Caracterização molecular de Staphylococcus aureus isolados de queijos artesanais da Serra da Canastra / Molecular characterization of Staphylococcus aureus isolated from artisanal cheeses from Serra da Canastra

O queijo Minas Artesanal da Canastra é produzido na Serra da Canastra (MG), utilizando leite cru, coalho e pingo, que é uma cultura endógena natural de cada queijaria. Devido ao uso de leite cru, o produto pode veicular microrganismos causadores de doenças veiculadas por alimentos, como Staphylococcus aureus. A caracterização molecular é uma ferramenta importante para avaliar a população microbiana do alimento e direcionar a aplicação de medidas de controle na produção. Este estudo caracterizou a diversidade genética, o potencial de virulência e determinou o perfil de susceptibilidade a antimicrobianos de S. aureus isolados de queijos produzidos na Serra da Canastra. Para o estudo transversal foram analisados 248 isolados de queijos que tinham um tempo de maturação de 22 dias, provenientes de 83 propriedades. Por outro lado, no estudo longitudinal foram analisados outros 197 isolados coletados ao longo do processo de maturação, provenientes de três propriedades. Os isolados foram submetidos a testes bioquímicos para confirmação do gênero e para a confirmação da espécie de S. aureus, foi identificado o gene nuc por meio da técnica de PCR. Além disso, foi pesquisado o gene mecA para a detecção de S. aureus Resistente a Meticilina (MRSA). Após os testes de confirmação, 144 isolados do estudo transversal e 159 do estudo longitudinal foram positivos para o gene nuc, específico para S. aureus. Posteriormente, o perfil clonal foi determinado por Eletroforese de Campo Pulsado (PFGE) utilizando a enzima SmaI e tipagem do locus agr por PCR multiplex. A análise por PFGE foi realizada no programa BioNumerics. A técnica PCR foi realizada para identificar a presença de genes que codificam a produção de hemolisinas, toxina TSST-1, enterotoxinas SEs (SEA, SEB, SEC, SED, SEE, SEG, SEH, SEI, SEJ, SEO, SEM), formação de biofilme e Componentes Microbianos de Superfície que Reconhecem a Matriz de Moléculas Adesivas (MSCRAMMs). Os isolados foram submetidos ao teste de susceptibilidade a antimicrobianos por disco de difusão. Por último, a formação de biofilme em microplaca de 96 poços, em caldo TSB a 37°C, foi verificada pela metodologia de Cristal Violeta. O gene mecA foi detectado em 1,9% dos 445 isolados. A tipagem agrrevelou que 83 (27,4%) dos isolados são do tipo agr-I, 95 (31,4%) agr-II e 43 (14,2%) agr-III, sendo que não foram detectados isolados classificados como agr-IV. A tipagem por PFGE revelou um total de 54 perfis. Assim, um isolado representativo de cada perfil foi utilizado nos demais testes que mostraram a presença dos genótipos spa mais frequentes t127 e t605 (20,58%); t002 (14,70%), seguidos pelos tipos t267 (8,82%); t1234 e t693 (5,8%) e t021, t177, t306, t321, t359, t442, t521, t693 e t5493 (2,9%). Além disso, encontramos a presença dos genes do grupo SEs, sea 1 (1,8%), seh 11 (20,3%), sei 10 (18,5%), sej 7 (12,9%), seg e seo 14 (25,9%), sem 8 (14,8%), e os genes seb, sec, sed, see e tst não foram detectados. Para os genes das hemolisinas, hla foi positivo em todos os isolados e hlb foi positivo em 53 (98,1%) isolados. Os genes positivos para MSCRAMMS foram fnbA, fnbB 18 (33,3%), clfA, clfB e eno 53 (98,1%), fib 44 (81,4%), bbp 4 (7,4%), cna 17 (31,4%) e ebps 10 (18,5%). Por último, os genes de formação de biofilme icaA e icaD estiveram presentes em 38 (70,3%) e 25 (46,2%) dos isolados, respectivamente. Na avaliação de susceptibilidade a antibióticos dos 54 isolados escolhidos, 25 (46,3%) apresentaram maior resistência a penicilina e 13 (24,0%) a tetraciclina. Em menor porcentagem (1,8%), 1 isolado cada foi resistente a eritromicina, cefoxitina, clindamicina, gentamicina, cotrimazol, azitromicina e trimetropim. Além disso, 8 isolados (14,8%) apresentaram resistência intermediaria a tetraciclina, 3 (5,5%) a gentamicina e 1 (1,8%) a tobramicina. No teste para a determinação da formação de biofilme por cristal violeta, 13,7%, foram classificados em isolados não formadores, 60,8% em fracamente formadores, 25,5% moderadamente formadores e nenhum como fortemente formador. A alta diversidade de cepas de S. aureus observada neste estudo mostrou que existem vários tipos de linhagens circulando na região da Canastra. A caracterização revelou uma elevada frequência de genes de virulência e que mais estudos são necessários para avaliar o potencial de produção de enterotoxinas nos queijos artesanais. A melhora dos procedimentos de higienização durante todas as etapas de produção pode ser uma solução para a redução dos níveis de contaminação por S. aureus

Canastra Minas Artesanal cheese is produced in Serra da Canastra (MG), using raw milk, rennet and a natural endogenous culture called pingo. Due to the use of raw milk, the product can carry microorganisms that cause foodborne diseases, such as Staphylococcus aureus. Molecular characterization is an important tool to assess the microbial population of food and guide the application of control measures in production. This study characterized the genetic diversity, virulence potential and determined the antimicrobial susceptibility profile of S. aureus isolated from cheeses produced in Serra da Canastra. A total of 248 isolates from 22 days ripened cheeses were obtained from 83 properties (cross sectional study). Another 197 isolates were collected during maturation (longitudinal study), in three properties. The isolates were submitted to biochemical tests to confirm the genus and to confirm the S. aureus species, the nuc gene was identified by PCR. In addition, the detection of mecA gene was performed for the detection of Methicillin Resistant S. aureus (MRSA). After confirmation tests, 144 isolates from the cross-sectional study and 159 from the longitudinal study were positive for the nuc gene, specific for S. aureus. Subsequently, the clonal profile of the isolates was determined by Pulsed Field Gel Electrophoresis (PFGE) using the SmaI enzyme and typing of the agr locus by multiplex PCR. PFGE analysis was performed using the BioNumerics program. PCR was performed to identify the presence of genes encoding the production of hemolysins, TSST-1 toxin, enterotoxins SEs (SEA, SEB, SEC, SED, SEE, SEG, SEH, SEI, SEJ, SEO, SEM), biofilm formation and microbial surface components recognizing adhesive matrix molecules (MSCRAMMs). The isolates were submitted to the antimicrobial susceptibility test by disc diffusion. Finally, biofilm formation in a 96-well microplate in TSB broth at 37°C was verified by the Cristal Violeta method. The mecA gene was detected in 1.9% of the 445 isolates. Agr typing revealed that 83 (27.4%) of the isolates are agr-I, 95 (31.4%) agr-II and 43 (14.2%) agr-III, and no isolate was classified as agr-IV. PFGE typing revealed a total of 54 profiles. Thus, a representative isolate of each profile was used in the other tests that showed the presence of the most frequent spagenotypes t127, t605 (20.58%); t002 (14.70%), followed by types t267 (8.82%); t1234, t693 (5.8%) e t021, t177, t306, t321, t359, t442, t521, t693 and t5493 (2.9%). In addition, we found the presence of the genes of the SEs group: sea 1 (1.8%), seh 11 (20.3%), sei 10 (18.5%), sej 7 (12.9%), seg and seo 14 (25.9%), sem 8 (14.8%), while seb, sec, sed, see and tst genes were not detected. For hemolysin genes, hla was positive in all isolates and hlb was positive in 53 (98.1%) isolates. The positive genes for MSCRAMMS were: fnbA, fnbB 18 (33.3%), clfA, clfB e eno 53 (98.1%), fib 44 (81.4%), bbp 4 (7.4%), cna 17 (31.4%) and ebps 10 (18.5%). Finally, the biofilm formation genes icaA and icaD were present in 38 (70.3%) and 25 (46.2%) of the isolates, respectively. In the evaluation of antibiotic susceptibility of the 54 isolates, 25 (46.3%) showed greater resistance to penicillin and 13 (24.0%) to tetracycline. In a lower percentage (1.8%), 1 isolate each was resistant to erythromycin, cefoxitin, clindamycin, gentamicin, contrimazole, azithromycin and trimethoprim. In addition, 8 isolates (14.8%) showed intermediate resistance to tetracycline, 3 (5.5%) to gentamicin and 1 (1.8%) to tobramycin. In the test for the determination of biofilm formation by crystal violet, 13.7% were classified as non-forming isolates, 60.8% as weakly forming, 25.5% moderately forming and none as strongly forming. The high diversity of S. aureus strains observed in this study showed that there are several types of strains circulating in the Canastra region. The characterization revealed a high frequency of virulence genes and that further studies are needed to assess the potential for enterotoxin production in artisanal cheeses. The improvement of hygiene procedures during all stages of production can be a solution for reducing the levels of contamination by S. aureus

Brote de intoxicación alimentaria en un jardín de infantes de la provincia de Buenos Aires / Food poisoning outbreak in a kindergarten in the Province of Buenos Aires, Argentina

Resumen El 27 de noviembre de 2008 ocurrió un brote de intoxicación alimentaria asociado al consumo de salpicón de ave en un jardín de infantes de Hurlingham, provincia de Buenos Aires. Treinta y siete niños y 10 adultos presentaron síntomas gastrointestinales. Cinco niños fueron internados con signos de deshidratación, y uno de ellos requirió cuidados intensivos. Se aisló Staphylococcus aureus subsp. aureus del alimento involucrado, de 4/5 muestras de materia fecal de pacientes y de 3/5 manipuladores (nariz del manipulador 1, manos de manipuladores 2 y 3). Las cepas aisladas portaban los genes que codifican las enterotoxinas SEA y SED. Por electroforesis de campo pulsado con la enzima SmaI, los patrones de macrorrestricción presentaron 100% de similitud. La investigación oportuna del brote permitió identificar al agente causal de la intoxicación, determinar las fallas en la elaboración del alimento e implementar las medidas correctivas correspondientes.

Abstract On November 27, 2008, a foodborne disease outbreak associated with the consumption of chicken salad occurred in a kindergarten in the District of Hurlingham, Province of Buenos Aires. Thirty-seven children and 10 adults with gastrointestinal symptoms were affected. Five children were hospitalized with signs of dehydration, one of them requiring intensive care. Staphylococcus aureus subsp. aureus was isolated from the mentioned food in 4 out of 5 stool specimens from the patients, and in 3 out of 5 food handlers (nose of food handler #1, hands of food handlers #2 and 3). The isolates carried the genes coding for enterotoxins SEA and SED. The macrorestriction patterns showed 100% similarity by pulsed-field gel electrophoresis using the SmaI enzyme. A timely outbreak investigation allowed us to identify the causative agent of the food poisoning as well as the failures in food processing and to implement corrective measures.

Presencia de estafilococos coagulasa positiva ambientales, su relación clonal, factores de resistencia y habilidad para formar biopelícula / Presence of environmental coagulase-positive staphylococci, their clonal relationship, resistance factors and ability to form biofilm

Coagulase-positive staphylococci (CoPS) are opportunistic pathogens carrying various mechanisms of resistance that have a large number of virulence factors, and whose ability to induce illness is associated with the host. This study aimed to investigate the presence of environmental coagulase-positive staphylococci, their susceptibility profile, clonal relationship and ability to form biofilm. The 16S rRNA genes from CoPS isolates were analyzed, and their antibiotic susceptibility was evaluated using the agar dilution method in accordance with Clinical and Laboratory Standards Institute guidelines. The clonal profile was obtained by pulsed-field gel electrophoresis (PFGE) and biofilm formation was measured by a crystal violet retention assay. A total of 72 Staphylococcus spp. strains were isolated from air, metal surfaces, and nostrils from humans, dogs, cats, and birds. Three species were identified: Staphylococcus aureus (17%), Staphylococcus intermedius (63%), and Staphylococcus pseudintermedius (21%). Ninety three percent (93%) of the strains were resistant to at least one of 13 tested antibiotics. S. pseudintermedius strains were the only resistant ones to methicillin while most of these isolates were multidrug-resistant, had significantly higher ability to form biofilm and PFGE grouped into seven different patterns, without showing clonal dispersion among animals and environmental isolates. This study suggests that dogs, cat, and air are environmental sources potentially carrying multidrug-resistant S. pseudintermedius, which survives in different environments through biofilm formation and multidrug resistance, characteristics that can be transmitted horizontally to other bacteria and exacerbate the problem of antibiotic resistance in humans.

Los estafilococos coagulasa-positiva (CoPS) son patógenos oportunistas, portan varios mecanismos de resistencia, tienen un gran número de factores de virulencia y su capacidad para inducir la enfermedad está asociada con el hospedero. El objetivo de este estudio fue investigar la presencia de CoPS en el medio ambiente, su perfil de sensibilidad a los antibióticos, su relación clonal y su capacidad para formar biopelícula. De los aislamientos de CoPS se analizaron los genes 16S ARNr y se evaluó la sensibilidad a los antibióticos mediante el método de dilución en agar según el CLSI. El perfil clonal se obtuvo por electroforesis en gel de campo pulsado (PFGE) y la formación de biopelícula se analizó por retención de cristal violeta. Se aislaron 72 cepas de Staphylococcus spp. a partir de aire, superficies metálicas y narinas de humanos, perros, gatos y aves. Se identificaron tres especies: Staphylococcus aureus (17%), Staphylococcus intermedius (62%) y Staphylococcus pseudintermedius (21%). El 93% de las cepas fueron resistentes al menos a uno de 13 antibióticos probados. Los aislamientos de S. pseudintermedius fueron los únicos resistentes a meticilina y la mayoría fueron resistentes a múltiples fármcos, tuvieron una capacidad significativamente mayor para producir biopelícula y la PFGE los agrupó en 7 diferentes patrones, sin mostrar dispersión clonal entre los aislamientos de animales y de medio ambiente. Este estudio sugiere que los perros, los gatos y el aire son fuentes ambientales potencialmente portadoras de S. pseudintermedius resistente a múltiples antibióticos. Este agente sobrevive en diferentes entornos en virtud de la formación de biopelículas y la resistencia a múltiples antibióticos, características que pueden transmitirse horizontalmente a otras bacterias y, por ende, exacerbar el problema de la resistencia a los antibióticos en humanos.

Resistencia antimicrobiana y epidemiología molecular de aislamientos de Staphylococcus pseudintermedius de muestras clínicas de caninos / Antimicrobial resistance and molecular epidemiology of Staphylococcus pseudintermedius strains isolated from dog clinical samples

Se estudiaron 28 aislamientos obtenidos de muestras clínicas de perros e identificados por espectrometría de masas (MALDI-TOF) como Staphylococcus pseudintermedius; el objetivo fue evaluar la sensibilidad a los antimicrobianos por el método de difusión y establecer la relación clonal entre aislamientos por electroforesis en campo pulsado (PFGE). La resistencia a meticilina se evaluó mediante PCR por amplificación del gen mecA y se observó en 3/28 aislamientos (10,7 %). Quince aislamientos (53,6 %) presentaron resistencia a alguno de los antibióticos ensayados y 11 de ellos (39,3 %) presentaron resistencia múltiple (resistencia a 3 o más familias de antibióticos). Once aislamientos (39,3 %) presentaron resistencia a eritromicina, debido a la presencia de metilasa ribosomal ermB, y no se detectó resistencia inducible a clindamicina. Por PFGE se pudieron diferenciar 27 tipos clonales, lo cual demuestra gran diversidad clonal. Se destaca el hallazgo de aislamientos de S. pseudintermedius multirresistentes como una eventual problemática a considerar en el diagnóstico veterinario de laboratorio, el tratamiento de las infecciones caninas y el ámbito de la salud pública.

Twenty-eight strains isolated from dog clinical samples identified as Staphylococcus pseudintermedius by mass spectrometry (MALDI-TOF) were studied to assess antimicrobial susceptibility by the diffusion method and clonal relationship by pulsed field gel electrophoresis (PFGE). Methicillin resistance (3/28 isolates; 10,7 %) was evaluated by mecA PCR. Fifteen strains (53.6 %) were resistant to at least one of the antibiotics tested, and eleven of them (39.3 %) showed multiple resistance (3 or more antimicrobial families). Eleven isolates (39.3 %) were resistant to erythromycin due to the presence of ribosomal methylase ermB, whereas clindamycin inducible resistance was not detected. Twenty-seven (27) clonal types were differentiated by PFGE, suggesting high clonal diversity. We emphasize that the finding of multiresistant S. psedintermedius strains is an emerging problem to be considered in veterinary diagnostic laboratory treatment of canine infections and in public health settings.

Perfiles genéticos de Streptococcus uberis aislados de mastitis bovina / Genetic patterns of Streptococcus uberis isolated from bovine mastitis

El objetivo del presente estudio fue evaluar las relaciones genotípicas entre 40 Streptococcus uberis aislados de mastitis bovina mediante la técnica de electroforesis de campos pulsantes (pulsed-field gel electrophoresis [PFGE]). Además, se investigó la asociación entre los patrones de PFGE y los perfiles de virulencia. Los aislamientos mostraron 17 patrones de PFGE. Se encontraron diferentes cepas dentro de los tambos y en los distintos tambos, y un bajo número de aislamientos dentro del mismo tambo compartieron un perfil idéntico de PFGE. No se encontró ninguna asociación entre los patrones de PFGE y los perfiles de virulencia. Sin embargo, la detección de cepas particulares en algunos tambos podría indicar que algunas de ellas son más virulentas que otras. Sería importante avanzar en las investigaciones para identificar nuevos genes relacionados con la virulencia que podrían contribuir a la capacidad infecciosa de estas cepas

The aim of this study was to evaluate the genotypic relationships among 40 Streptococcus uberis isolated from bovine mastitis by using pulsed-field gel electrophoresis (PFGE). Additionally, the association between PFGE patterns and virulence profiles was investigated. The isolates exhibited 17 PFGE patterns. Different strains were found within and among herds; however, a low number of isolates within the same herd shared an identical PFGE type. No association between PFGE patterns and virulence profiles was found. However, the detection of specific strains in some herds could indicate that some strains are more virulent than others. Further research needs to be undertaken to elucidate new virulence-associated genes that might contribute to the capability of these strains to produce infection

Brote de shigelosis en la ciudad de Luján, Argentina / Shigelosis outbreak in the city of Lujan, Argentina

El objetivo del estudio fue describir un brote por Shigella sonnei ocurrido en julio de 2012 en Luján, Buenos Aires, Argentina. Estuvieron afectadas 5 personas que asistieron a una reunión familiar, donde consumieron una rosca vienesa de elaboración artesanal adquirida en un comercio. Todos presentaron fiebre, dolores articulares, escalofríos y diarrea no sanguinolenta con mucus. Se realizaron coprocultivos en los afectados y análisis microbiológicos de los ingredientes. Se aisló y caracterizó S.sonnei de todos los pacientes y de la crema de almendras empleada en la preparación de la rosca vienesa. A los aislamientos se les determinó el perfil de sensibilidad a los antimicrobianos y el genético por electroforesis en campo pulsado. Los resultados demostraron la relación genética de los aislamientos, y esto confirmó la ocurrencia de los casos por exposición a una misma fuente de infección, la crema de almendras. Al ser un ingrediente industrial, de improbable contaminación inicial, la crema de almendras podría haber sufrido una contaminación durante la manipulación en la panadería

The aim of this study was to describe an outbreak of Shigella sonnei that occurred in the city of Lujan, Buenos Aires, Argentina, in July 2012. Five individuals were affected after eating a handmade Viennese-style pastry at a family gathering. All of them presented with fever, joint pain, chills and non-bloody diarrhea containing mucus. Stool cultures were performed in all cases and the samples taken from the pastry ingredients were analyzed microbiologically. S.sonnei was isolated and identified in all the patients involved as well as in the almond cream filling. The isolates were analyzed for determining the antimicrobial susceptibility and genetic profiles by pulsed field gel electrophoresis (PFGE). The results showed the genetic relationship among the isolates, confirming that the cases occurred due to the patients' exposure to the same source of infection, i.e., the almond cream. Being the almond cream an industrially-manufactured ingredient, an initial contamination could have been unlikely; however contamination might have occurred as a result of manipulation in the bakery

Aislamiento y caracterización de Escherichia coli O157 en productos cárnicos bovinos y medias reses en la provincia de Tucumán / Isolation and characterization of Escherichia coli O157 in bovine meat products and cattle in the province of Tucuman

Escherichia coli O157 es un patógeno emergente asociado a diarrea, colitis hemorrágica y síndrome urémico hemolítico. Los productos cárnicos constituyen una importante fuente de contaminación con este microorganismo. Los objetivos de este estudio fueron establecer la frecuencia de detección de E. coli O157 en productos cárnicos y media res en la provincia de Tucumán, caracterizar los factores de virulencia de los aislamientos obtenidos, establecer la relación clonal entre cepas regionales mediante electroforesis de campo pulsado y comparar con lo consignado en la base de datos nacional. Desde 2004 hasta 2013 se analizaron 169 muestras de carne picada, 35 embutidos y 216 esponjados de media res. Se identificaron 13 aislamientos de E. coli O157; 6 de ellos fueron O157:H7 productores de toxina Shiga y se caracterizaron como stx2c(vh-a)/eae/ehxA (n = 5) y stx2/eae/ehxA (n = 1); los 7 aislamientos de E. coli O157 no toxigénicos fueron O157:NT(n = 4),O157:NM (n = 1),O157:ND (n = 1) y O157:H16 (n = 1). Los patrones de PFGE fueron diferentes entre sí y de los registrados en la base de datos nacional. Se concluye que existe gran diversidad genética en los aislamientos de E. coli O157 circulantes en nuestra región

Escherichia coli O157 is an emergent pathogen associated with diarrhea, hemorrhagic colitis and hemolytic uremic syndrome. Meat products constitute an important transmission source of this microorganism. The aims of this study were to characterize E. coli O157 isolated from cattle and meat products collected from abattoirs and retail stores, to establish the clonal relatedness among regional isolates and to compare them with those in the national database. Between 2004 and 2013, 169 minced meat, 35 sausage and 216 carcass samples were analyzed. Thirteen E. coli O157 isolates were identified; 6 of which were O157:H7 and characterized as stx2c(vh-a)/eae/ehxA (n = 5) and stx2/eae/ehxA (n = 1). The 7 remaining isolates were non-toxigenic E. coli strains, and serotyped as O157:NT (n = 4), O157:NM (n = 1), O157:ND (n = 1) and O157:H16 (n = 1). The strains yielded different XbaI-PFGE patterns. Compared to the E. coli O157 isolates in the National Database, none of these patterns have been previously detected in strains of different origin in Argentina

Tipificación mediante electroforesis de campos pulsantes de cepas de Streptococcus beta hemolíticos presentes en un brote de faringitis en niños / Typing by pulsed field gel electrophoresis of beta hemolytic Streptococcus strains present in a pharyngitis outbreak in children

Introducción: en infecciones por Streptococcus beta hemolíticos los del grupo A de Lancefield son el principal causante de faringitis en niños, y entre los no A los del Grupo C ocupan un lugar importante. Objetivo: tipificar molecularmente las cepas que participaron en un brote de faringitis en niños y demostrar la utilidad de la técnica de electroforesis de campos pulsantes en la identificación de las cepas circulantes. Métodos: se caracterizaron mediante electroforesis de campos pulsantes 12 aislados de Streptococcusbeta hemolíticos pertenecientes a niños atendidos en el Hospital Juan Manuel Márquez durante un brote de faringitis aguda en los meses de enero a marzo de 2008. Resultados: mediante el test de seroagrupamiento se encontró que 6 de los aislados, correspondiente al primer periodo del brote, eran Streptococcus del grupo C y los otros 6 aislados clasificaron como Streptococcuspyogenes, con una mayor presencia en la segunda etapa del brote. La subtipificación mediante la macrorrestriccion con SmaI y electroforesis de campos pulsantes mostró la existencia de dos poblaciones clonales consecutivas durante el brote. Conclusiones: los resultados obtenidos demuestran la utilidad que pudiera tener la subtipificación de aislados mediante electroforesis de campos pulsantes durante un brote o una reemergencia facilitando el control epidemiológico, la localización de la fuente y la toma de decisiones cuando esta fuera necesaria(AU)

Introduction: in the context of infection by beta hemolytic Streptococci, Lancefield group A is the main cause of pharyngitis in children, whereas Streptococci C play an important role in the non group A. Aims: the purpose of the study was to molecularly typify the strains involved in a pharyngitis outbreak in children, and show the usefulness of pulsed field gel electrophoresis technique for identification of circulating strains. Methods: twelve beta hemolytic Streptococcus isolates from children cared for at Juan Manual Márquez hospital were characterized by pulsed field gel electrophoresis during an acute pharyngitis outbreak from January to March 2008. Results: the serogrouping test found that six of the isolates, corresponding to the first stage of the outbreak, were group C Streptococci, whereas the other six classified as Streptococcus pyogenes, with a greater presence in the second stage. Subtyping by Sma I macrorestriction and pulsed field gel electrophoresis revealed the presence of two consecutive clonal populations during the outbreak. Conclusions: results show the potential usefulness of subtyping isolates with pulsed field gel electrophoresis during an outbreak or an instance of re-emergence, thus facilitating epidemiological control, location of the source, and decision making when required(AU)

Necrotizing fasciitis caused by a variant of epidemic methicillin resistant Staphylococcus aureus -15.

We report a case of necrotizing fasciitis (NF), caused by community-acquired epidemic methicillin resistant Staphylococcus aureus 15 (EMRSA 15). The patient had a prolonged recovery period following treatment with antibiotics and surgical debridement of the infected part. Molecular characterization revealed that the isolate carried Staphylococcal Cassette Chromosome mec (SCC mec) type IV harboring Panton-Valentine Leucocidin (pvl) gene and having accessory gene regulator (agr) type I. The isolate was positive for enterotoxin gene cluster (egc). Pulsed field gel electrophoresis patterns revealed that the isolate belonged sequence type 22, which is an Indian variant of EMRSA 15, reported earlier.

Molecular Typing in Public Health Laboratories: From an Academic Indulgence to an Infection Control Imperative / 예방의학회지

Using three Austrian case studies, the variegated applications of molecular typing in today's public health laboratories are discussed to help illustrate preventive management strategies relying on DNA subtyping. DNA macrorestriction analysis by pulsed field gel electrophoresis has become the gold standard for subtyping of food borne pathogens like listeria, salmonella, campylobacter and Bacillus cereus. Using a Salmonella Mbandaka outbreak from the year 2010 as example, it is shown how the comparison of patterns from human isolates, food isolates, animal isolates and feed isolates can allow to identify and confirm a source of disease. An epidemiological connection between the simultaneous occurrence of tuberculosis in cattle and deer with cases of human tuberculosis due to Mycobacterium caprae in 2010 was excluded using mycobacterial interspersed repetitive units variable-number tandem repeats subtyping. Also in 2010, multilocus sequence typing with nonselective housekeeping genes, the so-called sequence based typing protocol, was used to elucidate connections between an environmental source (a hospital drinking water system) and a case of legionellosis. During the last decades, molecular typing has evolved to become a routine tool in the daily work of public health laboratories. The challenge is now no longer to simply type microorganisms, but to type them in a way that allows for data exchange between public health laboratories all over the world.

Avaliação da suscetibilidade antimicrobiana e do perfil de macrorrestrição do DNA de isolados humanos de Salmonella serovar Typhimurium fagotipo 193, no período de 1970 a 2008 / Assessment of antimicrobial susceptibility and macrorestriction DNA of human isolates of Salmonella serovar typhimurium phage type 193 in the period 1970 to 2008

Para analisar cepas de Salmonella ser. Typhimurium isoladas de processos entéricos e extraintestinais humanos ocorridos no período de 1970 a 2008 de diferentes regiões do país foram selecionadas, com base nos registros contidos no banco de dados do Laboratório de Enterobactérias do IOC/FIOCRUZ, RJ, amostras do fagotipo prevalente 193, visando precipuamente o reconhecimento de clones epidêmicos. Foram selecionadas 553 cepas de Salmonella ser. Typhimurium fagotipo 193 representadas por 91, 65, 70 e 327 amostras referentes as décadas de 70, 80, 90 e ao período de 2000 a 2008, respectivamente. Na análise global da sensibilidade destas cepas, 52% apresentaram um ou mais marcadores de resistência a antibióticos incluídos no perfil ACSSuT. Este perfil de resistência completo foi verificado em 20,9% dos isolados, sendo os 21,9% restantes, sensíveis a todas as drogas testadas, especialmente no período de 2000 a 2008, representadas por 121 amostras (37,0%) em relação as 327 culturas dessa época. O maior percentual de resistência foi observado nas amostras da década de 70 (99%) sendo o perfil ACSSuT detectado em 35,2% dos isolados, ressaltando-se que todas as amostras foram isoladas de processos gastroentéricos ocorridos na cidade de São Paulo. Ao longo das quatro décadas de estudo, descreve-se um ponto de ruptura entre a prevalência de resistência e a suscetibilidade na transição entre as décadas de 80 e 90. Embora o número de isolados de Salmonalla ser. Typhimurium fagotipo 193 tenha aumentado no último período considerado, o percentual de mono e multirresistência aos antimicrobianos se situou em nível elevado (63,0%). A análise do polimorfismo obtido após macrorrestrição com a enzima Xbal revelou que cepas isoladas na década de 90 apresentaram elevado percentual de similaridade (>-85%) com cepas isoladas recentemente (período de 2000-2008), sendo agrupadas nos mesmos "subclusters". Por outro lado, as cepas da década de 70 inserem-se em "subclusters" independentes...

To analyze strains of Salmonella ser. Typhimurium isolated from human cases of enteric and extraintestinal occurred during the period 1970 to 2008 of different regions of Brazil were selected, based on records in the database from Enterobacteria Laboratory of IOC/FIOCRUZ, RJ, samples prevalent phage type 193 in order to recognition of epidemic clones. We selected 553 strains of Salmonella ser. Typhimurium phage type 193 represented by 91, 65, 70 and 327 samples concerning the 1970s, 1980s, 1990s and the period from 2000 to 2008, respectively. In a global analysis of the sensitivity of these strains, 52% had one or more antibiotic resistance markers included in the profile ACSSuT. This resistance profile was found complete in 20.9% of isolates and the remaining 21.9%, sensitive to all drugs tested, especially in the period 2000 to 2008, represented by 121 samples (37.0%) compared the 327 cultures of that time. The highest percentage of resistance was observed in the samples of the 70 (99%) being the profile ACSSuT detected in 35.2% of isolates, emphasizing that all strains were isolated from gastrointestinal processes occurring in São Paulo city. Over the four decades of study, we describe a breaking point between the prevalence of resistance and susceptibility in the transition between the 1980s and 1990s. Although the number of isolates of Salmonella ser. Typhimurium phage type 193 has increased in the last period, the percentage of mono-and-multidrug resistance to antimicrobial agents stood at high level (63.0%). The analysis of polymorphism obtained after macrorestriction with the enzyme Xbal showed that isolates in the 1990s showed a high percentage of similarity (>-85%) with strains isolated recently (2000-2008) and are grouped in the same subclusters. Moreover, the strains of the 1970s fall into subclusters independent, although the percentage of similarity between such subsclusters and the other is >- 70%, the same was observed for the strains...

Genetic heterogeneity of Escherichia coli strains isolated from raw milk, Minas Frescal cheese, and food handlers / Heterogeneidade genética de cepas de Escherichia coli isoladas de leite cru, queijo Minas Frescal e manipuladores

From February 2004 to March 2005, 140 samples of food handlers - hands and nostrils - (92), raw milk (24), and minas frescal cheese (24) were analyzed for the presence of Escherichia coli in a dairy processing plant of Goiás State. Forty-seven E. coli strains were obtained and compared by DNA macrorestriction patterns obtained from pulsed-field gel electrophoresis following XbaI restriction in order to investigate the possible sources of cheese contaminations. Based on PFGE genotyping, one strain isolated from food the hands of a handler and five strains isolated from raw milk were identical or closely related to six strains from cheese suggesting, in these cases, the probable source of E. coli contamination in cheeses. No strain isolated from the nostrils was related to those found in cheeses or milk strains. The results showed high diversity among the strains, demonstrating a lack of predominance of an endemic clone in the dairy plant. This paper highlights the usefulness of PFGE as an epidemiological tool for determining the source of E. coli contamination in the food industry.

Durante um ano, de fevereiro de 2004 a março de 2005, 140 amostras retiradas das mãos e das narinas de manipuladores de alimentos (92), do leite cru (24) e do queijo-de-minas frescal (24) foram analisadas para a presença de Escherichia coli, em um laticínio do Estado de Goiás. As 47 cepas obtidas foram comparadas por macrorrestrição do DNA com enzima XbaI, seguida de eletroforese em gel em campo pulsado (PFGE), a fim de investigar as possíveis fontes de contaminação do queijo. Baseado na genotipagem pelo PFGE, uma cepa obtida do leite cru e cinco cepas obtidas dos manipuladores mostraram similaridade maior que 80 por cento com seis cepas isoladas do queijo, denotando forte correlação genética entre elas e sugerindo, nestes casos, a fonte provável de contaminação do produto final. Nenhuma cepa isolada do nariz foi relacionada às isoladas do queijo ou do leite. Os resultados mostraram grande diversidade entre as cepas, demonstrando ausência de um clone endêmico no laticínio avaliado. Este estudo destaca a utilidade do PFGE como uma ferramenta importante em investigações epidemiológicas e na determinação de possíveis fontes de contaminação por E. coli na indústria de alimentos.

Molecular typing of Vibrio cholerae O1 isolates from Thailand by pulsed-field gel electrophoresis.

The aim of the present study was to genotypically characterize Vibrio cholerae strains isolated from cholera patients in various provinces of Thailand. Two hundred and forty V. cholerae O1 strains, isolated from patients with cholera during two outbreaks, i.e. March 1999-April 2000 and December 2001-February 2002, in Thailand, were genotypically characterized by NotI digestion and pulsed-field gel electrophoresis (PFGE). In total, 17 PFGE banding patterns were found and grouped into four Dice-coefficient clusters (PF-I to PF-IV). The patterns of V. cholerae O1, El Tor reference strains from Australia, Peru, Romania, and the United States were different from the patterns of reference isolates from Asian countries, such as Bangladesh, India, and Thailand, indicating a close genetic relationship or clonal origin of the isolates in the same geographical region. The Asian reference strains, regardless of their biotypes and serogroups (classical O1, El Tor O1, O139, or O151), showed a genetic resemblance, but had different patterns from the strains collected during the two outbreaks in Thailand. Of 200 Ogawa strains collected during the first outbreak in Thailand, two patterns (clones)--PF-I and PF-II--predominated, while other isolates caused sporadic cases and were grouped together as pattern PF-III. PF-II also predominated during the second outbreak, but none of the 40 isolates (39 Inaba and 1 Ogawa) of the second outbreak had the pattern PF-I; a minority showed a new pattern--PF-IV, and others caused single cases, but were not groupable. In summary, this study documented the sustained appearance of the pathogenic V. cholerae O1 clone PF-II, the disappearance of clones PF-I and PF-III, and the emergence of new pathogenic clones during the two outbreaks of cholera. Data of the study on molecular characteristics of indigenous V. cholerae clinical isolates have public-health implications, not only for epidemic tracing of existing strains but also for the recognition of strains with new genotypes that may emerge in the future.

Caracterización molecular y detecciónde betalactamasas de espectro extendido en cepas de E. coli y K. pneumoniae aisladas en las unidades de cuidados intensivos de un Hospital Universitario / Molecular characterization and extended spectrum betalactamase detection in E. coli and K. pneumoniae strains isolates from intensive care units in a Teaching Hospital

La producción de Betalactamasas de Espectro Extendido por cepas de E. coli y K. pneumoniae, es un grave problema de salud pública ya que causa la pérdida de la eficacia terapéutica a los antibióticos ß-lactámicos. En este trabajo se investigó la presencia de betalactamasas de espectro extendido en cepas de E. coli y K. pneumoniae aisladas de pacientes de las unidades de cuidados intensivos de un hospital universitario. Se estudiaron 41 cepas de E. coli y 59 de K. pneumoniae, aisladas de los cultivos bacteriológicos realizados en el Centro de Referencia Bacterológica del Sevicio Autónomo Hospital Universitario de Maracaibo (SAHUM). Para la detección de betalactamasas de espectro extendido se utilizaron los métodos normalizados por el Clinical and Laboratory Standards Institute (CLSI). El 39,02% de las cepas de E. coli y el 52,54% de las de K. pneumoniae fueron betalactamasas de espectro extendido positivas, en estas cepas se observó resistencia acompañante a quinolonas, aminoglicósidos, cloranfenicol, tetraciclina y trimetoprima/sulfametoxazol. El estudio epidemiológico mediante Electroforesis de Campo Pulsado, mostró una gran diversidad genética entre los aislamientos, esta policlonalidad indica que la diseminación dentro del ambiente hospitalario no se da por transmisión de una cepa entre pacientes, sino que se da por transferencia de plásmidos entre diferentes cepas producto de la alta presión selectiva ejercida por la mala utilización de cefalosporinas de tercera generació.

Evaluación de dos técnicas de subtipificación molecular para el estudio de Pasteurella multocida / Evaluation of two techniques of molecular subtyping to study Pasteurella multocida

Se determinó la tipibilidad, la reproducibilidad y el poder discriminatorio de ERIC-PCR y ApaI-PFGE para establecer la relación genética de cepas de Pasteurella multocida. Se estudiaron 49 cepas de diferente origen, subespecie, biotipo, grupo capsular, serotipo somático y perfil de resistencia antimicrobiana. Por ERIC-PCR se establecieron 31 patrones, los que presentaron entre 10 y 14 bandas en un rango comprendido entre 0,2 y 1,2 kb. Por ApaI-PFGE se detectaron 37 patrones de restricción, los cuales presentaron entre 7 y 15 bandas bien definidas de 34 a 450 kb. La tipibilidad de ERIC-PCR fue del 100% (T=1) y la de ApaI-PFGE del 94% (T=0,94). La reproducibilidad de ambas técnicas fue del 100% (R=1); sin embargo, el poder discriminatorio de ERIC-PCR fue 93% (D=0,93) y el de ApaI-PFGE 98% (D=0,98). Mediante ambas técnicas fue posible agrupar las cepas con relación epidemiológica y diferenciar claramente las cepas no relacionadas. Se demostró el valor de ERIC-PCR y ApaI-PFGE para complementar estudios epidemiológicos, principalmente si las cepas en estudio son analizadas por ambas técnicas.

Typeability, reproducibility, and discriminatory power of ERIC-PCR and ApaI-PFGE to establish the genetic relation of P. multocida strains were determined. Forty-nine strains of different source, biotype, capsular group, somatic serotype, and resistance to antimicrobials were studied. By ERIC-PCR, 31 patterns were defined with 10 to 14 bands in a rank of 0.2 and 1.2 kb. By ApaI-PFGE, 37 restriction patterns were established with 7 to 15 bands of 34 to 450 kb. Typeability was 100% (T=1) for ERIC-PCR, and 94% (T=0.94) for ApaI-PFGE. Reproducibility of both techniques was 100% (R=1). Discriminatory power was 93% (D=0.93) for ERIC-PCR, and 98% (D=0.98) for ApaI-PFGE. By using both techniques, epidemiologically related strains were grouped, and unrelated strains were clearly differentiated. The value of ERIC-PCR and ApaI-PFGE as complements to epidemiologic studies was demonstrated, especially when both techniques were used to analyze the strains.

Discriminatory powers of molecular typing techniques for methicillin-resistant Staphylococcus aureus in a university hospital, Thailand.

Discriminatory powers of various molecular techniques were evaluated for typing of methicillin-resistant Staphylococcus aureus (MRSA) isolated in Siriraj Hospital, Bangkok, Thailand. Thirty MRSA isolates were randomly selected in this study. They were characterized by pulsed-field gel electrophoresis, Clal-mecA and Clal-Tn554 polymorphisms, ribotyping, and PCR-based methods including SCCmec typing, spa and coa gene polymorphism, and repeat units in hypervariable region downstream of mecA. Individual molecular typing technique distinguished those MRSA isolates into 2 to 5 types. Eleven genetic backgrounds of MRSA isolates were elucidated by combination of typing methods with trimethoprim/sulfamethoxazole (TMP/SXT) susceptibility. Combination of all typing methods including TMP/SXT susceptibility yielded a discriminatory index of 0.94. Combination of PCR-based methods and TMP/SXT susceptibility, with the discriminatory index of 0.89, is a practical typing approach suitable for rapid epidemiological investigation of MRSA isolates in a hospital setting.