Factores relacionados con el control exitoso de un brote por Klebsiella pneumoniae productora de KPC-2 en una unidad de cuidado intensivo en Bogotá, Colombia / Factors related to successful control of an outbreak by Klebsiella pneumonia -producing KPC-2 in an intensive care unit in Bogotá, Colombia

La resistencia a carbapenémicos en Klebsiella pneumoniae ha aumentado de manera considerable, incrementando las tasas de morbimortalidad. El objetivo de este trabajo fue describir las características epidemiológicas, microbiológicas y las medidas de intervención que permitieron el control exitoso de un brote de Klebsiella pneumoniae productora de KPC-2. Métodos: El estudio se realizó en 2 periodos: el primero durante el brote, con instauración de un protocolo de medidas de intervención; y el segundo, de seguimiento posbrote. Se realizaron pruebas de identificación y susceptibilidad por sistema automatizado, tamización de carbapenemasas por test de Hodge modificado, PCR para detección de los genes bla KPC, bla KPC-2, NDM-1 y estudio de clonalidad por electroforesis de campos pulsados. Resultados: Durante el brote, se identificaron 18 aislamientos de Klebsiella pneumoniae productora de KPC en 11 pacientes. Tres casos fueron confirmados como infección intrahospitalaria. La técnica de PCR reveló la presencia del gen bla KPC en 21 de 22 aislamientos (pacientes y medio ambiente) y se identificó la presencia de un clon con una similitud superior al 75%. En el periodo posbrote los cultivos ambientales y de búsqueda de colonizados fueron negativos. Discusión: Se evidenció un control exitoso del brote producido por un clon. La implementación de un protocolo de intervención y la monitorización de su cumplimiento, la comunicación efectiva y el trabajo en equipo fueron indispensables para evitar su propagación y evitar un comportamiento endémico posbrote.

The considerable increase in carbapenem-resistant Klebsiella pneumoniae has caused an increase in mortality and morbidity rates. The aim of this study was to describe its epidemiological and microbiological characteristics and the intervention measures that controlled an outbreak caused by K. pneumoniae- producing KPC-2 B-lactamase. Methods: The study was divided into 2 periods: the first during the outbreak with the implementation of a bundle and the second a post-outbreak surveillance. We performed tests for identification and susceptibility by using an automated system, screening carbapenemases by the Modified-Hodge test, bla KPC, bla KPC-2 and NDM-1 identification by PCR and clonal relationship characterisation by PFGE. Results: During the outbreak, there were 18 isolates of Klebsiella pneumoniae -producing KPC- 2 in 11 patients. Three cases were confirmed as hospital-acquired infection. Of 22 isolates, 21 were positive to bla KPC by PCR (samples from patients and environment) and a clone was identified with a similarity of greater than 75%. During the post-outbreak surveillance, we did not find any new positive cultures from surfaces and there were no new colonisations. Discussion: This was a successful control of an outbreak produced by a clone. The implementation of a bundle and a subsequent surveillance to monitor its fulfilment, effective communication and teamwork were crucial to inhibit propagation of the infection and to prevent an endemic behaviour post-outbreak.

Microangiopatía trombótica en una paciente con infección por el virus de la inmunodeficiencia humana / Thrombotic microangiopathy in a patient with human inmunodeficiency virus infection

Notificamos un caso de microangiopatía trombótica, caracterizado por un proceso de agregación plaquetaria amenazante para la vida, que presentó afectación multisistémica y rápida evolución en una paciente con infección por el VIH. En este caso exponemos ampliamente los síntomas, la evolución y, finalmente, la necropsia clínica. Esta enfermedad es ahora infrecuente tras la llegada de los antirretrovirales de gran actividad, no obstante, se presenta con síntomas inespecíficos y evoluciona rápidamente a la afectación multisistémica y muerte. En consecuencia, un diagnóstico precoz con base en criterios clínicos y analíticos es fundamental para instaurar el tratamiento adecuado y mejorar la supervivencia.

We report on a case of thrombotic microangiopathy, defined as an extensive and dangerous intravascular platelet aggregation disorder, which progressed to multisystem involvement in a patient with HIV infection. For this clinical case, we detail the symptoms, evolution and, ultimately, the clinical autopsy. This disease is now uncommon due to the arrival of highactivity antiretroviral drugs; however, it can appear with nonspecific symptoms and rapidly progress to multisystem involvement and death. An accurate diagnosis on the basis of clinical and analytical criteria is essential to starting treatment and improving survival.

Protocolo de vigilância e resposta à ocorrência de microcefalia relacionada à infecção pelo vírus zika / Protocol for surveillance and response to the occurrence of microcephaly related to zika virus infection / Protocolo de vigilancia y respuesta a la ocurrencia de casos de microcefalia relacionada con la infección por el virus zika

Este protocolo tem como objetivo prover a profissionais de saúde e áreas técnicas de vigilância em saúde informações gerais,orientações técnicas e diretrizes relacionadas às ações de vigilância das microcefalias em todo território nacional. Deve ser ressaltado que as informações e recomendações aqui presentes e agora divulgadas foram fundamentadas e estabelecidas a partir das discussões conduzidas entre áreas técnicas do Ministério da Saúde do Brasil e especialistas de diversas áreas da medicina, epidemiologia, estatística, geografia e laboratório,além de representantes das Secretarias de Saúde de Estados e Municípios afetados. O Sistema Único de Saúde (SUS) concluiu a primeira etapa para elucidação desse evento, com investigações realizadas desde outubro,quando o Ministério da Saúde recebeu as primeiras notificações da Secretaria de Saúde do Estado de Pernambuco,até 28 de novembro de 2015, quando o Ministério da Saúde reconheceu a relação entre a presença do vírus e a ocorrência de microcefalias e óbitos...

Contaminación bacteriana en estetoscopios de las unidades de cuidados intensivos pediátricos: Hospital Central de San Cristóbal 2012 / Bacterial contamination of stethoscopes in pediatric intensive care units: Hospital Central de San Cristóbal 2012

Las infecciones adquiridas durante los cuidados de la salud (IACS), es un problema importante en Salud Pública. El presente trabajo tiene como objetivo determinar el porcentaje de estetoscopios contaminados con bacterias potencialmente productoras de IACS en las áreas de cuidados intensivos de pediatría y adultos. Se realizó un estudio clínico prospectivo transversal comparativo en la Unidades de Cuidados Intensivos pediátrico, neonatal y adulto del Hospital Central de San Cristóbal. Se tomaron cultivos a 37 instrumentos de los cuales 17 eran estetoscopios (52,9%). Nueve correspondieron a Pediatría y 8 al área de adulto. El tipo de personal que los utiliza representó un riego mayor de contaminación. De los estetoscopios con cultivos positivos el 85,6% venían de pediatría y el 36,4% de adultos; con una Odds ratio de 14.0. Conclusión: Los estetoscopios son una fuente de contaminación bacteriana siendo el área pediátrica un factor de riesgo elevado para su contaminación

Infections acquired during the (IACS) health care, is an important public health problem. This study aims to determine the percentage of stethoscopes contaminated with potentially producing bacteria of IACS in the areas of Pediatric and adult intensive care. A comparative study was conducted clinical prospective cross in the intensive care units paediatric, neonatal and adult of the Central Hospital of San Cristóbal. Cultures were taken at 37 instruments of which 17 (52,9%) were stethoscopes (9 corresponded to Pediatrics and 8 to the adult area). The type of personnel using it represented one major contamination risk. The stethoscopes with positive cultures the 85.6% came from Pediatrics and adults 36.4; with an Odds ratio of 14.0. Conclusion: Stethoscopes are a source of bacterial contamination being the Pediatric area a high risk of contamination of stethoscopes

Torque teno sus virus (TTSuV) infection at different stages of pig production cycle / Infecção pelo Torque teno sus virus (TTSuV) em diferentes categorias do ciclo de produção de suínos

Torque teno sus virus (TTSuV) infection is present in pig herds worldwide. It has been demonstrated that TTSuV might increase the severity of other important viral diseases with economic and public health impacts. At present, there is no information on the age distribution of pigs infected with TTSuV in Brazilian herds. This study evaluated the frequency of TTSuV infection in pigs at different stages of production. Fecal samples (n=190) from pigs at 1 to 24 weeks of age and from breeders at 6 farrow-to-weaning (up to 8 weeks of age) and 9 grower-to-finish (9 weeks of age onwards) farms in the western region of Paraná state, Brazil, were evaluated by PCR. Fragments of the 5' UTRs of TTSuV1 and/or TTSuVk2 DNAs were identified in 126 (66.3%) of the fecal samples. Significant differences were found with the percentages of positive samples for TTSuV1, TTSuVk2, and mixed infections by both genera between and within the different pig production stages. Fecal samples from the grower-to-finish farms had TTSuV detection rates (90.1%; 64/71) that were significantly (p<0.05) higher than those from the farrow-to-weaning farms (52.1%; 62/119). TTSuV detection was significantly (p<0.05) more frequent in finisher pigs than in the animals from the other stages. The UTR nucleotide sequences in this study presented higher similarities to strains from Norway (96%, TTSuV1), and Argentina and China (97.1%, TTSuVk2). These results suggest that TTSuV infection has spread to pigs of all production stages and that the viral infection rate increases with the age of the animals. In the western region of Paraná state, Brazil, TTSuV1 and TTSuVk2-induced infections were more frequently observed in suckling piglets and finisher pigs, respectively. Phylogenetic analysis pointed out the possibility of different strains of TTSuV1 and TTSuVk2 circulating in pig herds of Brazil.

A infecção pelo Torque teno sus virus (TTSuV) está presente em rebanhos suinícolas em todo o mundo. Tem sido demonstrado que a infecção pelo TTSuV pode aumentar a gravidade de outras importantes doenças virais com impactos econômicos e na saúde pública. Atualmente não há informações sobre a distribuição da infecção pelo TTSuV, de acordo com a faixa etária, em rebanhos suinícolas brasileiros. Este estudo avaliou a frequência da infecção pelo TTSuV nas diferentes categorias de produção de suínos. Amostras fecais (n=190) de suínos com 1 a 24 semanas de idade e de reprodutores provenientes 6 unidades produtoras de leitão (até 8 semanas de idade) e 9 unidades de terminação (9 semanas de idade em diante) da região oeste do Paraná, Brasil, foram avaliadas pela técnica de PCR. Fragmentos da região 5' UTR do DNA do TTSuV1 e/ou TTSuVk2 foram identificados em 126 (66,3%) amostras fecais. Diferenças significativas foram encontradas em relação às porcentagens de amostras positivas para o TTSuV1, TTSuVk2 e infecção mista por ambos os gêneros inter e intra categorias. Amostras fecais provenientes de unidades de terminação apresentaram taxas de detecção de TTSuV (90.1%; 64/71) significativamente (p<0.05) mais altas do que aquelas provenientes de unidades produtoras de leitão (52.1%; 62/119). A detecção do TTSuV em animais de terminação foi significativamente (p<0.05) mais frequente do que nos suínos de outras categorias. As sequências de nucleotídeos da UTR deste estudo apresentaram maior similaridade com cepas da Noruega (96%, TTSuV1) e Argentina e China (97,1%, TTSuVk2). Estes resultados sugerem que a infecção pelo TTSuV encontra-se disseminada em suínos de todas as categorias de produção e que a taxa da infecção viral aumenta de acordo com a idade dos animais. Na região oeste do estado do Paraná, infecções induzidas pelo TTSuV1 e TTSuVk2 foram mais frequentemente observadas em leitões de maternidade e suínos de terminação, respectivamente. A análise filogenética indicou a possibilidade de diferentes cepas de TTSuV1 e TTSuVk2 circulando em rebanhos suinícolas brasileiros.

Abortos em equinos na região sul do Rio Grande do Sul: estudo de 72 casos / Equine abortion in southern Brazil: study of 72 cases

Foi realizado um estudo retrospectivo das causas de aborto ocorridas em equinos na área de influência do Laboratório Regional de Diagnóstico (LRD), da Faculdade de Veterinária da Universidade Federal de Pelotas (UFPel), no período entre janeiro de 2000 e junho de 2011. Foram revisados os protocolos de necropsia e de 1.154 equinos ou materiais de equinos recebidos 72 (6,2 por cento) eram casos de abortos. A infecção bacteriana foi a principal causa de aborto neste estudo com 36,1 por cento dos casos. As causas não infecciosas corresponderam a 8,3 por cento dos casos, os abortos virais a 4,2 por cento, os parasitários a 1,4 por cento e os inflamatórios a 2,8 por cento. Em 47,2 por cento dos casos não foi possível determinar a causa/etiologia do aborto. Lesões macroscópicas e histológicas características foram observadas em casos de aborto por Leptospira sp. e por herpesvirus equino-1 sendo que nos demais casos as lesões foram inespecíficas. Ficou demonstrado que o envio do feto inteiro junto com a placenta, sob refrigeração, aumenta consideravelmente a eficiência do diagnóstico e o elevado número de abortos de causa não determinada foi atribuído em parte ao envio de material não adequado.

A retrospective study of the causes of equine abortion occurred in southern Rio Grande do Sul, Brazil, diagnosed from January 2000 to June 2011 by the Regional Diagnostic Laboratory (LRD) of the Veterinary School, Federal University of Pelotas (UFPel), is reported. Necropsy protocols were reviewed, and from 1.154 horses or equine materials received 72 (6.2 percent) were abortions. The main cause of abortion in this study was bacterial infection on 36.1 percent of the cases. Non-infectious causes accounted for 8.3 percent of the cases, viral abortions for 4.2 percent, parasitic for 1.4 percent and inflammatory for 2.8 percent. In 47.2 percent, it was not possible to determine the cause/etiology of abortions. Characteristic macroscopic and histological lesions were observed in abortion by Leptospira sp. and equine herpesvirus-1. No lesions were observed in the other cases. It was demonstrated that the analyses of whole fetus with the placenta under refrigeration increases the efficiency of diagnosis. The high number of abortions of undetermined cause was attributed in part to inadequate delivery of fetus material for diagnoses.

[Acute disseminated encephalomyelitis]

Acute disseminated encephalomyelitis [ADEM] is an acute, inflammatory, monophasic, demyelinating and immune-mediated disorder of central nervous system; occurs mostly in children after systemic viral infections or vaccinations. Acute polysymptomatic neurologic signs such as encephalopathy, paralysis of limbs, cranial nerve involvement, ataxia and optic neuritis are common manifestations. Brain magnetic resonance imaging study is essential for diagnosis and enabling prompt diagnosis and treatment. Evidence of multifocal lesions of demyelination in subcortical white matter are seen. They are usually bilateral and asymmetrical. Treatment options have included steroids, immunoglobulins, and plasmapheresis. ADEM is treatable and prognosis is good

Toll-like Receptors are Key Participants in Innate Immune Responses

During an infection, one of the principal challenges for the host is to detect the pathogen and activate a rapid defensive response. The Toll-like family of receptors (TLRs), among other pattern recognition receptors (PRR), performs this detection process in vertebrate and invertebrate organisms. These type I transmembrane receptors identify microbial conserved structures or pathogen-associated molecular patterns (PAMPs). Recognition of microbial components by TLRs initiates signaling transduction pathways that induce gene expression. These gene products regulate innate immune responses and further develop an antigen-specific acquired immunity. TLR signaling pathways are regulated by intracellular adaptor molecules, such as MyD88, TIRAP/Mal, between others that provide specificity of individual TLR- mediated signaling pathways. TLR-mediated activation of innate immunity is involved not only in host defense against pathogens but also in immune disorders. The involvement of TLR-mediated pathways in auto-immune and inflammatory diseases is described in this review article.

Evaluation of the rate of knowledge of health care workers toward hepatitis B at Mashhad Dental School in Autumn 2003

Hepatitis B is a primary viral infection of liver which is of high importance, clinically as well as socioeconomically, due to its capacity in producing chronic state. One of its significant routes of transmission is blood and contaminated fluids, items and surfaces with blood. Since health care workers are always in touch with patient's blood and their blood contaminated secretions, they are considered as high risk groups. Thus, their knowledgibility toward hepatitis B and its routes of transmission is important. The purpose of this study was to determine the knowledge rate of health care workers [apart from dentists] toward hepatitis B at Mashhad Dental School. In this descriptive study, all of the health care workers apart from dentists at Mashhad dental school were given a questionnaire concerning hepatitis B complications, its routes of transmission and methods of prevention. Totally, 170 questionnaires were analysed using SPSS statistical software. The nurses had the highest rate of knowledge. 16.6% had an agreeable knowledge about routes of transmission, 33/3% about complications and 50% about the methods of prevention. The servants had the lowest rate of knowledge, more than 90% of whom had little or very little knowledge about routes of transmission, complications and prevention methods [94%, 93% and 95/5% respectively]. None of them had an agreeable knowledge state about any of the studied variables of hepatitis B. This study revealed that the rate of knowledge increased with level of education. The nurses had the highest education and rate of knowledge and the servants had the lowest education and rate of knowledge. Although health care workers were more knowledgable about preventive methods than complications and transmission routes, a number of them had not been vaccinated against hepatitis B. This implies that the health care workers commitment toward hepatitis B is not at an agreeable state and necessitates continuous educational strategies as well as supervision over their practice

High prevalence of transfusion-transmitted virus infection in patients with chronic liver diseases in an endemic area of hepatitis B and C virus

To determine the prevalence and clinical impact of transfusion-transmitted virus [TTV] DNA in patients with chronic liver diseases in the Southeast Anatolia region of Turkey where hepatitis B and C viral infections are endemic. Subjects and Patients diagnosed with chronic liver disease by clinical, biochemical and histologic means were enrolled in the study. Serum samples of 60 patients [19 males, 41 females] with chronic liver diseases, and of 45 healthy volunteer blood donors as a control group were collected. The chronic liver disease group consisted of 11 patients with hepatitis B, 44 with hepatitis C and 5 with chronic liver disease of unknown etiology. Presence of TTV DNA was investigated by the polymerase chain reaction. Using a scoring system histological grading of inflammation and staging of fibrosis were performed only in the chronic hepatitis C group. TTV DNA was detected in 47 [78%] patients with chronic liver disease and 5 [11%] volunteers in the control group. The difference was statistically significant [p < 0.001]. Ten of the 11 [91%] patients with hepatitis B, 32 of 44 [73%] of those with hepatitis C-related chronic liver disease, and 5 of 5 [100%] of the patients with cryptogenic liver disease were positive for TTV DNA. TTV is highly prevalent in patients with chronic liver diseases in Southeast Anatolia, Turkey but no pathogenic effect attributable to TTV infection was detected

Infección en el paciente inmunocomprometido / Infection in the immunocompromised patient

Los pacientes con cáncer tienen mayor riesgo de presentar infección que la población general, sobre todo cuando la cuenta absoluta de neutrófilos es inferior a 500 células /µL. Comunmente la etiología de la infección es por microorganismos de la flora normal, aislándose con mayor frecuencia E. coli, Klebsiella pneumoniae, S. aureus, S. epidermidis y S. viridans; así como gérmenes oportunistas encontrándose implicados principalmente: Pneumocystis carinii, Candida sp, Aspergillus sp. y Cryptococcus neoformans. Puesto que en ocasiones la fiebre es la única manifestación presente en estos sujetos, es importante detectarlos oportunamente, por lo que debemos realizar un examen físico cuidadoso, poniendo especial atención a nivel hematológico, pulmonar, tejidos blandos y superficies mucosas, ya que en el huésped neutropénico son los principales sitios de infección. Es fundamental el inicio temprano del tratamiento, existiendo actualmente múltiples esquemas para niños inmunocomprometidos, siendo los más utilizados la combinación ceftazidima-amikacina y la monoterapia con imipenem, a las que se agrega anfotericina B cuando la fiebre persiste por más de una semana

Viral infection in immunocompromised patients

A total of 74 sera were collected from immunocompromised patient attending Baghdad Teaching Hospital, Saddam Medical City, out patient clinic. The sera were tested for the presence of IgM and IgG to cytomegalovirus [CMV] and IgG to herpes simplex virus types 1 and 2 [HSV] using an enzyme linked immunosorbent assay [ELISA]. Result indicated that there was no significant difference in the percentage of seropositive antibody to these viruses in different patient groups. A highly significant difference to CMV [igm] antibody between patients and control groups was detected. There was no significant association between these viruses

clinico-epidemiological study of acute viral hepatitis in hospitalised adults in Benghazi, Libya [SPLAJ]

164 adults were admitted with acute viral hepatitis at the Jamahiriya Hospital, Benghazi from January 1986 to June 1987. HbsAg positevely was detected in 26.22% of the cases. 100% presence of antibodies against hepatitis-A in Libyan children under 7 years was recently established by Gebreel et al. [1983]. Therefore, the remaining 73.78% of the cases were presumed to be suffering from viral hepatitis non-A non-B. Commonest mode of transmission in a majority [90.24%] was nonparenteral or horizontal. Yellow discolouration of sclera was the commonest clinical sign. Tender hepatomegaly was found in 73.17% of the cases while splenomegaly only in 17.07%. Recovery was slow in those patients who at the time of admission had high serum bilirubin [over 20 mg%] blood urea less than 3 mg%, hypokalemia, high prothrombin time and leukocytosis, suggesting a poor prognosis