Achado de bactérias selecionadas em crianças de Trinidad com doença amigdaliana crônica / Selected bacterial recovery in Trinidadian children with chronic tonsillar disease

Faringoamigdalite na população pediátrica é largamente tratada com antibióticos. OBJETIVO: Estudar a microflora presente na superfície e no núcleo de amígdalas após adenoamigdalectomia eletiva em crianças. MÉTODO: Amígdalas de 102 crianças de Trinidad foram prospectivamente estudadas por meio de culturas e identificações bacteriológicas feitas a partir de amostras das superfícies e núcleos de suas amígdalas entre 2005-2006. RESULTADOS: A partir de 360 amígdalas, foram isolados Streptococcus spp. (51,3 por cento), Staphylococcus spp. (42,3 por cento) e Gram-Negativos (6,4 por cento). A identificação de estafilococos e estreptococos tanto na superfície quanto no núcleo foi semelhante (p>0,05). Encontramos mais (p<0,001) Streptococcus spp. nas superfícies (82,2 por cento) do que nos núcleos (63,3 por cento); a prevalência de estreptococos alfa-hemolíticos foi maior (p<0,001) do que aquela de estreptococos beta-hemolíticos nas superfícies (74,4 por cento vs. 18,6 por cento) do que nos núcleos (58,9 por cento vs. 13,7 por cento). Não houve concordância entre superfícies e núcleos com relação a estreptococos (p<0,0004) e estreptococos alfa-hemolíticos (p<0,007). Estreptococos beta-hemolíticos foram mais identificados (p<0,05) em crianças dentre 6-16 anos do que naquelas entre 1-5 anos de idade (31 por cento e 23,8 por cento vs 12,5 por cento e 8 por cento). A prevalência de S. pyogenes na superfície e no núcleo foi de (84,6 por cento vs 70 por cento) e (50,0 por cento vs 25,0 por cento) em crianças de maior faixa etária e crianças mais novas, respectivamente. Klebsiella spp. (6,6 por cento, 2,2 por cento), Proteus (4,4 por cento, 4,4 por cento) e Pseudomonas (4,4 por cento, 1,1 por cento) cresceram nas superfícies e núcleos, respectivamente. CONCLUSÃO: As superfícies amigdalianas tinham mais estreptococos e estreptococos hemolíticos do que seus núcleos. Crianças mais velhas tiveram mais estreptococos beta-hemolíticos, e são altamente colonizadoras...

Pharyngotonsillitis in children is widely treated with antibiotics. AIM: To examine tonsil surface and core microflora following elective adenotonsillectomy in children. METHODS: Tonsils of 102 Trinidadian children were prospectively examined for surface and core bacteriological culture and identification between 2005-2006. RESULTS: Tonsils (360) yielded 800 isolates of Streptococcus spp. (51.3 percent), Staphylococcus spp. (42.3 percent) and Gram-negative genera (6.4 percent). Surface and core recovery of staphylococci and streptococci were similar (p>0.05). More (p<0.001) surfaces (82.2 percent) than cores (63.3 percent) grew Streptococcus spp.; α-haemolytic Streptococcus prevalence was higher (p<0.001) than ß-haemolytic Streptococcus on surfaces (74.4 percent vs. 18.6 percent) than cores (58.9 percent vs. 13.7 percent). Surfaces and cores were not concordant for streptococci (p<0.0004) and α-haemolytic Streptococcus (p<0.007). Surface and core ß-haemolytic Streptococcus yield was higher (p<0.05) in 6-16 than 1-5 year olds (31 percent and 23.8 percent vs 12.5 percent and 8 percent). S. pyogenes surface and core prevalence was (84.6 percent vs 70 percent) and (50.0 percent vs 25.0 percent) in older and younger children respectively. Klebsiella spp. (6.6 percent, 2.2 percent), Proteus (4.4 percent, 4.4 percent) and Pseudomonas (4.4 percent, 1.1 percent) grew on surfaces and cores respectively. CONCLUSION: Tonsil surfaces yield higher surface than core carriage for streptococci overall and for α haemolytic streptococci. Older children grow more β-haemolytic streptococci and are high colonizers of S. pyogenes. Studies probing the mechanisms of streptococcal adhesions in Trinidadian children are suggested.

Seroprevalence and risk factors of Toxoplasma gondii infection among pregnant women in Trinidad and Tobago

OBJECTIVE: To determine the seroprevalence of toxoplasmosis and the frequency of risk factors for the disease in women attending antenatal clinics in hospitals and local health centers in Trinidad and Tobago. METHODS: From November 2002-September 2003, 232 pregnant women at the antenatal clinics of two large hospitals were sampled during their first trimesters. From October 2003-February 2005, 218 pregnant women at five health care centers were followed through three trimesters, wherever possible, and blood samples collected. Sera were screened for Toxoplasma gondii IgG and IgM immunoglobulins using an enzyme immunoassay. Data on demographics, as well as practices considered to be risk factors for toxoplasmosis, were obtained. RESULTS: Of the 232 women sampled at the two hospital clinics, 83 (35.8 percent) and 8 (3.4 percent) were seropositive for immunoglobulins of T. gondii IgG and IgM, respectively. Of the 218 women at the health centers, 76 (34.9 percent) had evidence of past infection (IgG), while 26 (11.9 percent) were seropositive for IgM immunoglobulin, suggesting new infections during pregnancy. Only having "3 or more" children was significantly associated with infection by T. gondii. CONCLUSION: In Trinidad and Tobago, the seroprevalence of past infection by T. gondii in pregnant women is relatively low (39.3 percent) for patients in both hospital and health center clinics. Consequently, there is an elevated risk of primary infection during pregnancy and the potential for congenital infection.

OBJETIVO: Determinar la seroprevalencia de toxoplasmosis y la frecuencia de los factores de riesgo de la enfermedad en mujeres que asisten a consultas prenatales en hospitales y centros de salud en Trinidad y Tobago. MÉTODOS: Entre noviembre de 2002 y septiembre de 2003 se tomaron muestras de 232 mujeres que asistieron a consultas prenatales en dos grandes hospitales durante su primer trimestre de embarazo. Entre octubre de 2003 y febrero de 2005 se realizó el seguimiento durante tres trimestres, siempre que fue posible, y se tomaron muestras de sangre de 218 embarazadas atendidas en cinco centros de salud. Se analizaron las muestras de suero para detectar anticuerpos de las clases IgG e IgM contra Toxoplasma gondii mediante ensayos inmunoenzimáticos. Se tomó nota de los datos demográficos y las prácticas consideradas factores de riesgo para la toxoplasmosis. RESULTADOS: De las 232 mujeres estudiadas en los dos hospitales, 83 (35,8 por ciento) y 8 (3,4 por ciento) resultaron seropositivas para anticuerpos IgG e IgM contra T. gondii, respectivamente. De las 218 mujeres estudiadas en los centros de salud, 76 (34,9 por ciento) presentaban evidencias de infección pasada (anticuerpos IgG), mientras 26 (11,9 por ciento) eran positivas a anticuerpos IgM, lo que indicaba una infección reciente durante el embarazo. El único factor asociado significativamente con la infección por T. gondii fue tener tres hijos o más. CONCLUSIONES: En Trinidad y Tobago, la seroprevalencia de infección pasada por T. gondii encontrada en mujeres embarazadas que se atendían en los hospitales y los centros de salud fue relativamente baja (39,3 por ciento). Por consiguiente, existe un elevado riesgo de infección primaria durante el embarazo con la posibilidad de infección congénita.

A cross-sectional study of isolates from sputum samples from bacterial pneumonia patients in Trinidad

We determined the frequency of Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Gram-negative enteric bacteria (GNEB) in pneumonia patients, determined the antibiograms of these pathogens, and investigated the relationship between pneumonia and selected risk factors. Sputum and demographic data were collected from 124 pneumonia patients. Sputum was cultured for S. aureus, GNEB, H. influenzae and S. pneumoniae. The disc diffusion method was used to determine resistance to eight antimicrobial agents. Among the 124 sputum samples, eight (6.5 percent) were positive for S. aureus, 15 (12.1 percent) for GNEB, two (1.6 percent) for S. pneumoniae and one (0.8 percent) for H. influenzae. Hospitals, gender, ethnicity, co-morbidities and symptoms did not significantly (p > 0.05; chi2) affect the prevalence of these bacteria. GNEB infection was most prevalent (47 percent) in patients over 70 years old. Gentamicin and levofloxacin were the most effective against these bacteria.

Microbial contamination of disinfectants and antiseptics in four major hospitals in Trinidad

OBJECTIVE: To assess the microbial contamination of disinfectants and antiseptics in major hospitals on the Caribbean island of Trinidad. METHODS: For this cross-sectional study, disinfectants and antiseptics were sampled from the pharmacy departments, the pediatric/neonatal wards, and the surgical wards of four hospitals. The samples were cultured for aerobic bacteria on nutrient agar using the surface plating method. The antibiotic sensitivity of bacterial isolates was determined by the disk diffusion method, using 14 antimicrobial agents. We studied a total of 180 disinfectant/antiseptic samples: 60 of chlorhexidine gluconate (Hibitane), 60 of chlorhexidine gluconate and cetrimonium bromide (Savlon), and 60 of methylated spirit. RESULTS: Of the 180 samples studied, 11 of them (6.1 percent) were contaminated by aerobic bacteria. All bacteria isolated were Pseudomonas spp. Of the 11 contaminated samples, 6 of them (54.5 percent) occurred at the pharmacy level while 5 (45.5 percent) were from diluted pre-use or in-use samples in the pediatric/neonatal wards or the surgical wards. Chlorhexidine gluconate and cetrimonium bromide accounted for 9 of the 11 contaminated disinfectants/antiseptics (81.8 percent), and chlorhexidine gluconate accounted for the remaining 2 (18.2 percent). Only two of the four hospitals had contaminated disinfectant/antiseptic samples. All 24 isolates of Pseudomonas spp. tested were resistant to one or more of the 14 antimicrobial agents tested, with the prevalence of resistance to ciprofloxacin, norfloxacin, tobramycin, and gentamicin being 58.3 percent, 50.0 percent, 45.8 percent, and 41.7 percent, respectively. CONCLUSIONS: Our results show that contaminated disinfectants/antiseptics pose a health risk to patients, particularly in the pediatric and surgical wards. The high prevalence of resistance to antimicrobial agents exhibited by the Pseudomonas spp. that were isolated is of special therapeutic concern

Microbial quality of water in rural communities of Trinidad

A cross-sectional study was conducted in four rural communities of northeastern Trinidad to determine the microbial quality of water supply to households and that quality's relationship to source and storage device. Of the 167 household water samples tested, total coliforms were detected in 132 of the samples (79.0 por cent), fecal coliforms in 102 (61.1 por cent), and E. coli in 111 (66.5 por cent). There were significant differences among the towns in the proportion of the samples contaminated with coliforms (P < 0.001) and E. coli (P < 0.001). Of 253 strains of E. coli studied, 4 (1.6 por cent) were mucoid, 9 (3.6 por cent) were hemolytic, and 37 (14.6 por cent) were nonsorbitol fermenters. Of 69 isolates of E. coli tested, 10 (14.5 por cent) were verocytotoxigenic. Twenty-eight (14.0 por cent) of 200 E. coli isolates tested belonged to enteropathogenic serogroups. Standpipe, the most common water source, was utilized by 57 (34.1 por cent) of the 167 households. Treated water (pipeborne in homes, tandpipes, or truckborne) was supplied to 119 households (71.3 por cent), while 48 households (28.7 por cent) used water from untreated sources (rain, river/stream, or well) as their primary water supply. The type of household storage device was associated with coliform contamination. Water stored in drums, barrels, or buckets was more likely to harbor fecal coliforms (74.2 por cent of samples) htan was water stored in tanks (53.3 por cent of samples), even after controlling for water source (P = 0.04). Compared with water from other sources, water piped into homes was significantly less likely to be contaminated with total coliforms (56.9 por cent) versus 88.8 por cent, P<0.001) and fecal coliforms (41.2 por cent versus 69.8 por cent, P<0.01), even when the type of storage device was taken into account. However, fecal contamination was not associated with whether the water came from a treated or untreated source. We concluded that the drinking water in rural communities in Trinidad was grossly unfit for human consumption, due both to contamination of vaious water sources and during household water storage