Epidemiological indicators and predictors of lethality associated with fungal infections in a NICU: a historical series

Abstract Objectives: Fungal infections (FI) pose a public health concern and significantly increase mortality rates, especially within Neonatal Intensive Care Units (NICU). Thus, this study aimed to investigate epidemiological indicators, risk factors, and lethality predictors associated with FI in a NICU. Methods: This study included 1,510 neonates admitted to the NICU of a reference hospital in Brazil between 2015 and 2022. Demographic data, such as sex, birth weight, gestational age, and use of invasive devices were analyzed. Results: Thirty neonates developed invasive FI, totaling 33 episodes and an incidence of 1.2 per 1,000 patient days. Candida albicans was the most frequent species (52.9 %), the bloodstream was the most affected site (78.9 %), and 72.7 % of infections occurred between 2015 and 2018. The lethality rate associated with FI was 33.3 %, and 90 % of deaths occurred within 30 days of diagnosis of infection. Weight < 750 g, prolonged hospital stay, use of parenteral nutrition, and broad-spectrum antimicrobials were independent risk factors for infection occurrence, especially glycopeptides and 4th generation cephalosporins, having a considerable role in the increase in fungal infections. Weight < 750 g was considered a significant predictor of lethality, and C. albicans had the highest lethality rate (40 %). Conclusion: These findings highlight the elevated lethality rate associated with these infections, reinforcing the importance of developing strategies to control FI within NICU.

Identificação de Enterococcus SPP e Enterobacteriaceae em canais radiculares com infecção primária e secundária ou persistente / Identification of Enterococcus spp and Enterobacteriaceae in root canals with primary and secondary or persistent infection

O objetivo do presente estudo foi identificar microrganismos das espécies Enterococcus spp e Enterobacteriaceae em dentes com canais radiculares infectados portadores de infecção primária e/ou secundária/persistente. Métodos: A amostra do presente estudo foi de 23 pacientes que apresentaram necessidade de tratamento ou retratamento endodôntico. Foram coletadas amostras de 28 dentes infectados usando pontas de papel absorventes estéreis, transportadas em solução salina, diluídas, plaqueadas e incubadas em estufa de cultura bacteriológica. Para o crescimento de microrganismos foram utilizados jarros com gerador de atmosfera de anaerobiose. Colônias microbianas foram isoladas, caracterizadas e identificadas. Os dados coletados foram estatisticamente analisados com a utilização do software SPSS for Windows 10.0 (SPSS Inc., USA). Resultados: Foi isolada somente uma cepa do gênero Enterococcus spp, e nenhuma espécie do gênero Enterobacteriaceae. Das coletas microbiológicas realizadas em 28 canais radiculares, todas apresentaram crescimento microbiano em anaerobiose. Dezoito dentes apresentavam necrose pulpar e lesão periapical. Os outros 10 dentes já haviam recebido tratamento endodôntico prévio e em 6 destes houve constatação de lesão periapical, sendo que nos outros 4, não. Conclusão: Nas condições experimentais do presente estudo, pode-se concluir que não houve correlação da presença de espécies microbianas das famílias Enterococcus spp e/ou Enterobacteriaceae com infecção primária ou secundária do canal radicular.

The objective of the present study was to identify microorganisms of the Enterococcus spp and Enterobacteriaceae species in teeth with infected root canals with primary and/or secondary/persistent infection. Methods: The sample of the present study consisted of 23 patients who required endodontic treatment or retreatment. Samples of 28 infected teeth were collected using sterile absorbent paper points, transported in saline solution, diluted, plated and incubated in a bacteriological culture oven. For the growth of microorganisms, jars with an anaerobic atmosphere generator were used. Microbial colonies were isolated, characterized and identified. The collected data were statistically analyzed using the SPSS for Windows 10.0 software (SPSS Inc., USA). Results: Only one strain of the genus Enterococcus spp was isolated, and no species of the genus Enterobacteriaceae. From the microbiological collections carried out in 28 root canals, all showed microbial growth in anaerobic conditions. Eighteen teeth had pulp necrosis and periapical lesion. The other 10 teeth had already received previous endodontic treatment and in 6 of them there was a periapical lesion, and in the other 4, no. Conclusion: Under the experimental conditions of the present study, it can be concluded that there was no correlation between the presence of microbial species of the Enterococcus spp and/or Enterobacteriaceae families with primary or secondary root canal infection.

Insuficiencia cardíaca secundaria a mordedura de serpiente. La visión del intensivista: Reporte de caso / Heart failure secondary to a snake bite. The intensivist's vision: Case Report

RESUMEN Antecedentes: El accidente ofídico es una enfermedad desatendida que afecta a los países tropicales. América Latina es la segunda región después de África, con mayor número de casos a nivel mundial. Su curso clínico incluye lesiones locales hasta afectaciones sistémicas como lesiones renales, hematológicas y neurológicas. Las complicaciones cardiacas son raras, especialmente en pacientes que no tienen factores de riesgo cardiovascular. Hay reportes de infarto agudo de miocardio, pero existe poca información sobre la insuficiencia cardíaca debida a Bothrops spp. Reporte de caso: Presentamos el caso de un hombre de 25 años sin factores de riesgo cardiovascular que fue admitido en la unidad de cuidados intensivos y desarrolló insuficiencia cardíaca con choque cardiogénico y fallo multiorgánico secundario a una mordedura de serpiente. Conclusiones: Aunque el curso clínico característico de un accidente ofídico bothrópico y sus manifestaciones sistémicas están principalmente relacionadas con anomalías de la coagulación, hay complicaciones cardiovasculares dentro de su presentación clínica que, aunque raras, si no se detectan prontamente y no se manejan adecuadamente, están asociadas con alta morbilidad y mortalidad.

ABSTRACT Background: Ophidic accident is a neglected disease that affects tropical countries. Latin America is the second region after Africa, with the most cases worldwide. Local lesions accompany its clinical course up to systemic affectations such as renal, hematological, and neurological lesions. Cardiac complications are rare, especially in patients who do not have cardiovascular risk factors. There are reports of acute myocardial infarction, but there is little information about heart failure due to Bothrops spp. Case report: We present the case of a 25-year-old man without cardiovascular risk factors who was admitted to the intensive care unit and developed heart failure with cardiogenic shock and multi-organ failure secondary to a snake bite. Conclusions: Although the characteristic clinical course of a bothropic ophidian accident and its systemic manifestations are mainly related to coagulation abnormalities, there are cardiovascular complications within its clinical presentation that, although rare, if not detected promptly and not adequately managed, are associated with high morbidity and mortality.

Study of glycosides from Piper sintenense Hatusima / 中国药科大学学报

@#In order to investigate the chemical constituents of glycosides in Piper sintenense Hatusima, column chromatographic techniques such as silica gel, ODS, MCI GEL CHP20P, Sephadex LH-20, and semi-preparative high performance liquid chromatography were used to afford nine glycosides from the n-butanol part of the 95% ethanol extract of Piper sintenense Hatusima. Based on the physicochemical properties and NMR data, the above compounds were identified as (2S)-2-hydroxy-1-(4-hydroxy-3-methoxyphenyl)-1-propanone-2-O-β-D-glucopyranoside (1), 2-phenylethyl β-D-glucopyranoside (2), benzyl α-L-arabinopyranosyl-(1''→6')-β-D-glucopyranoside (3), benzyl β-D-xylopyanosyl-(1''→6')-β-D-glucopyranoside (4), phenethyl β-D-apiofuranosyl-(1''→ 2')-β-D-glucopyranoside(5), salidroside (6), phenethanol β-D-xylopyanosyl-(1''→6')-β-D-glucopyranoside (7), (Z)-hexenyl-O-α-L-arabinopyranosyl-(1''→6')-O-β-D-glucopyranoside (8), (Z)-hexenyl-O-β-D-xylopyanosyl-(1''→6')-O-β-D-glucopyranoside (9). Compound 1 was identified as a new compound, and compounds 3-9 were isolated from the genus Piper for the first time.

Prevalence and molecular detection of human Cryptosporidium infections: a review / 中国血吸虫病防治杂志

Cryptosporidium is an important intestinal parasite that is mainly transmitted through the fecal-oral route. Human infection may occur following ingestion of water and food contaminated by Cryptosporidium oocysts, and children and immunocompromised individuals are at a high risk of infections. The main symptoms of Cryptosporidium infections include diarrhea, vomiting, malnutrition, and even death. Because of high sensitivity and rapid procedures, molecular tests are helpful for the diagnosis of cryptosporidiosis and may reduce the public health risk of cryptosporidiosis. This review summarizes the advances in the latest prevalence and molecular detection of human Cryptosporidium infections during recent years.

Virulence of entomopathogenic nematodes and their symbiotic bacteria, under laboratory conditions, aiming controlling Saccharicoccus sacchari (Cockerell, 1895) (Hemiptera: Pseudococcidae) on sugarcane

Abstract Sugarcane crops Saccharum spp. (Poales: Poaceae) produces different derivatives to the world: sugar, ethanol and bioenergy. Despite the application of pesticides, insect pests still cause economic losses, among these the pink sugarcane mealybug Saccharicoccus sacchari (Cockerell, 1895) (Hemiptera: Pseudococcidae) causing direct and indirect damage to the plant. This study assess the virulence of three entomopathogenic nematodes (EPNs) species and their symbiont bacteria against the pink sugarcane mealybug, under laboratory conditions. Fourteen treatments represented by control (distilled water), Heterorhabditis bacteriophora Poinar, 1976 (HB EN01) (Rhabditida: Heterorhabditidae), Steinernema rarum (Doucet, 1986) (PAM25) and Steinernema carpocapsae Weiser, 1955 (All) (Rhabditida: Steinermatidae) at concentrations of 25, 50, 75 and 100 infective juveniles (IJs)/insect, and the standard chemical product, thiamethoxam, were assayed. In a second experiment, the bacteria Photorhabdus luminescens (Thomas and Poinar, 1979), Xenorhabdus szentirmaii Lengyel, 2005 and Xenorhabdus nematophila (Poinar and Thomas, 1965) (Enterobacterales: Morganellaceae) at 3.0 x 109 cells/ml were assessed for each treatment. Ten replications were stablished, each one counting ten females/mealybugs inside a 10 cm Petri dish, amounting 100 individuals/treatment. All treatments were kept under stable conditions (25±1 ºC, H 70±10%, in the dark). All nematodes species infected S. sacchari. Steinerma rarum (PAM25) provided the highest mortality against the pink sugarcane mealybug (79.25%), followed by H. bacteriophora (HB EN01) (58.25%) and S. carpocapsae (All) (42.50%) (P 0.001). The mortality rate caused by X. szentirmaii, P. luminescens and X. nematophila were 40, 45 and 20%, respectively. Steinerma rarum (PAM25) has conditions to be a potential agent to be incorporate into the integrated pest management in sugarcane.

Resumo A cultura da cana-de-açúcar Saccharum spp. (Poales: Poaceae) produz diferentes derivados para o mundo: açúcar, etanol e bioenergia. Apesar da aplicação de pesticidas, os insetos-praga ainda causam prejuízos econômicos, dentre eles a cochonilha rosada da cana-de-açúcar Saccharicoccus sacchari (Cockerell, 1895) (Hemiptera: Pseudococcidae) causando danos diretos e indiretos à planta. Este estudo avaliou a virulência de três espécies de nematoides entomopatogênicos (NEPs) e suas bactérias simbiontes contra a cochonilha rosada da cana-de-açúcar, em condições de laboratório. Quatorze tratamentos representados pelo controle (água destilada), Heterorhabditis bacteriophora Poinar, 1976 (HB EN01) (Rhabditida: Heterorhabditidae), Steinernema rarum (Doucet, 1986) (PAM25) e Steinernema carpocapsae Weiser, 1955 (All) (Rhabditida: Steinermatidae) nas concentrações de 25, 50, 75 e 100 juvenis infectantes (JIs)/inseto, e o produto químico padrão, tiametoxam, foram testados. Em um segundo experimento, a bactéria Photorhabdus luminescens (Thomas e Poinar, 1979), Xenorhabdus szentirmaii Lengyel, 2005 e Xenorhabdus nematophila (Poinar e Thomas, 1965) (Enterobacterales: Morganellaceae) em 3,0 x 109 células/ml foram avaliadas para cada tratamento. Dez repetições foram estabelecidas, cada uma contendo dez fêmeas/cochonilhas dentro de uma placa de Petri de 10 cm, totalizando 100 indivíduos/tratamento. Todos os tratamentos foram mantidos em condições estáveis (25±1 ºC, U 70±10%, no escuro). Todas as espécies de nematoides infectaram S. sacchari. Steinerma rarum (PAM25) proporcionou a maior mortalidade contra a cochonilha rosada da cana-de-açúcar (79,25%), seguida por H. bacteriophora (HB EN01) (58,25%) e S. carpocapsae (All) (42,50%) (P 0,001). As taxas de mortalidade causada por X. szentirmaii, P. luminescens e X. nematophila foram de 40, 45 e 20%, respectivamente. Steinerma rarum (PAM25) tem condições de ser um agente potencial a ser incorporado ao manejo integrado de pragas da cana-de-açúcar.

GSK-3 kinase a putative therapeutic target in trypanosomatid parasites

ABSTRACT Trypanosomatids are an important group of parasites that predominate in tropical and subtropical areas of the planet, which cause diseases that are classified as forgotten and neglected by the world health organization. In this group of parasites, we find Trypanosoma cruzi, Trypanosoma brucei, Trypanosoma brucei rhodesiense and Leishmania spp, for which there is no vaccine available, and its control has focused mainly on pharmacological treatment. Due to the poverty situation where these diseases are found and the biological complexity of these parasites, there are multiple variables to control, including the diversity of species, the complexity of their life cycles, drug resistance, cytotoxicity, the limited use in pregnant women, the high costs of treatment and the little-known pharmacological mechanisms of action, among others. It is therefore necessary to find new strategies and approaches for the treatment of these parasitic diseases. Among these new approaches is the rational search for new targets based on the allosteric inhibition of protein kinases, which have been little studied in trypanosomatids. Among these kinases, we find Glycogen Synthase Kinase-3 (GSK-3), a kinase of great pharmacological interest, which is under intense basic and clinical research by pharmaceutical companies for the treatment of cancer. This kinase, highly studied in the PI3K/AKT/mTOR pathway signaling in humans, has an orthologous gene in these parasites (GSK-3 s), which has proven to be essential for them in response to different challenges; Therefore, it is notable to increase research in this kinase in order to achieve a broad structural and functional characterization in the different species of trypanosomatids.

Establishment of a laboratory colony of Pressatia choti (Diptera: Psychodidae), a suspected vector of Leishmania braziliensis

ABSTRACT Background: Pressatia choti is a common sand fly found in the Atlantic Forest of Brazil, which is suspected to be involved in the transmission of Leishmania braziliensis. Herein, we aimed to establish a Pr. choti laboratory colony. Methods: Wild-caught female sand flies were blood fed on hamsters and maintained under controlled conditions (temperature: 26 °C; relative humidity: 70%). Results: Of the 301 collected female sandflies, 288 were identified as Pr. choti. The life cycle duration ranged from 31 to 56 days. Conclusions: We successfully established a Pr. choti colony, whose biological parameters were similar to those of other neotropical sand flies.

Xuebijing improves inflammation and pyroptosis of acute lung injury by up-regulating miR-181d-5p-mediated SPP1 inactivation

Abstract Background Xuebijing (XBJ) is widely applied in the treatment of Acute Lung Injury (ALI). This study focused on the potential mechanism of XBJ in Lipopolysaccharide (LPS)-induced ALI. Methods The rat ALI model was established by injection of LPS (10 mg/kg) and pretreated with XBJ (4 mL/kg) three days before LPS injection. BEAS-2B cell line was stimulated with LPS (1 μg/mL) and ATP (5 mM) to induce pyroptosis, and XBJ (2 g/L) was pretreated 24h before induction. The improvement effects of XBJ on pulmonary edema, morphological changes, and apoptosis in ALI lung tissue were evaluated by lung wet/dry weight ratio, HE-staining, and TUNEL staining. Inflammatory cytokines in lung tissue and cell supernatant were determined by ELISA. pyroptosis was detected by flow cytometry. Meanwhile, the expressions of miR-181d-5p, SPP1, p-p65, NLRP3, ASC, caspase-1, p20, and GSDMD-N in tissues and cells were assessed by RT-qPCR and immunoblotting. The relationship between miR-181d-5p and SPP1 in experimental inflammation was reported by dual luciferase assay. Results XBJ could improve inflammation and pyroptosis of ALI by inhibiting contents of inflammatory cytokines, and levels of inflammation- and pyroptosis-related proteins. Mechanistically, XBJ could up-regulate miR-181d-5p and inhibit SPP1 in ALI. miR-181d-5p can target the regulation of SPP1. Depressing miR-181d-5p compensated for the ameliorative effect of XBJ on ALI, and overexpressing SPP1 suppressed the attenuating effect of XBJ on LPS-induced inflammation and pyroptosis. Conclusion XBJ can regulate the miR-181d-5p/SPP1 axis to improve inflammatory response and pyroptosis in ALI.

Virulence of entomopathogenic nematodes and their symbiotic bacteria, under laboratory conditions, aiming controlling Saccharicoccus sacchari (Cockerell, 1895) (Hemiptera: Pseudococcidae) on sugarcane / Virulência de nematoides entomopatogênicos e suas bactérias simbióticas, sob condições de laboratório, visando controlar Saccharicoccus sacchari (Cockerell, 1895) (Hemiptera: Pseudococcidae) na cana-de-açúcar

Sugarcane crops Saccharum spp. (Poales: Poaceae) produces different derivatives to the world: sugar, ethanol and bioenergy. Despite the application of pesticides, insect pests still cause economic losses, among these the pink sugarcane mealybug Saccharicoccus sacchari (Cockerell, 1895) (Hemiptera: Pseudococcidae) causing direct and indirect damage to the plant. This study assess the virulence of three entomopathogenic nematodes (EPNs) species and their symbiont bacteria against the pink sugarcane mealybug, under laboratory conditions. Fourteen treatments represented by control (distilled water), Heterorhabditis bacteriophora Poinar, 1976 (HB EN01) (Rhabditida: Heterorhabditidae), Steinernema rarum (Doucet, 1986) (PAM25) and Steinernema carpocapsae Weiser, 1955 (All) (Rhabditida: Steinermatidae) at concentrations of 25, 50, 75 and 100 infective juveniles (IJs)/insect, and the standard chemical product, thiamethoxam, were assayed. In a second experiment, the bacteria Photorhabdus luminescens (Thomas and Poinar, 1979), Xenorhabdus szentirmaii Lengyel, 2005 and Xenorhabdus nematophila (Poinar and Thomas, 1965) (Enterobacterales: Morganellaceae) at 3.0 x 109 cells/ml were assessed for each treatment. Ten replications were stablished, each one counting ten females/mealybugs inside a 10 cm Petri dish, amounting 100 individuals/treatment. All treatments were kept under stable conditions (25±1 ºC, H 70±10%, in the dark). All nematodes species infected S. sacchari. Steinerma rarum (PAM25) provided the highest mortality against the pink sugarcane mealybug (79.25%), followed by H. bacteriophora (HB EN01) (58.25%) and S. carpocapsae (All) (42.50%) (P<0.001). The mortality rate caused by X. szentirmaii, P. luminescens and X. nematophila were 40, 45 and 20%, respectively. Steinerma rarum (PAM25) has conditions to be a potential agent to be incorporate into the integrated pest management in sugarcane.

A cultura da cana-de-açúcar Saccharum spp. (Poales: Poaceae) produz diferentes derivados para o mundo: açúcar, etanol e bioenergia. Apesar da aplicação de pesticidas, os insetos-praga ainda causam prejuízos econômicos, dentre eles a cochonilha rosada da cana-de-açúcar Saccharicoccus sacchari (Cockerell, 1895) (Hemiptera: Pseudococcidae) causando danos diretos e indiretos à planta. Este estudo avaliou a virulência de três espécies de nematoides entomopatogênicos (NEPs) e suas bactérias simbiontes contra a cochonilha rosada da cana-de-açúcar, em condições de laboratório. Quatorze tratamentos representados pelo controle (água destilada), Heterorhabditis bacteriophora Poinar, 1976 (HB EN01) (Rhabditida: Heterorhabditidae), Steinernema rarum (Doucet, 1986) (PAM25) e Steinernema carpocapsae Weiser, 1955 (All) (Rhabditida: Steinermatidae) nas concentrações de 25, 50, 75 e 100 juvenis infectantes (JIs)/inseto, e o produto químico padrão, tiametoxam, foram testados. Em um segundo experimento, a bactéria Photorhabdus luminescens (Thomas e Poinar, 1979), Xenorhabdus szentirmaii Lengyel, 2005 e Xenorhabdus nematophila (Poinar e Thomas, 1965) (Enterobacterales: Morganellaceae) em 3,0 x 109 células/ml foram avaliadas para cada tratamento. Dez repetições foram estabelecidas, cada uma contendo dez fêmeas/cochonilhas dentro de uma placa de Petri de 10 cm, totalizando 100 indivíduos/tratamento. Todos os tratamentos foram mantidos em condições estáveis (25±1 ºC, U 70±10%, no escuro). Todas as espécies de nematoides infectaram S. sacchari. Steinerma rarum (PAM25) proporcionou a maior mortalidade contra a cochonilha rosada da cana-de-açúcar (79,25%), seguida por H. bacteriophora (HB EN01) (58,25%) e S. carpocapsae (All) (42,50%) (P<0,001). As taxas de mortalidade causada por X. szentirmaii, P. luminescens e X. nematophila foram de 40, 45 e 20%, respectivamente. Steinerma rarum (PAM25) tem condições de ser um agente potencial a ser incorporado ao manejo integrado de pragas da cana-de-açúcar.

Cryptococcoma hipofisiario: un extraño caso de hipofisitis granulomatosa secundaria / Pituitary cryptococcoma: a strange case of secondary granulomatous hypophysitis

Resumen La hipofisitis es una afección con baja incidencia y prevalencia. Asimismo, las infecciones profundas por hongos en pacientes inmunocompetentes también re presentan un fenómeno infrecuente. Más raro aún es el caso que se describe a continuación, en donde se conjugan estos dos elementos mencionados, a saber: cryptococcoma hipofisario o hipofisitis granulomatosa causado por dicho patógeno en un huésped sin altera ción de la respuesta inmune. Luego de una búsqueda realizada en PubMed, existen limitados casos en la literatura médica de hipofisitis granulomatosa por Cryptococcus spp., que simuló por manifestaciones clínicas e imagenológicas un macro adenoma hipofisario. No encontramos informes en los que no haya evidencia de afectación del tejido meníngeo. La etiología micótica está escasamente descrita en las guías de referencia para hipofisitis y creemos que Cryp tococcus spp. debe ser tenido en cuenta en el diagnóstico diferencial de las hipofisitis granulomatosas secundarias dado que es un patógeno ubicuo y el tratamiento es sustancialmente diferente a otras entidades. Cobra mayor relevancia ante la tendencia actual al uso de glucocorticoides sistémicos a altas dosis para el tratamiento de la hipofisitis, que podría haber gene rado mayor daño de no haberse hecho el diagnóstico correcto.

Abstract Hypophysitis is a pathology with low incidence and prevalence. Likewise, deep fungal infections in immuno competent patients also represent a rare phenomenon. Even rarer is the case described below, where these two mentioned elements are combined, namely: pituitary cryptococcoma or granulomatous hypophysitis caused by said pathogen in a host without altered immune response. After research in PubMed, there are limited cases in the medical literature of granulomatous hypophysitis caused by Cryptococcus spp., which simulated a pituitary macroadenoma by clinical and imaging manifestations. We did not find reports in which there is no evidence of involvement of the meningeal tissue. The fungal etiology is scarcely described in the reference guidelines for hypophysitis and we believe that Cryptococcus spp. it should be taken into account in the differential diagnosis of secondary granuloma tous hypophysitis since it is a ubiquitous pathogen and the treatment is substantially different from other entities. It becomes more relevant given the current trend towards the use of high-dose systemic glucocorticoids for the treatment of hypophysitis, which could have generated greater damage if the correct diagnosis had not been made.

PCR múltiplex para el diagnóstico de microorganismos atípicos transmitidos sexualmente / Multiplex PCR testing for the atypical microorganisms diagnosis sexually transmitted

Resumen Antecedentes: Las infecciones de transmisión sexual son un problema de salud pública mundial. El análisis rutinario incluye solo pruebas microbiológicas y serológicas para el diagnóstico de patógenos. Los microorganismos atípicos como Chlamydia trachomatis y micoplasmas no son identificados debido a los requerimientos. Además, no es incluida Gardnerella vaginalis, aunque se asocia a la vaginosis bacteriana. Objetivo: Desarrollar una PCR múltiplex para el diagnóstico de C. trachomatis, micoplasmas y G. vaginalis. Método: Se estandarizó la PCR múltiplex utilizando oligonucleótidos para C. trachomatis (gen ompA, orf6 plasmídico), Mycoplasma/Ureaplasma y G. vaginalis (genes rRNA16s). Resultados: Se estandarizaron pruebas de PCR múltiplex para los microorganismos estudiados, optimizándose las concentraciones y condiciones de las reacciones múltiplex. Se obtuvieron PCR dúplex para C. trachomatis (ompA, orf6), Chlamydia/Gardnerella y Chlamydia/micoplasmas y tríplex para Chlamydia/Mycoplasma/Ureaplasma. También un cuádruplex para Chlamydia/Mycoplasma/Ureaplasma/Gardnerella. Los resultados fueron verificados por PCR e hibridación automática (HybriSpot 12) y análisis in silico. Conclusión: Se desarrollaron pruebas de PCR múltiplex con una alta sensibilidad y especificidad para la identificación de C. trachomatis, micoplasmas y G. vaginalis.

Abstract Background: Sexually transmitted infections are a global public health problem. Routine analysis includes microbiological and serological tests for the diagnosis of pathogens. Atypical microorganisms such as Chlamydia trachomatis and mycoplasmas are not determined due to the requirements for their identification. Furthermore, Gardnerella vaginalis is not included despite being associated with bacterial vaginosis. Objective: To develop a multiplex PCR to diagnose Chlamydia, mycoplasmas, and Gardnerella. Method: Standardization of multiplex PCR tests was carried out using oligonucleotides for the identification of Chlamydia (ompA gene, plasmid orf6), Mycoplasma/Ureaplasma and Gardnerella (rRNA16s genes). Results: Multiplex PCR tests were standardized for the microorganisms studied, optimizing the concentrations and conditions of the multiplex reactions. Duplex PCR was obtained for Chlamydia (ompA, orf6), Chlamydia/Gardnerella, and Chlamydia/mycoplasmas, and triplex PCR for Chlamydia/mycoplasmas. Also, a quadruplex for Chlamydia, Mycoplasma/Ureaplasma and Gardnerella. PCR and automatic hybridization verified the results obtained (HybriSpot 12) and in silico analysis. Conclusion: Multiplex PCR tests with high sensitivity and specificity were developed to identify C. trachomatis, mycoplasmas, and G. vaginalis.

Riesgo de mortalidad en infecciones invasoras por Fusarium spp en niños con enfermedades hemato-oncológicas: una revisión sistemática de la literatura / Risk of mortality in invasive infections by Fusarium spp in children with hematooncological diseases: a literature systematic review

INTRODUCCIÓN: Los estudios sobre la infección fúngica invasora (IFI) por Fusarium spp en pacientes pediátricos con patología hemato-oncológica, son escasos, correspondiendo en general a series clínicas descriptas en forma retrospectiva, lo que dificulta conocer en profundidad sus características y evolución. OBJETIVO: Analizar la evolución fatal de la IFI causada por Fusarium spp en pacientes pediátricos con patología hemato-oncológica, llevándose a cabo una revisión sistemática. MATERIAL Y MÉTODOS: La búsqueda bibliográfica se realizó con fecha 23 de marzo de 2023, en las principales bases de datos (Medline (a través de PubMed), Embase (a través de Embase-Elsevier), The Cochrane Library (a través de Wiley), Cinahl (a través de EbscoHOST), SCI-EXPANDED y Scielo (a través de la WOS) y Scopus (a través de Scopus-Elsevier) y libre (mediante el motor Google) y revisando las citas de los artículos incluidos. RESULTADOS: Se rescataron 1.341 artículos, de los cuales se descartaron 931 por diversas razones. Mediante el análisis de los textos completos, finalmente se incluyeron 11 estudios. Todos los estudios eran de nivel 4 (serie de casos). Se detectó una notoria heterogeneidad (p < 0,008) entre los mismos. La mediana de la frecuencia de muerte observada implicó a un tercio de los afectados (Md 33 %; Q1:22,7-Q4:75). CONCLUSIONES: La mortalidad por IFI por Fusarium spp fue alta en niños con patología hemato-oncológica, en especial en aquellos con neutropenia profunda y mala respuesta al tratamiento de su enfermedad de base

BACKGROUND: Studies on invasive fungal infection (IFI) by Fusarium spp in pediatric patients with hemato-oncological pathology are scarce and limited and a few series of cases described retrospectively, which makes it difficult to fully understand their characteristics and outcome. With the aim of analyzing the fatal evolution of these patients, this systematic review was carried out. METHODS: The literature search was performed up to March 23, 2023, in the main databases, as Medline (through PubMed), Embase (through Embase-Elsevier), The Cochrane Library (through Wiley), Cinahl (through EbscoHOST), SCI-EXPANDED and Scielo (through WOS) and Scopus (through Scopus-Elsevier) and free (through the Google engine) and reviewing the citations of the included articles. RESULTS: 1341 articles were retrieved, of which 931 were discarded for various reasons. By analyzing its full texts, 11 studies were finally included. It was observed that heterogeneity among them was relevant (p < 0.008). Median frequency of death involved one third of those affected (Md 33%; Q1:22,7-Q4:75). CONCLUSIONS: Mortality due to IFI due to Fusarium spp was high in children with hemato-oncological pathology, especially in those with severe neutropenia and poor response to treatment of their underlying disease.

Riesgo de mortalidad en infecciones invasivas por Mucor SPP. en niños con enfermedades hemato-oncológicas: revisión sistemática / Mortality risk of invasive Mucor spp. infections in children with cancer: A systematic review

Los estudios sobre la infección fúngica invasiva (IFI) por Mucor spp. en pacientes pediátricos con patología hematooncológica, son de baja solidez científica, lo que dificulta conocer en profundidad sus características y evolución. Con el objetivo de analizar la evolución fatal de esos pacientes, se llevó a cabo esta revisión sistemática (RS). Material y métodos: La búsqueda bibliográfica se realizó con fecha 23 de marzo de 2023, en las principales bases de datos (Medline (a través de Pubmed), Embase (a través de Embase-Elsevier), The Cochrane Library (a través de Wiley), Cinahl (a través de Ebsco HOST), SCI-EXPANDED, SciELO (a través de la WOS) y Scopus (a través de Scopus-Elsevier), libre (mediante el motor Google) y revisando las citas de los artículos incluidos. Resultados: Se rescataron 1393 artículos, de los cuales se descartaron 1386 por diversas razones. Mediante el análisis de los textos completos, finalmente se incluyeron 7 estudios. Todos los estudios eran series de casos (nivel 4). La mediana de la frecuencia de muerte observada fue de 36,6% (Q1 20% - Q347%). Conclusiones: Esta RS mostró en niños con patología hemato-oncológica, que la mortalidad por IFI por Mucor spp. alcanzó a casi un tercio de los pacientes (AU)

Studies on invasive fungal infection (IFI) by Mucor spp. in pediatric patients with cancer have a low level of evidence, which makes it difficult to elucidate its characteristics and progression. To analyze the fatal outcome of these patients, this systematic review (SR) was conducted. Material and methods: A literature search was carried out on March 23, 2023, in the following main databases (Medline (via Pubmed), Embase (via Embase-Elsevier), The Cochrane Library (via Wiley), Cinahl (via Ebsco HOST), SCI-EXPANDED, SciELO (via the WOS) and Scopus (via Scopus-Elsevier). Additionally, a complementary search was carried out using free search engines (such as Google) and by reviewing the references of the included articles. Results: A total of 1393 articles were retrieved, of which 1386 were excluded for various reasons. After a thorough analysis of the full-text articles, 7 studies were ultimately included in the review. All studies were case series (level 4). The median observed death rate was 36.6% (IQR, 20% - 47%). Conclusions: This SR showed that in children with hematological-oncological disease, mortality due to IFI by Mucor spp. affected almost one third of the patients (AU)

Cultivo de Acanthamoeba spp. en agua apirógena / Acanthamoeba spp. culture in pyrogen-free water / Cultura de Acanthamoeba spp. em água apirogênica

Resumen El objetivo de este estudio fue evaluar el cultivo de cepas de Acanthamoeba spp. en agua destilada estéril apirógena de uso farmacéutico. Se utilizaron dos cepas de genotipo T4 [un aislamiento de encefalitis granulomatosa amebiana (EGA) y una ambiental] y cepas correspondientes a los genotipos T5 y T15. Los quistes de cada una de las cepas se sembraron en placas de Petri con agar no nutritivo con diferentes soluciones (agua destilada estéril apirógena uso médico para preparaciones inyectables, agua destilada filtrada, medio Page) y combinados con suspensiones de Escherichia coli. Las placas se incubaron a 37 °C y se monitorearon diariamente durante 15 días para la detección de trofozoítos. El crecimiento se evaluó mediante examen microscópico directo. Cada cultivo contó con cuatro repeticiones para cada una de las cepas (n=96). En conclusión, se hallaron diferencias estadísticamente significativas en el crecimiento de las cepas por día. Las cepas T5 y T4 (encefalitis amebiana granulomatosa) desarrollaron mayor cantidad de trofozoítos en el primer día respecto de la cepa T15 (H=16,42; p=0,001). En el agua apirógena con E. coli se obtuvo un crecimiento igual a la solución de Page con E. coli (H=24,64; p=0,0001). No se hallaron diferencias estadísticamente significativas en la cantidad de trofozoítos obtenidos en agua apirógena con E. coli y solución de Page con E. coli en la cepa T4 (EGA) (U=4; p<0,05) pero sí en la cepa T4 ambiental (U=0; p<0,05).

Abstract The objective of this study was to evaluate the culture of strains of Acanthamoeba spp. in sterile apyrogenic distilled water for pharmaceutical use. Two T4 genotype strains [one isolate of granulomatous amebic encephalitis (GAE) and one environmental], a T5 and T15 genotype strains were used. The cysts of each of the strains were seeded in Petri dishes with non-nutritive agar with different solutions (pyrogenic sterile distilled water for medical use for injectable preparations, filtered distilled water, Page medium) and combined with Escherichia coli suspensions. Plates were incubated at 37 °C and monitored daily for 15 days for the detection of trophozoites. Growth was assessed by direct microscopic examination. Each medium culture counted four replicates for each of the strains (n=96). Concluding, statistically significant differences were found in the growth of the strains per day. Strains T5 and T4 (granulomatous amebic encephalitis) developed a greater number of trophozoites on the first day compared to strain T15 (H=16.42; p=0.001). In apyrogenic water with E. coli, a growth equal to Page's solution with E. coli was obtained (H=24.64; p=0.0001). No statistically significant differences were found in the amount of trophozoites obtained in apyrogenic water with E. coli and Page's solution with E. coli in strain T4 (GAE) (U=4; p<0.05), but significant differences were found in the environmental T4 strain (U=0; p<0.05).

Resumo O objetivo deste trabalho foi avaliar o cultivo de cepas Acanthamoeba spp. em água destilada apirogênica estéril para uso farmacêutico. Foram utilizadas duas cepas de genótipo T4 [um isolamento de encefalite granulomatosa amebiana (EGA) e uma ambiental], e cepas correspondentes aos genótipos T5 e T15. Os cistos de cada uma das cepas foram semeados em placas de Petri com ágar não nutritivo com diferentes soluções (água destilada estéril apirogênica para uso médico para preparações injetáveis, água destilada filtrada, meio Page) e combinados com suspensões de Escherichia coli. As placas foram incubadas a 37 °C e monitoradas diariamente durante 15 dias para detecção de trofozoítos. O crescimento foi avaliado através de exame microscópico direto. Cada cultura contou com quatro réplicas para cada uma das cepas (n=96). Em conclusão, diferenças estatisticamente significativas foram encontradas no crescimento das cepas por dia. As cepas T5 e T4 (encefalite amebiana granulomatosa) desenvolveram maior número de trofozoítos no primeiro dia em relação à cepa T15 (H=16,42; p=0,001). Em água apirogênica com E. coli, foi obtido crescimento igual ao da solução de Page com E. coli (H=24,64, p=0,0001). Não foram encontradas diferenças estatisticamente significativas na quantidade de trofozoítos obtidos em água apirogênica com E. coli e solução de Page com E. coli na cepa T4 (EGA) (U=4; p%<0,05), mas sim na cepa T4 ambiental (U=0; p<0,05).

Caracterización de la utilización de colistín en un hospital de alta complejidad / Evaluation of colistin use in a highly complex hospital

RESUMEN: El aumento de la resistencia y la escasez de nuevos antibacterianos ha requerido la reintroducción de antiguos antimicrobianos entre ellos colistín. OBJETIVO: Caracterizar la utilización de colistín durante el año 2017 en un hospital universitario, mediante la descripción de los pacientes, los tratamientos, la microbiología asociada y efectos adversos. PACIENTES Y MÉTODOS: Trabajo observacional retrospectivo. Se revisaron los datos de todos los pacientes que recibieron colistín intravenoso (IV) por al menos 48 horas, durante el año 2017. RESULTADOS: Se incluyeron 53 pacientes, equivalentes a 91 tratamientos. El foco respiratorio fue el principal (46,2%). El 68,1% de los tratamientos fue iniciado en la UCI. La mayoría de los pacientes tenía una hospitalización reciente (83,5%), y presentaban uso previo de antibacterianos (89%). Los dos patógenos mayoritariamente identificados fueron Pseudomonas aeruginosa y Klebsiella spp. El consumo promedio de colistín fue de 2,4 DDD/100 camas/día. El servicio que más consumió colistín fue la UCI, con 45,5 DDD/100 camas/día, usando generalmente la dosis de 3 MUI cada 8 horas IV y con una baja utilización de dosis de carga. CONCLUSIÓN: Colistín corresponde a un antimicrobiano de uso restringido a infecciones sospechadas o confirmadas por agentes bacterianos multi resistentes. En esta serie, su uso inicial fue principalmente empírico, en pacientes con factores de riesgo para resistencia antibacteriana; se usó en forma asociada a otros antimicrobianos, siendo el foco principal el respiratorio.

BACKGROUND: The increase in resistance and the shortage of new antibiotics has led to the reintroduction of old antimicrobials such as colistin. AIM: To evaluate the use of colistin during 2017 in a university hospital, through the characterization of patients and treatment, associated microbiology, response to treatment and adverse effects. METHODS: Retrospective observational design. The data of all patients who received colistin for at least 48 hours during the year 2017 were reviewed. RESULTS: 55 patients were included, equivalent to 144 treatments. The respiratory focus was the main one (57.9%). 64% of the treatments began in the ICU, while 7% in the ward. Most of the patients has a recent hospitalization (86.8%) and has previous use of antibiotics (90.4%). The two main pathogens identified were Pseudomonas aeruginosa and Klebsiella spp. In 87.1% of the cases with microbiological justifications for the use of colistin, a favorable response was obtained. The average consumption of colistin was 2.4 DDD/100 beds/day. The department that consumed the most colistin was the ICU, with 45,5 DDD/100 beds/day, generally using a dose of 3 MIU every 8 hours IV and with low use of loading doses. CONCLUSION: Colistin corresponds to an antibiotic whose use is restricted to infections suspected or confirmed by multi-resistant bacterial agents. Its initial use in this serie was mainly empirical, in patients with risk factors for antibiotics resistance, it was used in association with other antimicrobials, being the respiratory the main infectious focus.

Microascus gracilis y otomicosis / Microascus gracilis and otomycosis

Microascus spp, teleomorfo de Scopulariopsis, es un hongo saprofito encontrado normalmente en suelo, alimentos, vegetales e incluso en ambientes interiores. Considerado un contaminante ambiental, se caracteriza por la resistencia intrínseca a los antifúngicos disponibles. Existen escasas referencias de infecciones por Microascus gracilis, asociándose como causa de eumicetoma o enfermedad diseminada en pacientes sometidos a trasplante pulmonar. Presentamos un caso de otomicosis por M. gracilis con el fin de considerar la búsqueda de hongos en los cultivos óticos y poner de relevancia el poder patógeno y colonizador de este agente.

Microascus spp, a teleomorph of Scopulariopsis, is a saprophytic fungus normally found in soil, food, vegetables, and even indoors. Considered an environmental pollutant, it is characterized by its intrinsic resistance to available antifungals. There are few references to infections by Microascus gracilis, associating it as a cause of eumycetoma or disseminated disease in lung transplant recipients. We present a case of otomycosis caused by M. gracilis, to consider the search for fungi in ear cultures and highlight the pathogenic and colonizing power of this agent.

Susceptibilidad in vitro a antifúngicos de especies de Cándida / In vitro antifungal susceptibility of Candida spp

Resumen Objetivo. Analizar la susceptibilidad in vitro de aislamientos de Candida spp. provenientes de onicomicosis obtenidos entre 2016 y 2019, para contribuir con el conocimiento sobre la necesidad o no de realizar pruebas de susceptibilidad a los microorganismos aislados antes de prescribir el tratamiento. Métodos. El estudio consistió en identificar 23 aislamientos de Candida spp. utilizando el sistema automatizado Vitek2® (bioMérieux, Francia). Se determinó la susceptibilidad in vitro de estos aislamientos ante dos antifúngicos tópicos (amorolfina y ciclopirox) y dos antifúngicos sistémicos (fluconazol e itraconazol) por el método de microdilución en caldo M27-A3 del Instituto Estándares para el Laboratorio Clínico (CLSI por sus siglas en inglés) de los Estados Unidos de América. Resultados. La mayoría de los aislamientos correspondieron a Candida parapsilosis (34,8 %), seguido por C. albicans (30,3 %), C. guilliermondii (17,4 %), C. tropicalis (8,7 %), C. dubliniensis (4,4 %) y C. krusei (4,4 %). No se encontraron diferencias estadísticamente significativas entre las CIMs de los diferentes antifúngicos y en promedio hubo susceptibilidad para todos los antifúngicos analizados. Sin embargo, para fluconazol se encontró un aislamiento con CIM alta de C. guilliermondii y un aislamiento resistente de C. parapsilosis. Conclusiones. Las directrices internacionales recomiendan pruebas de susceptibilidad para Candida spp. de hemocultivos o tejidos tras infecciones sistémicas. En todas las demás candidiasis se identifica la especie y se revisan sus patrones de susceptibilidad en la literatura. Por lo tanto, es de importancia conocer que aislamientos de onicomicosis de Candida no-albicans, especialmente de C. guilliermondii y C. parapsilosis, presentan una susceptibilidad disminuida a ciertos antifúngicos que se utilizan como tratamiento, por lo que se recomienda realizar pruebas de susceptibilidad en caso de no tener una buena respuesta al tratamiento en casos de onicomicosis por estas levaduras.

Abstract Aim. The purpose of this investigation was to determine the in vitro susceptibility patterns of Candida spp. isolated from onychomycosis, in order to contribute with strategies for optimal clinical laboratory management of patients with onychomycosis infected with these yeasts. Methods . A total of 23 isolates of Candida spp. were identified with the automatized system Vitek®2 (system bioMérieux, France). In vitro susceptibility patterns were evaluated with two topic antifungals (amorolfine and ciclopirox) and two systemic antifungals (fluconazole and itraconazole) using the Clinical Laboratory and Standards Institute (CLSI) broth microdilution M27-A3 guidelines. Results . Most of the isolates were identified as Candida parapsilosis (34,8 %), followed by C. albicans (30,3 %), C. guilliermondii (17,4 %), C. tropicalis (8,7 %), C. dubliniensis (4,4 %) and C. krusei (4,4 %). There were no statistically significant differences among the MICs of the antifungals tested. However, there was one isolate of C. guilliermondii with high MIC for fluconazole and one fluconazole resistant isolate of C. parapsilosis. Conclusions. Susceptibility tests are only recommended internationally for Candida spp. isolated from blood stream or tissue in systemic infections. In every other candidiasis there is only a species identification, while its susceptibility pattern for treatment is reviewed in literature. Therefore, it is important to report that Candida no-albicans isolates from onychomycosis, especially C. guilliermondii and C. parapsilosis, have a reduced susceptibility to some antifungals commonly used for treatment. According to the obtained in vitro results, we recommend performing antifungal susceptibility testing in those cases of onychomycosis caused by Candida spp. no responsive to treatment.

Comprehensive evaluation of abattoirs with no Hazard Analysis Critical Control Point plan in Tucumán,Argentina / Evaluación integral de frigoríficos sin un plan de análisis de peligros y puntos críticos de control en Tucumán, Argentina

Abstract This work focused on the comprehensive study of two provincial transit abattoirs inTucumán, Argentina, with no Hazard Analysis Critical Control Point (HACCP) plan. Visits (n = 20)were conducted between 2016 and 2018 during the operational and post-operational processes.Risk was estimated and the bacteriological analysis of carcass and environmental samples wasperformed. Risk estimation showed the predominance of high risk in both abattoirs. The maindeviations from the HACCP plan were: deficient building conditions, deficient workflow, lack of sectorization of changing rooms and bathrooms, lack of implementation of Standardized Sanitary Operational Procedures, and no food safety training of workers. The counts of indi-cator microorganisms from both abattoirs were not significant. Salmonella spp. was isolated from 7.5% carcass and 7.3% environmental samples. The Salmonella serovars identified were Cerro, Corvallis, Havana and Agona. Shiga toxin (stx) genes were detected in 24.4% carcass and 30.9% environmental samples. The isolates were characterized as Escherichia coli O8:H7/stx1, O116:H49/stx2 and O136:H40/stx2. Based on these results, it would be possible to implement an improvement plan in Tucumán abattoirs together with the local health authorities. Still, the need to work jointly with the sanitary authority in search of a unique sanitary standard for Argentina remains unaddressed.

Resumen Este trabajo se centró en el estudio integral de dos frigoríficos de tránsito provincial en Tucumán, Argentina, carentes de un plan de análisis de peligros y puntos críticos de control (HACCP, por sus siglas en inglés). Las visitas (n = 20) se realizaron entre 2016 y 2018 durante los procesos operativos y posoperativos. Se realizó la estimación del riesgo y el análisis bacteriológico de medias reses y muestras ambientales. La estimación del riesgo demostró un predominio de riesgo alto en ambos frigoríficos. Las principales desviaciones del plan HACCP fueron las deficientes condiciones edilicias, un inadecuado flujo de trabajo, la falta de sectorización de vestuarios y banños, una implementación nula de procedimientos operativos estandarizados de saneamiento y una insuficiente capacitación en seguridad alimentaria de los operarios. Los recuentos de microorganismos indicadores de ambos frigoríficos no presentaron diferencias significativas. Salmonella spp. se aisló del 7,5% de muestras de medias reses y del 7,3% de muestras ambientales. Se identificaron las siguientes serovariedades de Salmonella: Cerro, Corvallis, Havana y Agona. Se detectaron genes de toxina Shiga (sfx) en el 24,4% de las muestras de medias reses y en el 30,9% de las muestras ambientales. Los aislamientos se caracterizaron como Escherichia coli O8:H7/sfx1, O116:H49/sfx2 y O136:H40/sfx2. Teniendo en cuenta estos resultados, sería posible implementar un plan de mejoramiento en frigoríficos de Tucumán conjuntamente con las autoridades locales de salud. Aun así, sigue sin abordarse la necesidad de trabajar en vinculación con las autoridades sanitarias en la búsqueda de una norma integrada única para Argentina.

Orquiepididimitis por Salmonella spp en un lactante bajo los tres meses de edad / Salmonella spp epididymo-orchitis in a infant under three months-old

El compromiso genitourinario en una infección causada por Salmonella spp es poco frecuente, especialmente en niños. Se presenta un paciente de 40 días de vida que presentó una orquiepididimitis por Salmonella entérica serotipo Newport, con documentación microbiológica en hemocultivos, cultivo de secreción escrotal y coprocultivo. No presentó compromiso del sistema nervioso central. Un tratamiento médico y quirúrgico tempranos permitieron la evolución favorable del paciente.

Genitourinary involvement in a Salmonella spp infection is rare, especially in pediatric patients. A 40-day-old patient who presented an orchiepididymitis due to Salmonella enterica Serotype Newport is reported, with microbiological documentation in blood cultures, culture of scrotal purulent material and stool culture. There was no involvement of the central nervous system. Early medical and surgical treatment allowed the favorable evolution of the patient.