supernatant activity was assayed in HT-29 cells. Eighteen B. fragilis strains isolated from symptomatic patients were enterotoxigenic, because induced alterations in target cell morphology. It was not identified in healthy women (P<0.05). 77.7% of enterotoxigenic B. fragilis strains were not associated with other specific pathogens. This fact suggests that enterotoxigenic B. fragilis could be a cause for vaginitis. The effect of enterotoxin on E-cadherin of vaginal epithelium could facilitate invasion and its possible pathogenic role in the vagina. This is the first report that associates enterotoxigenic Bacteroides fragilis as a possible cause of infectious vaginitis.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Bacteroides fragilis/patogenicidade , Enterotoxinas/análise , Vaginose Bacteriana/microbiologia , Toxinas Bacterianas/análise , Bacteroides fragilis/isolamento & purificação , Bacteroides fragilis/metabolismo , Coinfecção , Candida albicans/isolamento & purificação , Candidíase Vulvovaginal/microbiologia , Exsudatos e Transudatos/microbiologia , Gardnerella vaginalis/isolamento & purificação , Metaloendopeptidases/análise , Infecções por Mycoplasma/microbiologia , Mycoplasma hominis/isolamento & purificação , Infecções Estafilocócicas/microbiologia , Vagina/microbiologiaRESUMO
BACKGROUND: Non-typeable Haemophilus influenzae (NTHi) and Streptococcus pneumoniae are major causes of bacterial acute otitis media (AOM). Data regarding AOM are limited in Latin America. This is the first active surveillance in a private setting in Venezuela to characterize the bacterial etiology of AOM in children < 5 years of age. METHODS: Between December 2008 and December 2009, 91 AOM episodes (including sporadic, recurrent and treatment failures) were studied in 87 children enrolled into a medical center in Caracas, Venezuela. Middle ear fluid samples were collected either by tympanocentesis or spontaneous otorrhea swab sampling method. Standard laboratory and microbiological techniques were used to identify bacteria and test for antimicrobial resistance. The results were interpreted according to Clinical Laboratory Standards Institute (CLSI) 2009 for non-meningitis isolates. All statistical analyses were performed using SAS 9.1 and Microsoft Excel (for graphical purposes). RESULTS: Overall, bacteria were cultured from 69.2% (63 of the 91 episodes); at least one pathogen (S. pneumoniae, H. influenzae, S. pyogenes or M. catarrhalis) was cultured from 65.9% (60/91) of episodes. H. influenzae (55.5%; 35/63 episodes) and S. pneumoniae (34.9%; 22/63 episodes) were the most frequently reported bacteria. Among H. influenzae isolates, 62.9% (22/35 episodes) were non-capsulated (NTHi) and 31.4% (11/35 episodes) were capsulated including types d, a, c and f, across all age groups. Low antibiotic resistance for H. influenzae was observed to amoxicillin/ampicillin (5.7%; 2/35 samples). NTHi was isolated in four of the six H. influenzae positive samples (66.7%) from recurrent episodes. CONCLUSIONS: We found H. influenzae and S. pneumoniae to be the main pathogens causing AOM in Venezuela. Pneumococcal conjugate vaccines with efficacy against these bacterial pathogens may have the potential to maximize protection against AOM.
Assuntos
Cápsulas Bacterianas/análise , Infecções por Haemophilus/epidemiologia , Infecções por Haemophilus/microbiologia , Haemophilus influenzae/classificação , Haemophilus influenzae/patogenicidade , Otite Média/epidemiologia , Otite Média/microbiologia , Pré-Escolar , Exsudatos e Transudatos/microbiologia , Feminino , Haemophilus influenzae/isolamento & purificação , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Moraxella catarrhalis/isolamento & purificação , Infecções por Moraxellaceae/epidemiologia , Infecções por Moraxellaceae/microbiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Estudos Prospectivos , Streptococcus pneumoniae/isolamento & purificação , Venezuela/epidemiologiaAssuntos
Antifúngicos/farmacologia , Candida/isolamento & purificação , Candidíase Vulvovaginal/microbiologia , Antifúngicos/uso terapêutico , Argentina/epidemiologia , Candida/classificação , Candida/efeitos dos fármacos , Candidíase Vulvovaginal/tratamento farmacológico , Candidíase Vulvovaginal/epidemiologia , Criança , Farmacorresistência Fúngica , Exsudatos e Transudatos/microbiologia , Feminino , Humanos , Puberdade , Especificidade da Espécie , Vagina/microbiologiaRESUMO
Cholera toxin (CT) gene-negative Vibrio cholerae non-O1, non-O139 strains may cause severe diarrhea though their pathogenic mechanism remains unclear. V. cholerae cytolysin (VCC) is a pore-forming exotoxin encoded in the hlyA gene of V. cholerae whose contribution to the pathogenesis is not fully understood. In this work, the virulence properties of a CT gene-negative V. cholerae non-O1, non-O139 strain causing a cholera-like syndrome were analyzed. Inoculation of rabbit ileal loops with the wild type strain induced extensive fluid accumulation, accompanied by severe histopathological damage characterized by villus shortening, lymphangiectasia and focal areas of necrosis. These pathogenic effects were abrogated by mutation of the hlyA gene thus pointing out the main role of VCC in the virulence of the strain. Interestingly, this toxin was capable of triggering apoptosis in human intestinal cell lines due to its anion channel activity. Moreover, the wild type strain also induced increased apoptosis of the intestinal epithelium cells which was not observed upon inoculation of the VCC null mutant strain, indicating that VCC may trigger apoptotic cell death during infection in vivo. Altogether, these results support a main role of VCC in the pathogenesis of the CT gene-negative V. cholerae non-O1, non-O139 strain and identify apoptosis as a previously unrecognized cell death pathway triggered by VCC.
Assuntos
Apoptose , Proteínas de Bactérias/toxicidade , Cólera/microbiologia , Proteínas Hemolisinas/toxicidade , Vibrio cholerae não O1/patogenicidade , Animais , Proteínas de Bactérias/genética , Linhagem Celular , Sobrevivência Celular , Toxina da Cólera/genética , Fragmentação do DNA , Células Epiteliais/microbiologia , Células Epiteliais/ultraestrutura , Exsudatos e Transudatos/microbiologia , Deleção de Genes , Proteínas Hemolisinas/genética , Humanos , Íleo/microbiologia , Íleo/patologia , Linfangiectasia/microbiologia , Microscopia Eletrônica de Transmissão , Mutagênese Insercional , Necrose/microbiologia , Coelhos , Vibrio cholerae não O1/genética , Virulência , Fatores de Virulência/genética , Fatores de Virulência/fisiologiaRESUMO
BACKGROUND: Levofloxacin has excellent activity against common respiratory pathogens and therefore is likely to be effective in treating children with persistent or recurrent otitis media. OBJECTIVE: The objective of this study was to assess the efficacy and safety of levofloxacin treatment in the eradication of bacterial pathogens from the middle ear fluid (MEF) of children with, or at high risk for, persistent or recurrent otitis media. METHODS: An open-label multicenter trial was conducted that involved tympanocentesis at entry and selectively 3 to 5 days after starting levofloxacin (10 mg/kg twice a day for 10 days). RESULTS: : Two hundred five children (80% < or =2 years) were enrolled. One child did not have a confirmed diagnosis of acute otitis media and did not return for follow-up visits. Of the remaining 204 children, 94 (46%) had bilateral infection and 63 (31%) were receiving antimicrobials immediately before entry. One hundred five isolates of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus. pyogenes were recovered in pure or mixed cultures. All isolates were susceptible to levofloxacin. During-treatment bacterial eradication from MEF occurred in 88% (78 of 89) of bacteriologically evaluable patients, including 90% (65 of 72) of children < or =24 months of age. Bacteria initially isolated from MEF were eradicated in 31 of 37 (84%) children infected with S. pneumoniae and in 54 of 54 (100%) children infected with H. influenzae. Overall, clinical success rate after therapy was 94% for the total study population and 92% for the bacteriologically evaluable population. Levofloxacin was well tolerated. Vomiting (4%) was the most common treatment-limiting adverse event. CONCLUSIONS: Levofloxacin was safe and effective in treating and eradicating common bacterial pathogens from MEF in children with, or at risk for, recurrent or persistent otitis media.
Assuntos
Antibacterianos/uso terapêutico , Bactérias/classificação , Bactérias/efeitos dos fármacos , Infecções Bacterianas/tratamento farmacológico , Levofloxacino , Ofloxacino/uso terapêutico , Otite Média/tratamento farmacológico , Otite Média/microbiologia , Doença Aguda , Antibacterianos/administração & dosagem , Bactérias/isolamento & purificação , Infecções Bacterianas/microbiologia , Pré-Escolar , Exsudatos e Transudatos/microbiologia , Feminino , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Ofloxacino/administração & dosagem , Ofloxacino/efeitos adversos , Paracentese , Resultado do TratamentoRESUMO
As amostras de líquido pleural obtidas por toracocentese para o diagnóstico de transudatos e exsudatos devem obedecer a uma rotina de coleta e preservação para a realização de uma análise laboratorial adequada. Igualmente, fragmentos de biópsia de pleura obtidos para o diagnóstico diferencial dos exsudatos devem ser coletados de forma sistemática com o objetivo de otimizar o diagnóstico e facilitar a instituição da terapêutica adequada.
The samples of pleural fluid obtained by thoracentesis for the diagnosis of transudates and exudates shall follow a routine of collection and preservation for an appropriate laboratorial analysis. Equally, fragments of pleura biopsy obtained for the differential diagnosis of the exudates should be collected in a systematic way in order to optimize the diagnosis and facilitate the institution of appropriate therapeutics actions.
Assuntos
Humanos , Biópsia por Agulha/métodos , Exsudatos e Transudatos/química , Paracentese/métodos , Derrame Pleural/diagnóstico , Preservação Biológica/métodos , Exsudatos e Transudatos/microbiologiaRESUMO
The samples of pleural fluid obtained by thoracentesis for the diagnosis of transudates and exudates shall follow a routine of collection and preservation for an appropriate laboratorial analysis. Equally, fragments of pleura biopsy obtained for the differential diagnosis of the exudates should be collected in a systematic way in order to optimize the diagnosis and facilitate the institution of appropriate therapeutics actions.
Assuntos
Biópsia por Agulha/métodos , Exsudatos e Transudatos/química , Paracentese/métodos , Derrame Pleural/diagnóstico , Preservação Biológica/métodos , Exsudatos e Transudatos/microbiologia , Humanos , Pleura/patologiaRESUMO
PURPOSE: To compare the collection of vaginal exudates with and without the use of a speculum to diagnose vaginal infections. MATERIAL AND METHODS: We examined 45 patients with vaginal discharge. Two vaginal swabs were taken, one with and the other without a speculum. Both were examined by wet mount microscopy to detect bacterial vaginosis (BV), Trichomonas vaginalis, and the presence of blastospores with or without pseudomycelium. RESULTS: A total of 90.9% of patients whose vaginal exudates were negative for BV when extracted with a speculum were also negative in the swab taken without a speculum. In the case of BV-positive exudates using a speculum, the correspondence was 90.5% with the swabs taken without a speculum. Among those exudates obtained with a speculum that were negative for Candida, 92.6% of those obtained without a speculum tested negative. In patients with pseudomycelium, when a speculum was used, 100% also presented a diagnosis of pseudomycelium from the swabs taken without a speculum. A concordance test between the techniques involving the use or nonuse of a speculum was performed for each of the diagnoses showed a good agreement according to the observed Kappa statistics (0.8467 and 0.8396 for BV and Candida, respectively). CONCLUSIONS: A very good agreement between the results obtained with and without the use of a speculum was observed. Swabbing without the use of a speculum is especially convenient for pregnant women who require frequent testing for these types of infections during their pregnancies.
Assuntos
Candidíase Vulvovaginal/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/microbiologia , Instrumentos Cirúrgicos , Vaginite por Trichomonas/diagnóstico , Vaginose Bacteriana/diagnóstico , Candidíase Vulvovaginal/complicações , Exsudatos e Transudatos/microbiologia , Feminino , Humanos , Gravidez , Vaginite por Trichomonas/complicações , Descarga Vaginal/etiologia , Esfregaço Vaginal/instrumentação , Vaginose Bacteriana/complicaçõesRESUMO
The aim of this study was to identify the aerobic and the anaerobic microorganisms which can be related to duct ectasia. The patients were divided into two groups. Group 1 comprised 100 patients with coloured nipple discharge (duct ectasia group), and Group 2 (the control group) was composed of 50 patients without nipple discharge. The culture media used were BHI-PRAS, blood agar, mannitol agar and MacConkey agar. There was a high frequency of bacterial growth in the two groups: 85% in Group 1 and 88% in Group 2. The most prevalent bacteria were Staphylococcus aureus and Staphylococcus epidermidis. There was a statistically significant higher rate of smokers in the duct ectasia group compared with the control group, 25 (25%) patients vs. 5 (10%), respectively (p = 0.03). These findings allow us to put forth the hypothesis that the genesis of duct ectasia may be a non-infectious inflammatory process.
Assuntos
Bactérias/isolamento & purificação , Exsudatos e Transudatos/microbiologia , Mamilos/microbiologia , Adulto , Idoso , Doenças Mamárias/imunologia , Doenças Mamárias/microbiologia , Doenças Mamárias/patologia , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Dilatação Patológica , Feminino , Humanos , Pessoa de Meia-Idade , Mamilos/imunologia , Mamilos/patologia , Paridade , Gravidez , Fumar/efeitos adversosRESUMO
A case of waterborne otitis in a patient with AIDS was reported, who got infected with Yibrio fluvialis by swimming in a pool of sea water. This is the first case reported in Cuba and as far as we know in the world. We describe the clinical features associated with this an unusual case and discuss its significance.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS , Otite Externa/microbiologia , Vibrioses , Vibrio/isolamento & purificação , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/etiologia , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Exsudatos e Transudatos/microbiologia , Humanos , Masculino , Otite Externa/diagnóstico , Otite Externa/tratamento farmacológico , Otite Externa/etiologia , Piscinas , Tetraciclina/administração & dosagem , Tetraciclina/uso terapêutico , Fatores de Tempo , Resultado do Tratamento , Vibrioses/complicações , Vibrioses/diagnóstico , Vibrioses/tratamento farmacológico , Vibrioses/etiologiaRESUMO
BACKGROUND: The kinetics of systemic responses triggered by bacterial peritonitis were analysed in the blood, bronchoalveolar lavage (BAL) and several organs. MATERIALS AND METHODS: The murine model of cecal ligation and puncture was employed. The parameters were analysed at different periods of time (4 to 72 h). RESULTS: Fecal peritonitis triggered a progressive, but not significant, decline of blood leukocytes between 4 and 6 h, becoming significant at 24 to 48 h (p<0.05). This profile was closely associated with the enhancement of leukocytes both in the abdomen (p<0.05) and in the BAL (p<0.05). A significant abdominal exudation was detected between 4 and 72 h (p<0.01), whereas maximal growth of aerobic bacteria in the blood and lungs was observed 24 and 72 h after. Maximal exudation in the studied tissues occurred at different time points (heart=24 h, spleen and kidney=48 h, liver and lung= 72 h). CONCLUSION: Using this model, evidence of sepsis can be easily measured in different body systems.