A multicenter hospital surveillance of invasive Streptococcus pneumoniae, Puerto Rico, 2001

Although antimicrobial resistance to Streptococcus pneumoniae has been increased dramatically worldwide, there is limited information of pattern of susceptibility for this pathogen in Puerto Rico. Hospital-based surveillance for invasive pneumococcal infections was begun among 38 hospitals island-wide in Puerto Rico from January to December, 2001. One hundred ninety-two cases of invasive pneumococcal disease were identified. Of the 177 isolates available for susceptibility testing, 50.3were susceptible to penicillin and 49.7were nonsusceptible (intermediate (I) and resistance (R)) (19.2I, 30.5R). Resistance was documented for expanded spectrum cephalosporins and macrolides. All isolates were susceptible to vancomycin. Diabetes, cardiovascular disease, smoking and bronchial asthma were the most common risk factors associated with invasive pneumococcal disease of the adult population. Bronchial asthma was the most common disease in the pediatric population with a fatality rate of 21. There was no increased mortality detected among patients infected with penicillin resistant strains. Most of the isolates serotypes are represented in the 23-valent polysaccharide vaccine (78) and 7-valent conjugate vaccine (62). Penicillin-resistant isolates (47) were 14, 19F, 6B, 6A, 9V, 23F, 19A and 35B serotype. Our data indicated a high prevalence for drug-resistant strains of S. pneumoniae in Puerto Rico. Continue surveillance for this common but serious pathogen is needed. Asthma is an important risk factor for pneumococcal disease. The pneumococcal vaccine should be recommended for all age groups with this risk factor.

Prevalence of primary and secondary resistant mutations to antiretroviral drug in a population of Puerto Rican infected with HIV

INTRODUCTION: Several studies have reported increasing number of therapeutic failures with HAART in HIV-infected individuals. In order to assess the impact HIV antiretroviral resistance could have on treatment, we decided to determine the prevalence of primary and secondary antiretroviral resistant genotypes in a population of HIV-infected Puerto Ricans and compare the mutational distribution pattern with that reported in Europe and US. METHOD: In a total of 80 plasma samples from patients with detectable viral load of over 1,000 RNA copies/ml, the Trugene Visible Genetics HIV sequencing method was used to detect antiretroviral resistance mutations. RESULTS: We found 55 subjects (69 per cent) with high level of resistance to ZDV in the reverse transcriptase gene and 46 subjects (58 per cent) with high level of resistance to NFV in the protease gene. Mutation frequencies to the NRTI ranged in appearance from as high as 54 per cent (i.e., M184V) in the studied subjects to a low of less than 5 per cent (i.e., M184I and V75T). For the NNRTI the most common mutation was K103N in 40 per cent of the subjects and found to confer cross resistance to NVP, DLV and EFV. Another concerning finding is the increasing trend of the frequency of primary and secondary resistant mutations from year 2000 to 20001. Nine (23 per cent) of the total detected primary mutations, to either RTI or PI, showed an increase of at least 5 per cent from one year to the other. Similarly, there were 6 (11 per cent) secondary resistant mutations showing an increase of at least 5 per cent during the two years studied. CONCLUSIONS: In two year period we detected a tendency to increase in primary and secondary HIV-resistant mutation in a population of HIV-infected Puerto Ricans.

The investigation of emerging and re-emerging viral diseases: a paradign

Emerging virus infections are defined as previously nonthreatening viruses that can decimate new populations by finding fresh hosts and vectors--often with the help of humans who introduce new species into virgen environment, Several etiologic agents of these diseases, some of the interacting factors that contribute to their development and the role of molecular medicine in their understanding is discussed