Brazilian Journal of Infectious Diseases, Volume: 11, Issue: 2, Published: 2007
  • A pharmacodynamic strategy to optimize empirical antibiotic therapy for gram-negative bacteria in a Brazilian Intensive Care Unit Brief Communications

    Kiffer, Carlos R.V.; Kuti, Joseph L.; Mendes, Caio M.F.; Oplustil, Carmen P.; Amarante, Jorge B.; Biancalana, Maria L.; Xavier, Nelson; Nicolau, David P.

    Abstract in English:

    Pharmacodynamic analyses were proposed to determine optimal empirical antibiotic therapy against Gram-negative bacteria isolated in a Brazilian ICU. Due to high resistance rates, standard regimens of cefepime, ciprofloxacin, meropenem, and piperacillin/tazobactam were not able to attain significant bactericidal CFR. Prolonged infusion of meropenem achieved 88% CFR, making it a possible empirical regimen in this ICU until susceptibilities become available. Still, even through administration of high dose prolonged infusions, 12.0% of simulated subjects did not achieve bactericidal exposure, suggesting that combination therapy would frequently be required in this setting. In conclusion, we recommend that in the presence of identified resistance problems among Gram-negative bacteria in a unit or hospital, MIC testing of formulary agents should be conducted along with pharmacodynamic simulation to assist in choosing an optimal antibiotic and dosage regimen for empirical use of severe infections until cultures and susceptibilities become available.
  • Use of the D test method to detect inducible clindamycin resistance in coagulase negative staphylococci (CoNS) Brief Communications

    Perez, Leandro Reus Rodrigues; Caierão, Juliana; Antunes, Ana Lúcia Souza; d'Azevedo, Pedro Alves

    Abstract in English:

    According to the National Committee for Clinical Laboratory Standards (NCCLS, 2004), a method to evaluate the inducible clindamycin resistance in accordance with an approach of the disks of erythromycin and clindamycin - the D test - has been reported. We analyzed the performance of this method in 200 coagulase negative staphylococci (CoNS) strains obtained from blood cultures of hospitalized patients at a general hospital in Southern Brazil. Twenty-seven clinical isolates with suitable profile (erythromycin-resistant and clindamycin-susceptible) were evaluated for the D test realization. Thus, only 5 CoNS were D test positive. The D test method showed to be simple and an important technique in the detection of inducible clindamycin resistance.
  • The environmental cofactors in carcinogenesis in high risk HPV/HIV-positive women Original Papers

    Paulo, Michele; Borges, Alex Bittencourt; Duarte, Geraldo; Quintana, Silvana Maria; Montes, Marlise Bonetti Agostinho; Toloi, Maria Regina Torqueti

    Abstract in English:

    The objective of the present study was to assess the presence of human papilloma virus (HPV) in HIV-infected women, with comparison between the Papanicolaou cytologic technique and the molecular PCR technique, as well as to determine the type of HPV, to measure cellular immunocompetence and to identify the presence of risk factors for the acquisition of HPV infection. Thirty HIV-infected women were selected. Vaginal and endocervical samples were collected from 27 of them. The smears were examined by 3 experienced cytologists to diagnose the presence of HPV by the Papanicolaou technique and the results were compared to HPV detection and typing by PCR. HPV-infected patients were interviewed in order to identify the presence of risk factors for the acquisition of the virus. Eight of the 27 patients analyzed (29%) presented HPV in endocervical samples submitted to PCR, 6 of them (75%) presented HPV involving a high risk of development of cervical cancer. For 5 of these patients, the cytologic diagnosis was not confirmed by PCR. When cellular immunocompetence was related to HPV infection, PCR revealed a diagnosis of HPV in 37.50% of the patients at intermediate risk for HPV infection and in 83.33% of the patients at high risk for HPV infection. These immunologically compromised HPV-infected patients are at higher risk of developing cervical neoplasia. We showed here that PCR is adequate for HPV detection and that, if only the Papanicolaou method is used for the follow-up of these patients, we will not provide good prevention of cervical cancer.
  • CCR5 genotypes and progression to HIV disease in perinatally infected children Original Papers

    Angelis, Daniela Souza Araújo de; Freire, Wilton Santos; Pannuti, Cláudio Sergio; Succi, Regina Célia de Menezes; Machado, Daisy Maria

    Abstract in English:

    The CCR5 molecule, a chemokine receptor, is the most important co-receptor for macrophage-tropic HIV-1. A 32-bp deletion in the gene encoding CCR5 (CCR5-del32) confers nearly complete resistance to HIV-1 infection in homozygotes, and slows the rate of progression to AIDS in heterozygous adults. The aim of this study was to describe the CCR5 genotypes and the characteristics of HIV disease progression in perinatally infected children. From a total of 51 children analyzed for the CCR5-del32 mutation, 18 (35%) were considered to be rapid progressors, 28 (55%) were moderate progressors and 5 (10%) were slow progressors. A portion of the CCR5 gene was amplified by PCR from genomic DNA followed by agarose gel electrophoresis. Forty-nine children (96%) carried the homozygous wild type genotype for CCR5 while 2 (4%) carried the heterozygous wt/del32 genotype. In the population studied, the CCR5 genotype was unable to account for the differences in pattern of the disease progression among the three groups (rapid, moderate and slow progressors), and the allele frequency of CCR5-del32 was too low to allow statistical comparisons with adequate resolving power. Studies on larger populations may help to further elucidate the role of this allele and other host factors in the regulation of HIV-1 pathogenesis in children.
  • Ocular problems in brazilian patients with AIDS before and in highly active antiretroviral therapy (HAART) era Original Papers

    Rodrigues, Marcia Lopes; Rodrigues, Maria de Lourdes Veronese; Figueiredo, José Fernando de Castro; Freitas, João Alberto Holanda de

    Abstract in English:

    This study determined the total frequency of patients with AIDS and ophthalmologic problems before and after the introduction of combined highly active antiretroviral therapy (HAART), regardless of the use of this treatment; it also determined the frequency of external ocular diseases, intraocular infections and inflammations, and problems of the anterior portion of the optic nerve in these two groups of patients; and it determined the differences in the frequency of ophthalmologic problems in patients receiving HAART or not. This was a retrospective study of 207 patients examined using the same protocol, from June 1995 to February 1998 (n=58, pre-HAART era) and from March 1998 to May 2005 (n=149, HAART era). The frequency of ophthalmologic problems was significantly higher in the pre-HAART group, with a predominance of intraocular infections and inflammations. Comparison of patients receiving HAART or not revealed that ocular involvement tended to be reduced in the treated group and that treatment was effective in preventing infectious diseases; however, the prevalence of external ocular diseases was similar in the patients receiving HAART or not. As a consequence of HAART, we observed a reduction in the frequency of ocular problems, especially intraocular infections and inflammations. However, this benefic influence was less important in the ocular surface or in external ocular disease.
  • Efficacy of amphotericin B in a fat emulsion for the treatment of cryptococcal meningitis in AIDS patients Original Papers

    Rubio, Fernando Góngora; Zanon, Jeferson Rodrigo; Almeida, Margarete Teresa Gottardo de; Góngora, Delzi Vinha Nunes de

    Abstract in English:

    Several formulae have been developed in an attempt to reduce the toxicity of amphotericin B (AmB), but their high costs preclude widespread use. The aim of this study was to evaluate the efficacy of amphotericin B in a fat emulsion, i.e. Intralipid (AmB-IL), in 37 AIDS patients with cryptococcal meningitis (CM). We retrospectively reviewed data collected in a non-comparative open study between January 1999 and December 2001. The therapeutic cure was defined as complete resolution or improvement of the clinical symptoms or complete absence or improvement of the mycological alterations of the CSF. The outcomes were evaluated at 2 weeks, induction phase (IP), and at the end of treatment or consolidation phase (CP) with the last available CSF. Prior to the diagnosis of CM, 72% of patients had had one or more OI and 67.57% had a concomitant OI. The median CD4-cell count was 32 cells/mm³, the median leukocyte count in the CSF was 29 cells/mm³ and the median cumulative dose of AmB-IL was 1,200 mg (300-2,500). The therapeutic cure was 57.14% in the IP and 64.86% in the CP. During IP, 9 patients died (24.32%) and 4 (10.81%) during the CP (p=0.2). Thus, the overall mortality rate was 35.14%. AmB-IL, an inexpensive preparation, might be an alternative to conventional AmB. Some questions remain such as its compatibility, stability and level of toxicity. The benefit is especially important in developing countries, where no drugs other than AmB are available to treat systemic fungal infections.
  • Prevalence of HIV infection in patients hospitalized for tuberculosis in Bahia, Brazil Original Papers

    Matos, Eliana Dias; Lemos, Antônio Carlos Moreira; Bittencourt, Carolina; Mesquita, Critiane Leite; Kuhn, Patrícia Chamadoira

    Abstract in English:

    HIV infection is an important risk factor for the development of tuberculosis (TB), and also affects its morbidity and mortality. This study estimated the prevalence of HIV infection in patients hospitalized for TB in Bahia (in northeastern Brazil) and to evaluate its impact on in-hospital mortality. A total of 375 patients with TB, admitted consecutively to a TB reference hospital in Salvador (Bahia, Brazil), were evaluated between July 2001 and July 2003. Anti-HIV serology was performed in all patients irrespective of clinical and/or epidemiological data suggestive of HIV infection. Death during hospitalization was the principal event-dependent variable. Mean age of patients was 41.4 ± 16.2 years and the male/female ratio was 3.4:1.0. The prevalence of HIV infection was 8.8% (95%CI: 6.2-12.0%). Patients in the HIV-positive group were younger than those in the HIV-negative group (37.1 versus 41.9 years; p=0.05). In-hospital mortality was 10.9% for the whole group (95%CI: 9.4-15.9%), but was significantly greater in the HIV-positive group compared to the HIV-negative group (27.3% versus 9.4%; RR=2.9; 95%CI: 1.5-5.6; p=0.002). The prevalence of HIV infection in patients hospitalized for TB in Bahia (northeastern Brazil) is relatively high (8.8%) and mortality is significantly higher (2.9-fold) in the HIV-positive group. These findings justify carrying out HIV testing, as recommended by the Brazilian Ministry of Health, in all TB patients, particularly those requiring hospitalization.
  • The incidence of cytomegalovirus infection in lung transplant recipients under universal prophylaxis with intravenous ganciclovir Original Papers

    Schröeder, Regina; Michelon, Tatiana; Wurdig, João; Fagundes, Iara; Schio, Sadi; Sanchez, Leticia; Camargo, José J.; Sukkienik, Teresa C.; Pasqualotto, Alessandro C.; Neumann, Jorge

    Abstract in English:

    The best strategy for control of cytomegalovirus (CMV) infection in lung transplant patients is still not determined. The aim of this study was to document the incidence of CMV infection in a cohort of lung transplant recipients under universal prophylaxis with intravenous ganciclovir. All patients received immunosuppressive regimens consisting of cyclosporine, azathioprine, and prednisone. Regardless of CMV serostatus, intravenous ganciclovir was prescribed for every patient in the first 3 months post-transplantation. CMV infection was defined as the detection of CMV pp65 in leukocytes. Eighty-two lung transplant patients were included over a 5-year period. The incidence of CMV infection in the first year post-transplantation was 68.3%, occurring after a median length of 114 days (range, 26-343 days). This study revealed a high incidence of CMV infection in the first year following lung transplantation despite prolonged universal ganciclovir prophylaxis.
  • Salivary anti-PGL IgM and IgA titers and serum antibody IgG titers and avidities in leprosy patients and their correlation with time of infection and antigen exposure Original Papers

    Nagao-Dias, Aparecida T.; Almeida, Thereza Lúcia P.; Oliveira, Maria de Fátima; Santos, Rivanda C.; Lima, Ana Laura P.; Brasil, Márcia

    Abstract in English:

    The present work proposed to correlate serum antibody avidity and salivary antibody titers as parameters for time of infection and antigen exposure in a co-hort study evaluating leprosy patients in different periods of treatment. Colorimetric enzyme-immunoassays for salivary antibodies, serum antibody IgG titers and avidities were performed in the samples. Anti-PGL-1 IgA and IgM salivary antibodies were significantly higher in multibacillar (MB-L) patients compared to normal controls (p<0.05), but not when compared to borderline tuberculoid (BT) or to paucibacillar (PB-L) patients (p>0.05). A good correlation was found between salivary anti-PGL-1 IgA and IgM levels in MB-L patients (r=0.41, p<0.01). Two out of 33 tested saliva samples from patients who had completed the drug regimen treatment presented positive salivary antibodies. Among non-treated patients, samples with low, medium or high serum IgG antibody avidity were found in similar frequencies. In patients under treatment, most of the serum samples showed low or medium IgG antibody avidity. The treated MB-L patients showed medium or high antibody avidity, except for two, who showed very low antibody avidity results. We suggest that salivary anti-PGL antibodies and serum IgG avidity could be useful for the indication of recent exposure or re-exposure to bacteria after chemotherapy.
  • Impact of respiratory infections by influenza viruses A and B in pediatrics patients from Federal University of Paraná, Brazil Original Papers

    Coelho, M.C.; Tsuchiya, L.R.R.V.; Nogueira, M.B.; Pereira, L.A.; Takahashi, G.A.; Cruz, C.R.; Raboni, S.M.

    Abstract in English:

    The objective of the present study was to determine the impact of influenza virus on pediatric hospitalized patients. We retrospectively reviewed records of children with laboratory diagnoses, by cell culture and/or indirect immunofluorescence assay, of influenza virus seen in a period of 6 years. A total of 1,033 samples were analyzed, 45 (4.3%) of them being reactive to influenza virus. Thirty-one samples were positive to influenza A virus and 14 to influenza B. The frequency of hospitalization in intensive care and medical emergency was found to be high. Three (8.6%) patients died, two of them due to respiratory failure. Low frequency of influenza virus infection was observed in the study. The data suggest the need of more efficient epidemiological surveillance measures in order to obtain reliable information to better assess the impact of the virus on our region and determine the need of preventive measures, such as immunization.
  • Short-interfering RNAs as antivirals against rabies Original Papers

    Brandão, Paulo Eduardo; Castilho, Juliana Galera; Fahl, Willian; Carnieli Jr., Pedro; Oliveira, Rafael de Novaes; Macedo, Carla Isabel; Carrieri, Maria Luiza; Kotait, Ivanete

    Abstract in English:

    This study aimed to test in vitro a RNA-interference based antiviral approach for rabies with short-interfering RNAs (siRNAs) against rabies virus nucleoprotein mRNA. BHK-21 cells were infected with serial dilutions of PV rabies virus strain and transfected with a pool of three siRNAs. Direct immunofluorescence staining showed a 5-time decrease in virus titer when compared to a non-treated plate, showing a promising new approach to the development of antivirals for rabies treatment.
  • Definition of a diagnostic routine in individuals with inconclusive serology for chagas disease Original Papers

    Picka, Mariele Cristina Modolo; Meira, Domingos Alves; Carvalho, Thaís Batista de; Peresi, Eliana; Marcondes-Machado, Jussara

    Abstract in English:

    Despite the existence of highly sensitive tests, inconclusive serological results are frequent in chronic chagasic infection. This study aimed to define a diagnostic conduct for 30 individuals with inconclusive serology (G3) for chagasic infection assisted at the Outpatient Unit for Infectious and Parasitic Diseases of the Botucatu School of Medicine. Twenty-one individuals with negative serology (G1) and 33 with positive serology (G2) were also studied. Serological methods ELISA, HAI, IFI and immunoblotting TESA-cruzi were used for G1, G2 and G3, and parasitological methods xenodiagnosis, hemoculture and PCR-LIT were used for G2 and G3 individuals. ELISA, HAI and IFI were performed in 5 different blood samples in G2 and G3. TESA-cruzi was carried out only once in G1, G2 and G3 and, since it is the most sensitive, it was utilized as standard. In G3, positivity for ELISA reached 86% in the fifth blood sample; the ELISA+HAI+IFI combination showed a maximum of 44.8% in the second sample; and TESA-cruzi, 76% in one single sample. Xenodiagnosis positivity was 9.4%; hemoculture showed 15.2%; and PCR-LIT exhibited 22% positivity in G2. Nevertheless, in G3, positivity percentage was 3.4% for xenodiagnosis, 6.7% for PCR-LIT, and no positive result was found for hemoculture. In G3, PCR-LIT resolved one case which was still inconclusive according to serology tests. In order to define inconclusive diagnoses, the results suggest the combined use of ELISA+HAI+IFI in 2 blood samples, decreasing the occurrence of false positive/negative results. If results remain inconclusive, the performance of TESA-cruzi and PCR-LIT, if necessary, is recommended.
  • Inactivation of Escherichia coli O157:H7 by essential oil from Cinnamomum zeylanicum Original Papers

    Senhaji, Ouafae; Faid, Mohamed; Kalalou, Ichraq

    Abstract in English:

    Escherichia coli O157:H7 is a pathogen strain, which causes hemorrhagic colitis, hemolytic uremic syndrome and thrombotic thrombocytopenic purpura in humans. The control of bacterial cells in foods is an important factor to reduce foodborne diseases due to E. coli O157:H7. Assays to inactivate E. coli O157:H7 were carried out by using the cinnamon oil obtained by steam distillation for 6 hours. When E. coli O157:H7 cells were incubated at 37°C for 2 hours in the presence of 0.025% of the essential oil from cinnamon, a dramatic decrease was observed in the viable counts (from 10(7) to 3.10(4) CFU/mL-1). In the presence of 0.05% of the oil, most of cells were killed after 30 min, suggesting that the antimicrobial activity of essential oil is bactericidal against E. coli. The minimal inhibitory concentration of the essential oil from cinnamon was around 625 ppm against E. coli O157:H7 and E. coli ATCC 25921, around 1250 ppm against E. coli ATCC25922 and around 2500 ppm against E. coli ATCC11105.
  • Utility of the ceftazidime-imipenem antagonism test (CIAT) to detect and confirm the presence of inducible AmpC beta-lactamases among enterobacteriaceae Original Papers

    Cantarelli, Vlademir Vicente; Inamine, Everton; Brodt, Teresa Cristina Z.; Secchi, Carina; Cavalcante, Bianca C.; Pereira, Fabiana de Souza

    Abstract in English:

    Detection of AmpC beta-lactamase production by enterobacteria has been problematic. Contrary to ESBLs, no specific guidelines are available for detection and confirmation of AmpC production by clinical relevant microorganisms. Moreover, some bacterial species may produce inducible AmpC beta-lactamases that can be easily overlooked by routine susceptibility tests. We reported here a new test based on the strong inducible effect of imipenem on AmpC genes and the consequent antagonism with ceftazidime. This test is very simple and proved to be helpful in detecting AmpC-inducible enzymes among several species of clinical isolates.
  • C-reactive protein-guided approach may shorten length of antimicrobial treatment of culture-proven late-onset sepsis: an intervention study Original Papers

    Couto, Renato C.; Barbosa, José A. A.; Pedrosa, Tânia M.G.; Biscione, Fernando M.

    Abstract in English:

    Late-onset sepsis (LOS) (i.e., sepsis in a neonate after 72 hours of life) is associated with high mortality and significantly prolonged antibiotic exposure and hospital stay in neonates admitted to intensive care units (ICU). In this study, we assessed the reliability of serum C-reactive protein (CRP) as a determinant of antimicrobial treatment duration of LOS. From January 1996 to December 2002, all consecutive infants aged <28 days admitted to a single medical-surgical ICU and diagnosed with primary LOS were enrolled in a prospective, intervention trial with historical controls. Only blood culture-positive LOSs were included. Exclusion criteria were: age >28 days at diagnosis of LOS, development of site-specific infection, and central venous catheter-related LOS. From January 1996 to July 1998 (historical control group), antimicrobial treatment of LOS was offered for at least 14 days. From August 1998 to December 2002 (intervention group), neonates underwent serial semiquantitative measurements of serum CRP, and antimicrobial treatment was discontinued when CRP was <12 mg/L. Primary efficacy endpoint was the duration of antimicrobial therapy. Secondary efficacy endpoints were the proportion of relapsing sepsis within 72 hours of antibiotic withdrawal and the overall mortality rate. The historical control group comprised 76 neonates developing 85 episodes of LOS; 138 LOS occurring in 120 patients comprised the intervention group. Length of antimicrobial treatment of LOS was significantly shorter during the second study period (16 days vs. 9 days, p<0.001). Secondary efficacy endpoints showed similar rates of relapsing sepsis and overall mortality in both time periods.
  • Community-acquired pneumonia in the childhood: analysis of the diagnostic methods Original Papers

    Requejo, Henry I. Z.

    Abstract in English:

    Immunological assays such as CIE, LA, and Dot-ELISA were compared in order to diagnose community-acquired pneumonia. Serum, pleural fluid and urine samples were comparatively employed for bacterial antigen detection. Dot-ELISA proved to be an original and practical alternative procedure for detecting bacterial polysaccharide antigens from pleural fluid and/or concentrated urine samples, providing a rapid diagnosis for pediatric patients with community-acquired pneumonia.
  • Accuracy of a self-collection kit for the microbiological study of the vaginal content Original Papers

    Passos, Mauro Romero L.; Varella, Renata Q.; Barreto, Nero A.; Garcia, Maria Luiza; Giraldo, Paulo C.

    Abstract in English:

    Diagnosis of vaginal discharge is frequently performed in an empirical way, leading to inadequate treatment. This study tested the accuracy of a self-collection kit for microbiological study of the vaginal content. One hundred and forty-two women of Family Health Program units in Niterói and Piraí cities were enrolled in order to have their vaginal content studied. A brief explanation and a self-collection kit were provided in order to sample the vaginal content. The self-collection kit was composed of one empty plastic tube, two glass slides, a long handle cytobrush, an identification card and guideline notes. The vaginal sample was applied on the glass slides by the women and stained by Gram technique. A second sampling was done by the medical personnel. The microbiological diagnosis in a blinded analysis was made under optical microscopy. A validation diagnosis test was done taking the medical collection results as a gold standard. A total of 106 women had followed the protocol and were included in the study. Microbiological analysis was unsatisfactory in 12 cases (6 cases of self-collection material and 6 cases of medical collection). The microbiological analyses in the self-collection and in the medical collection material were respectively: bacterial vaginosis in 21.7% and 17.9%, non bacillar flora in 10.3% and 11.3%, vaginal trichomoniasis in 5.66% and 5.6%, candidiasis in 3.78% and 2.8% and a normal microbiota in 52.8% and 56.6%. The Kappa coefficient suggested a "very good correlation" of the microbiological results between the two methods of collection (K=0.7945). The self-collection kit provides samples for microbiological analysis of the vaginal microbiota as good as medical collection.
  • Genital ulcers in women: clinical, microbiologic and histopathologic characteristics Original Papers

    Gomes, Christiane Maria Moreira; Giraldo, Paulo César; Gomes, Francis de Assis Moraes; Amaral, Rose; Passos, Mauro Romero Leal; Gonçalves, Ana Katherine da Silveira

    Abstract in English:

    Female genital ulcer is a disease that affects a large number of women, and its etiologic diagnosis can be difficult. The disease may increase the risk of acquiring HIV. Genital ulcer may be present in sexually transmitted diseases (STD) - syphilis, chancroid, genital herpes, donovanosis, lymphogranuloma venereum and other non-STD disorders (NSTD) - Behçet's syndrome, pemphigus, Crohn's disease, erosive lichen planus and others. This study evaluated the clinical-histopathologic-microbiologic characteristics of female genital ulcers. A cross-sectional descriptive prospective study was conducted during a six-month period to investigate the first 53 women without a definitive diagnosis, seeking medical care for genital ulcers at a genital infections outpatient facility in a university hospital. A detailed and specific history was taken, followed by a dermatologic and gynecologic examination. In addition to collecting material from the lesions for microbiologic study, a biopsy of the ulcer was performed for histopathologic investigation. The average age of the patients was 32.7 years, 56.6% had junior high school education and higher education. The most frequent etiology was herpetic lesion, followed by auto-immune ulcers. At the time of their first consultation, around 60% of the women were using inadequate medication that was inconsistent with the final diagnosis. Histologic diagnosis was conclusive in only 26.4% of the patients (14/53). Cure was obtained in 99% of the cases after proper therapy. The female genital ulcers studied were equally distributed between sexually transmitted and non-sexually transmitted causes. Herpes was the most frequent type of genital ulcer, affecting women indiscriminately, mostly between the ages of 20 and 40 years. The etiologic diagnosis of herpetic ulcers is difficult to make even when various diagnostic methods are applied. It is imperative that NSTD should be included in the differential diagnoses of female genital ulcers. The histopathologic exam is not a diagnostic tool in the majority of cases and should not be considered the gold standard test, being of little value in cases of NSTD and STD ulcers.
  • Phenotypical characteristics of group B streptococcus in parturients Original Papers

    Simoes, Jose Antonio; Alves, Valeria Moraes Neder; Fracalanzza, Sergio Eduardo Longo; Camargo, Rodrigo Pauperio Soares de; Mathias, Lenir; Milanez, Helaine Maria Besteti Pires; Brolazo, Eliane Melo

    Abstract in English:

    Colonization by Group B Streptococcus (GBS) is highly prevalent among pregnant women, with prevalence rates ranging between 4% and 30%. The infection may be transmitted vertically and may result in serious neonatal consequences. In the period from November 2003 to May 2004, a cross-sectional study was carried out among 316 parturients at the Jundiaí Teaching Hospital to establish the prevalence of genital GBS colonization, to identify the factors associated with colonization and the characteristic phenotypes of these streptococci. Samples from rectal and vaginal areas were collected for selective culture in Todd-Hewitt broth. Susceptibility to 7 antimicrobial agents was tested using the antibiotic diffusion disk technique, and the isolated strains were classified using specific antisera. The prevalence of GBS colonization was 14.6%. No strain was resistant to penicillin, ampicillin, erythromycin or nitrofurantoin. The majority of strains were sensitive to cephalothin. Greatest resistance was to gentamicin (76.1%), followed by clindamycin (17.4%). The most frequent serotype was Ib (23.9%), followed by serotypes II and Ia (19.6% and 17.4%, respectively). There was no correlation between serotype and greater antimicrobial resistance. In conclusion, the prevalence of GBS in parturients was high and penicillin continues to be the drug of choice for intrapartum prophylaxis. The most frequent serotype (Ib) found in this study differs from those found in the majority of studies carried out in other countries, revealing the need to identify prevalent serotypes in each region so that specific vaccines can be designed.
  • Risk factors for nosocomial bloodstream infection caused by multidrug resistant gram-negative bacilli in pediatrics Original Papers

    Arnoni, Mariana V.; Berezin, Eitan N.; Martino, Marinês D.V.

    Abstract in English:

    The aim of this study was to identify the risk factors for nosocomial bloodstream infections by multidrug resistant Gram-negative bacilli. From November 2001 to December 2003, in the Pediatric Department of the Santa Casa de São Paulo, a retrospective case-control study was developed concerning patients who had nosocomial bloodstream infection caused by Gram-negative bacilli. Patients with multidrug resistant infections were designated as case patients, and control patients were those with an infection that did not meet the criteria for multidrug resistance. Previous use of central venous catheter and previous use of vancomycin plus third generation cephalosporins were associated to a higher chance of infections by multidrug resistant Gram-negative bacilli (Odds ratio - 5.8 and 5.2, respectively). Regarding sensitivity of the isolated agents, 47.8% were multidrug resistant, 54.2% were Klebsiella spp. ESBL producers and 36.4% were imipenem resistant Pseudomonas aeruginosa. The lethality rate was 36.9% in the studied cases and this rate was significantly higher in the group of patients with multidrug resistant infections (p=0.013). Risk factor identification as well as the knowledge of the susceptibility of the nosocomial infectious agents gave us the possibility to perform preventive and control strategies to reduce the costs and mortality related to these infections.
  • Prevalence of newborn bacterial meningitis and sepsis during the pregnancy period for public health care system participants in Salvador, Bahia, Brazil Original Papers

    Silva, Luzia Poliana Anjos da; Cavalheiro, Laura Giotto; Queirós, Fernanda; Nova, Camila Vila; Lucena, Rita

    Abstract in English:

    Bacterial meningitis is still a major public health threat inside developing countries. In Brazil, the Department of Public Health estimates that the prevalence of bacterial meningitis is 22 cases per 100,000 persons. During the neonatal period, the bacterial meningitis develops special characteristics that can result in hearing problems and movement loss due to neurological and psychological damages. This study had the aim to analyze the prevalence of bacterial meningitis and sepsis in newborns during the pregnancy period for those using the public health care system in Salvador-Bahia. One of the goal was to describe the risk factors of bacterial meningitis and sepsis in newborns. A second goal was to identify, based on newborn health records, the difficulties to predict issues with the hearing, neurological and psychological problems. This study has a cross-sectional design. The newborns that were included in this study had bacterial meningitis or sepsis within 0-28 days of life. They were admitted in the maternity wards between June-December 2005 at the newborn intensive unit care. We analyzed 72 reports of newborns and only 11 (17%) were bacterial meningitis or sepsis newborn cases. These cases were associated to high intake of ototoxic drugs that can cause oto and nephrotoxicity, and cause serious sequels on the child development. Nervous system infection is one of the 2 major problems in clinical practice, especially during the first month after birth. During this first month, the nervous system infection develops special characteristics, which are different from regular symptoms and it requires treatment due to the increased risk to develop complications. It is strongly recommended to monitor ototoxic drugs use to prevent effects on the hearing system.
  • Cefepime restriction improves gram-negative overall resistance patterns in neonatal intensive care unit Original Papers

    Araujo, Orlei Ribeiro de; Silva, Dafne Cardoso Bourguignon da; Diegues, Ana Regina; Arkader, Ronaldo; Cabral, Eloíza Aparecida Ferreira; Afonso, Marta Rodriguez; Louzada, Maria Eduarda; Albertoni, Andréa de Cássia Stéfano

    Abstract in English:

    Antibiotic restriction can be useful in maintaining bacterial susceptibility. The objective of this study was verify if restriction of cefepime, the most frequently used cephalosporin in our neonatal intensive care unit (NICU), would ameliorate broad-spectrum susceptibility of Gram-negative isolates. Nine hundred and ninety-five premature and term newborns were divided into 3 cohorts, according to the prevalence of cefepime use in the unit: Group 1 (n=396) comprised patients admitted from January 2002 to December 2003, period in which cefepime was the most used broad-spectrum antibiotic. Patients in Group 2 (n=349) were admitted when piperacillin/tazobactam replaced cefepime (January to December 2004) and in Group 3 (n=250) when cefepime was reintroduced (January to September 2005). Meropenem was the alternative third-line antibiotic for all groups. Multiresistance was defined as resistance to 2 or more unrelated antibiotics, including necessarily a third or fourth generation cephalosporin, piperacillin/tazobactam or meropenem. Statistics involved Kruskal-Wallis, Mann-Whitney and logrank tests, Kaplan-Meier analysis. Groups were comparable in length of stay, time of mechanical ventilation, gestational age and birth weight. Ninety-eight Gram-negative isolates were analyzed. Patients were more likely to remain free of multiresistant isolates by Kaplan-Meier analysis in Group 2 when compared to Group 1 (p=0.017) and Group 3 (p=0.003). There was also a significant difference in meropenem resistance rates. Cefepime has a greater propensity to select multiresistant Gram-negative pathogens than piperacillin/tazobactam and should not be used extensively in neonatal intensive care.
  • Nosocomial outbreak of Pantoea agglomerans in a pediatric urgent care center Original Papers

    Bicudo, Eliana L.; Macedo, Vanise O.; Carrara, Marlene A.; Castro, Fabíola F.S.; Rage, Ruth I.

    Abstract in English:

    Pantoea agglomerans is a Gram-negative bacterium whose isolates can be found in blood cultures and other secretions. This article described one outbreak of sepsis due to this bacterium in the pediatric urgent care center of a tertiary hospital, in Brasilia, Federal District. This was a case-control study and it evaluated the risk factors for acquisition of nosocomial sepsis caused by Pantoea agglomerans. Six case-patients and 15 control-patients have been found. The risk factors were: vomiting in the internment and presence of solution compositions in the intravenous hydration therapy received in bigger number than 2 compositions. The transference tube used for the compositions was contaminated with Pantoea agglomerans, characterizing the outbreak with common source. The evolution of all the patients was favorable.
  • Risk factors for nosocomial infection in trauma patients Original Papers

    Giamberardino, Heloisa Ihle Garcia; Cesário, Eliane Pereira; Carmes, Eliane Ribeiro; Mulinari, Rogério Andrade

    Abstract in English:

    Several factors are implicated in the increased vulnerability of multiple trauma victims to infection, especially in intensive care-units (ICU). This cohort study was designed to report the incidence, the topography, the etiology and to identify the risk factors for infection in trauma patients admitted in an ICU. From January 2000 to December 2001, 416 trauma patients were admitted to the ICU for more than 24 hours, the mean length of stay was 9.3 days (range 2-65) and 188 (45%) patients developed a total of 290 NI. The most prevailing infections were pneumonia (49%), bloodstream (19%) and urinary tract infections (12%). The variables studied were: the demographic data, diagnosis on admission, site and mechanism of injury, type and number of surgeries, use of invasive devices, days under mechanical ventilation (MV) and site and number of NI. These variables were analyzed with a univariable and multivariable regression analysis. The NI was associated with injury in more than 1 anatomic segment (OR=1.6; CI95%1.06-2.40); mechanical ventilation for more than 3 days (OR=12; CI95% 6.87-24.02); more than 1 surgery (OR=3.13;CI95%1.75-5.65) and more than 2 invasive devices (OR=4.7; CI95%2.99-7.37). Deaths over the first 5 days had high association (RR=3.18) with NI. Three significant variables were identified in the logistic regression, which are: more than 3 days under MV, number of invasive devices and number of surgeries.
  • Dyslipidaemia associated with the highly active antiretroviral therapy in aids patient: reversion after switching (stavudine to tenofovir and lopinavir/ritonavir to atazanavir/ritonavir) Case Reports

    Domingos, Hamilton; Cunha, Rivaldo Venâncio da; Paniago, Anamaria Mello Miranda

    Abstract in English:

    Antiretroviral therapy has been associated with hyperlipidemia in AIDS patients. This case illustrates the classic metabolic effects associated to the HAART including protease inhibitors and/or stavudine. It was showed that the management of the HAART-associated dyslipidaemia with conventional antihyperlipidemic therapy may fail, being the switching strategy the best option.
  • Esophageal ulcers caused by reactivation of ganglionary tuberculosis: a case report Case Reports

    Hadlich, Everton; Galperim, Bruno; Rizzon, Carlos Fernando

    Abstract in English:

    The involvement of the esophagus in tuberculosis (TB) is extremely rare. This is a case report of an immunocompetent male patient, who presented ganglionary TB reactivation, with the development of extensive esophageal ulcers. The endoscopic approach made the diagnosis possible and there was a total resolution of the symptoms after the treatment.
  • Successful treatment of vancomycin-resistant enterococcus ventriculitis in a child Case Reports

    Silva, Paulo Sérgio Lucas da; Monteiro Neto, Henrique; Sejas, Lílian Márcia

    Abstract in English:

    Enterococci are an uncommon cause of CNS infection. A 20 month-old boy, diagnosed with hydrocephalus with ventriculoperitoneal shunt and history of lengthy hospitalization and use of wide spectrum antibiotics, was admitted to the pediatric intensive care unit diagnosed with ventriculitis. On the 14th day of empirical antibiotic therapy (vancomycin and meropenem) the child presented fever while the CSF sample culture evidenced vancomycin-resistant Enterococcus faecium. The patient received intravenous linezolid achieving cerebrospinal fluid sterilization. Conclusion: Intravenous linezolid appears to be a safe and effective therapy for vancomycin-resistant enterococcus ventriculoperitoneal shunt infection.
  • Septicemia caused by Vibrio cholerae O1 biotype El Tor, in São Paulo, Brazil Case Reports

    Abboud, C.S.; Ferreira, C.E.S.; Barbosa, V.L.B.; Araújo, D.A.C.; Zandonadi, E.C.; Pasternak, J.

    Abstract in English:

    We reported a case of septicemia by Vibrio cholerae O1, in São Paulo, Brazil. A 70-year-old male patient, living in an urban area, entered the emergency service having sepsis, dying 12 hours later. Blood culture was positive for Vibrio cholerae O1. This is the first case of bacteremia by Vibrio cholerae O1 reported in South America.
  • Vibrio vulnificus infection in São Paulo, Brazil: case report and literature review Case Reports

    Araujo, Maria Rita Elmor de; Aquino, Caroline; Scaramal, Elton; Ciola, Claudete Sílvia; Schettino, Guilherme; Machado, Marcel Cerqueira Cesar

    Abstract in English:

    Non cholera Vibrio may cause conjunctivitis, wound infection, gastroenteritis and serious sepsis. Transmission to men is through contact with skin, mucosa or wounds exposed to marine water, and consumption of certain barely cooked or raw seafood, more frequently in the summer. This is one of the first cases of severe infection related to Vibrio vulnificus described in Brazil. The patient was an old man, who ingested seafood in Guarujá, a seashore city near São Paulo, 3 days before hospitalization. He was admitted to the emergency room in an ill state with septic shock. On 2 sets of blood culture a highly virulent microorganism was isolated, Vibrio vulnificus, which leads to sepsis and frequently to death in susceptible patients. The objective of this report was to use this case to discuss clinical aspects, microbiological diagnosis and treatment of the infection caused by this agent, besides the review of epidemiology, associated risk factors and prevention before consuming or getting in contact with seafood, especially in patients with greater susceptibility to this kind of infection.
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