Resumo em Inglês:

The genetic similarity of carbapenem-resistant Pseudomonas aeruginosa strains isolated in the Hospital Universitário São Francisco, Bragança Paulista, São Paulo, Brasil, was evaluated by pulsed field gel electrophoresis (PFGE). A unique clone was detected among 5 of 7 isolates, suggesting that cross-contamination might have played a role in the spread of carbapenem-resistant P. aeruginosa strains. Interestingly, a similar PFGE pattern was encountered in a P. aeruginosa strain isolated from Hospital São Paulo that was used as a PFGE control.

Resumo em Inglês:

A cohort study was carried out at the Marilia Medical School Hospital. In the first phase the pattern of antibiotic use was evaluated. Antibiotics were prescribed for 55.4% of the patients; antibiotic combinations were used in 43%. Therapeutic use of antibiotics was considered inadequate in 27%. Respiratory and skin infections were the most frequently diagnosed. In up to 31% of the cases the treatment of respiratory infections was considered inadequate. The surgical use of antibiotic prophylaxis was evaluated in the second phase. Prophylaxis was indicated in 73.2% of the surgeries. The antibiotics most used for prophylaxis were first generation cephalosporins. In 78.9% of the surgeries, the antibiotic was correctly chosen. In 15.9% of the surgeries, the initial antibiotic administration was correctly timed. The use of antibiotics in the post-operative period was appropriate in 29.8% of the cases. The independent risk factors for surgical site infection (SSI), as determined by logistic regression analysis adjusted to class of wound risk, were the choice of antibiotic to be used prophylactically and the duration of antibiotic treatment in the post-operative period. Those who received appropriate prophylactic antibiotics had a lower rate of SSI than those who received innapropriated antibiotics [RR=0.49/95%; CI=0.25-0.90]. Patients who received prophylactic antibiotics correctly in the post-operative period had a lower risk of SSI than those who did not [RR=0.21/95%; CI=0.70-0.63]. The mean length of hospital stay was shorter among patients whose prophylactic treatment was correctly employed than among for which it was not [6.1 (±9.8) and 11.1 (±13.5) days, p=0.25].

Resumo em Inglês:

We analyzed the first 96 patients tested for HIV resistance to antiretroviral therapy in three Brazilian states. The HIV-1 reverse transcriptase (RT) and protease (PR) were sequenced by using the ABI ViroSeq system. The drugs previously used for each patient were recorded and correlated with the mutations found in the samples. Viral load (VL) and CD4 count were also recorded. Only one patient had the wild type sequence. The most prevalent mutations were: 184V (59%), 41L (47.9%), 63P (53%), 215Y (50%), 36I (46%), 10I (35%), 67N (42%), 77I (37%), 90M (36%) and 210W (33%). A positive correlation between the number of previously used ARVs and the number of mutations was observed (p<0.05). Associations between mutations and ARV drugs were identified at positions 69, 118, 184 and 215 with previous exposure to NRTI, mutations at positions 98, 100, 103, 181 and 190 with previous NNRTI use and at positions 10, 20, 30, 46, 53, 54, 71, 73, 82, 84, 88 and 90 with previous PI therapy (p<0.05). Previous exposure to ARV drugs was associated with previous genotypic resistance to specific drugs, leading to treatment failure in HIV patients. Genotypic resistance was clearly associated with virological and immunological failure.

Resumo em Inglês:

In the advanced stages of AIDS, characterized by severe immunodepression, tuberculosis (TB) may present with a clinical picture of septic shock, due to typical bacteremia. Hematogenic dissemination of mycobacteria is frequent in immunodepressed patients with TB or disseminated mycobacteriosis, leading to increased positivity in detection by automated blood culture. The objective of our study was to determine the prevalence of mycobacteremia in patients with AIDS and with prolonged fever seen at the Emilio Ribas Institute of Infectology. Patients with a history of daily fever (37.8ºC), lasting more than 30 days, and with CD4+ helper lymphocyte counts below 200 cells/mL, were selected from February 2001 to March 2002. A 5 mL peripheral blood sample was collected from each patient for mycobacterial blood culture by an automated method, using the BACTEC 9000 MB and MB/BACT techniques. Forty-five patients aged on average 35 years, most of them males, were included in the study. The mean T CD4+ lymphocyte count was 58 cells/mL. Among the samples submitted to blood culture, 30% gave M. tuberculosis growth, with 62% sensitivity. Among the patients with a negative blood culture, nine had received a diagnosis of TB by another method. Automated blood culture proved to be a technique of relevant diagnostic value for M. tuberculosis in patients with prolonged fever in advanced stages of AIDS. The method is simple, and it helps the physician to select the best therapeutic option.

Resumo em Inglês:

OBJETIVO: Examine the prevalence and clinical/epidemiological aspects of patients with nontuberculous mycobacteria (NTM) isolated from sputum provided by an outpatient clinic specializing in the treatment of multiresistant tuberculosis (MRTB) in Bahia, Brazil. METHODS: All patients followed at the MRTB outpatient clinic of the Octávio Mangabeira Specialized Hospital (HEOM) were evaluated retrospectively from July 1998 to July 2003. All patients underwent direct examinations and cultures to identify the mycobacteria species found during initial and subsequent evaluations. The following variables were recorded: age, gender, clinical symptoms and signs, pre-existing lung disease, prior TB treatment, HIV serology, and NTM species. Categorical and quantitative variables were respectively characterized using proportions and measures ± SD. RESULTS: NTM were isolated in 19 of 231 patients (8.2%; 95%CI: 5.2%-12.3%), with the following species distribution: 58% (11/19) M. chelonae/abscessus; 16% (3/19) M. avium-intracellular complex; 16% (3/19) M. kansasii; and 11% (2/19) M. fortuitum. HIV serology was positive for just one patient (5%), from whom M. chelonae/abscessus was isolated. Productive coughing was observed in all cases. American Thoracic Society (ATS) diagnostic criteria for NTM lung disease were observed in 14 patients (74%). CONCLUSION: The prevalence of NTM isolated from patients referred to the MRTB outpatient clinic in Bahia was 8.2% (CI 95%: 5.2%-12.3%); rapid-growth mycobacteria (M. chelonae/M. fortuitum) were the most frequently isolated (68%).

Resumo em Inglês:

Since 2002, the Brazilian Ministry of Health has recommended a score system for tuberculosis diagnosis of children and adolescents that does not need bacteriological positivity, because most cases in this age group have few bacteria. An observational, transversal study was carried out at the outpatient health care service of the reference medical service in Salvador, Bahia, including 164 patients with pulmonary tuberculosis, with ages ranging between 1 and 15 years of age, who were treated from 1990 to 2001. The gold standard used to establish the diagnosis was clinical, radiological, epidemiological and based on follow-up data. The score system for diagnosis purposes was tested retrospectively. The median age and the average age of the 164 patients were 6 and 6.62 years (SD ± 4.33), respectively. About 65% of the sample reported a history of close contact with a tuberculous adult. The BCG vaccine coverage was 70.7% (116/164). It was found that 26% (43/164) of the patients had severe malnutrition. Out of this group, 26/43 (60.47%) were < 5mm reactive to the tuberculin test. On the other hand, out of the 91 patients with tuberculin test < 5mm, 29% (26/ 91) had severe malnutrition. The use of the score gave the following distribution: a) TB very likely in 81.7% (134/164) of the patients; b) possible TB in 15.9% (26/164) and TB unlikely in 2.4% (4/164). Among patients who had been vaccinated more than 2 years before, there was a 9 times higher risk of finding a tuberculin test above 10 mm in individuals with probable TB in comparison with the patients with possible or unlikely TB.

Resumo em Inglês:

INTRODUCTION: In Rio de Janeiro, in almost half of the cases of pleural tuberculosis (PT) treatment begins without substantiation of diagnosis. We examined variables associated with this disease. METHOD: We studied 215 consecutive patients; 104 had tuberculosis (TB) and 111 did not (NTB): 41 neoplasms, 29 transudates, 28 para-pneumonic and 13 other etiologies. Clinical and laboratory variables were assessed in a combined manner using likelihood ratios (LR) and Bayes' theorem to determine the probability of PT. RESULTS: Among the variables examined, adenosine deaminase (ADA) levels, lymphocyte cell percentage, protein and age were the best indicators for the diagnosis of PT. Association of ADA with any of the other variables led to a LR+ higher than 10 and a LR- lower than 0.1, indicating the presence or absence of PT, with an individual probability of more than 90% or of less than 10% considering that there was a 50% initial probability associated with the presence of PT. CONCLUSIONS: Since ADA is highly sensitive, we can practically exclude TB as the cause of effusion when there are low ADA values. However, to confirm the possibility of TB we recommend that other variables, such as prevalence of lymphocytes (higher than 90%), and high protein levels (more than 4g/dL); low age (less than 45 years) also should be considered.

Resumo em Inglês:

Cryptosporidium parvum is an endemic, zoonotic coccidian parasitosis that is highly prevalent in third-world countries where waterborne fecal contamination of food and drink or person-to-person contact with oocysts are the most common methods of transmission of the enteric protozoan. This type of transmission of the parasite made the villages around Lake Atitlan, Guatemala a unique site to compare environmental risk factors with the level of Cryptosporidium infections in the local residents. The study was carried out in two villages, San Antonio Palopo and Santa Catarina Palopo, located in the highlands above the shores of the lake. Smears from stool specimens of patients with gastroenteritis were processed using Kinyoun's modified acid-fast stain and observed with light microscopy. Of the 100 residents examined from the two villages, 32% had Cryptosporidium infections. Female children had the highest prevalence of infection (44% in San Antonio Palopo and 46% in Santa Catarina Palopo, p<0.05), and they also had significantly higher infection rates than males, 50% vs. 17%, respectively. The prevalence rate was not influenced by the season of the year or by the location of the residents. We found differences in prevalence rates due to age and gender, and we suggest that the high infection rates of specific groups are associated with their exposure to the contaminated water supply from Lake Atitlan.

Resumo em Inglês:

Pertussis is increasing in frequency among adults, but early diagnosis requires special attention to details in the medical history. We describe a 64 year-old male with classic signs and symptoms of pertussis and documented Bordetella pertussis infection that were overlooked because he presented with a chief complaint of cough and fear of falling asleep. Coughing paroxysms and a feeling of suffocation (30-60 seconds) only occurred at night after short periods of deep sleep (30-45 minutes). The physicians did not observe these episodes during daytime examinations, and the basis of the patient's fear of sleep was not explored. We recommend reassessment of how adults describe symptoms of pertussis, including fear of sleep, and we suggest the use of PCR technology to allow early diagnosis and prompt treatment.

Resumo em Inglês:

The authors report a case of deficiency of the eighth component of complement in a young adult with a history of three episodes of meningitis; one of them proved to be meningococcal. The literature was reviewed and meningitis due to Neisseria meningitidis strains causing disease in complement-deficient and complement-sufficient patients was demonstrated. Meningococcal disease may be the first manifestation of complement deficiency; screening for complement function must be considered for those with invasive meningococcal disease, with posterior evaluation of the components of the terminal pathway of complement.