Molecular characterization of nontuberculous Mycobacteria in a tuberculosis and HIV reference unit in the State of Amazonas, Brazil

ABSTRACT Background: In recent years, the prevalence of nontuberculous mycobacterial (NTM) infections has increased in different regions of the world. The American Thoracic Society (ATS) recommends standardized identification criteria, reinforcing the need for faster and less complicated clinical and laboratory techniques. Methods: In this retrospective study, NTM species isolated from pulmonary, extrapulmonary, and disseminated samples from patients treated at a TB/HIV reference unit in the State of Amazonas from 2011 to 2014 were identified through a combination of molecular techniques. Results: To identify the molecular technique, 50 cryopreserved NTM cultures were recovered and subcultivated in culture medium. The potentially pathogenic NTM species identified were M. avium, M. intracellulare, M. kansasii, M. chelonae, M. abscessus, M. fortuitum, and M. peregrinum. Results of GenoType® showed moderate agreement with those of genomic sequencing (kappa = 0.60), whereas the results obtained by the PRA-hsp65 technique disagreed with the results obtained by sequencing (kappa = 0.49). Conclusions: Our findings highlight that GenoType CM is a good method for the identification of NTM, as well as the need for the application of standardized criteria, such as those set forth by the ATS.

Estudo dos fatores de risco maternos associados à sepse neonatal precoce em hospital terciário da Amazônia brasileira / Study of maternal risk factors associated with early-onset neonatal sepsis in a tertiary hospital of the Brazilian Amazonia

OBJETIVO: identificar os fatores de risco maternos envolvidos na sepse neonatal precoce, pesquisando vaginose bacteriana, microorganismos isolados em cultura de urina materna e na hemocultura do recém-nascido na sala de parto. MÉTODOS: estudo de coorte longitudinal prospectivo, envolvendo, aleatoriamente, 302 mães e seus recém-nascidos, que foram acompanhados até sete dias de vida, a fim de diagnosticar sepse. RESULTADOS: diagnosticados 16 casos (5,3 por cento) de sepse neonatal precoce. O número médio de consultas no pré-natal foi 5,2 (DP=1,8). Das 269 (89,1 por cento) grávidas que fizeram acompanhamento pré-natal, porém, 117 (43,4 por cento) fizeram mais de seis consultas; 90 (29,8 por cento) tiveram bolsa rota antes do parto, somente 22 (7,3 por cento) tinham mais de 18 horas. Cento e vinte e três grávidas (40,7 por cento) queixavam-se de corrimento vaginal, entretanto 47 (15,6 por cento) tinham vaginose bacteriana. Em 23 (7,6 por cento), foi identificada bacteriúria; duas (0,7 por cento) apresentavam febre no domicílio e 122 (40,4 por cento) fizeram antibioticoprofilaxia intraparto. Quarenta recém-nascidos (13,2 por cento) foram prematuros, 37 (12,3 por cento) com baixo peso. A avaliação do risco relativo mostrou significância para prematuridade (RR=92,9; IC95 por cento=12,6-684,7), número de consultas no pré-natal inferior a seis (RR=10,8; IC95 por cento=1,4-80,8), febre no domicílio (RR=10,0; IC95 por cento=2,3-43,5), baixo peso ao nascer (RR=21,5; IC95 por cento=7,3-63,2) e Apgar inferior a sete no quinto minuto (RR=19,5; IC95 por cento=9,0-41,9). Foram encontradas diferenças significantes no nível de 5 por cento na comparação das médias para o baixo número de consultas no pré-natal, prematuridade e baixo peso ao nascer. CONCLUSÕES: o principal microorganismo isolado na hemocultura dos recém-nascidos foi o Streptococcus agalactiae. Prematuridade, ausência de seguimento pré-natal e baixo peso ao nascer foram os fatores de risco...

PURPOSE: to identify the main maternal risk factors involved in early-onset neonatal sepsis, evaluating the risk associations between bacterial vaginosis and isolated microorganisms found in the maternal urine culture and in the newborn blood culture in the delivery room. METHODS: randomized longitudinal cohort study involving 302 mothers and their newborns. All neonates were followed up for seven days in order to diagnose sepsis. RESULTS: the outcomes were the following: 16 (5.3 percent) early-onset neonatal sepsis cases (incidence of 53 cases per 1,000 live births). The average number of prenatal appointments with a doctor was 5.2 (SD=1.8). The number of women with prenatal follow-up was 269 (89.1 percent), but only 117 (43.4 percent) of them went to six or more medical appointments, 90 (29.8 percent) had premature rupture of membranes before delivery, but only 22 (7.3 percent) had it for more than 18 hours. A total of 123 women (40.7 percent) complained of vaginal discharge, but only 47 (15.6 percent) of them had bacterial vaginosis, 92 (30.4 percent) complained of urinary infection, but only 23 (7.6 percent) of them had bacteriuria, two (0.7 percent) had fever at home, 122 (40.4 percent) received intra-partum antibiotic prophylaxis, 40 (13.2 percent) had premature delivery and 37 (12.3 percent) had low-birth-weight babies. Gestational age was a significant risk factor (RR=92.9; IC95 percent:12.6-684.7), as well as the number of prenatal appointments (RR=10,8; IC95 percent:1,4-80,8), fever (RR=10,0; IC95 percent:2,3-43,5), low-birth-weight (RR=21,5; IC95 percent:7,3-63,2) and early neonatal death (RR=89,4; IC95 percent:11,16-720,6). A significant difference of 5 percent was found in the comparison of the averages of lower number of prenatal appointments, prematurity and lower birth weight. CONCLUSIONS: the major microorganism isolated in the newborns’ blood culture was the Streptococcus agalactiae. Prematurity, lack of prenatal follow...