Correlación de colonización de Staphylococcus aureus en mucosa nasal e infecciones faciales de origen no odontogénico / Corelation between Staphylococcus aureus colonization in nasal mucosa and facial infections from non-odontogenic origin

En la actualidad, las tasas que se conocen de colonización de piel y mucosa por el staphylococcus aureus están incrementando día a día. Se ha encontrado una fuerte correlación de la invasión de estos en otras partes del cuerpo (zona axilar, mucosa nasal, entre otras) con la aparición de celulitis y/o abscesos faciales. Se demostró que la flora nasal es muy diversa, encontrándose patógenos como streptococcus viridans, staphylococcus aureus, staphylococcus coagulasa negativa y Corynebacterium sp, pero sin posibilidad de definir con exactitud cuál es la constancia de los mismos pudiendo presentarse variaciones de esta. A su vez, esto se ve agravado por la falta de adherencia al tratamiento por parte de los pacientes y de otras condiciones como, el mismo contagio o predisposición del medio (sudoración, altas temperaturas, mala higiene, etc.), que facilitan la capacidad de dicho microorganismo de tornarse más resistente, incrementar su población y aumentar así la patogenicidad a través de la codificación de una exotoxina llamada Pantón Valentín (SAMR). Se demostrará entonces, la metodología que se llevó a cabo a través de un análisis descriptivo transversal de los casos tratados en el Hospital Mariano y Luciano de La Vega, con el fin de correlacionar causalidad y efecto (AU)

At present, the rates known for skin and mucosa colonization by Sthapylococcus aureus are increasing day by day. A strong correlation has been found of the invasion of these in other parts of the body (axillary area, nasal mucosa, among others, being the latter the most representative), with the appearance of cellulite and/or facial abscesses. It was shown that the nasal flora is very diverse, finding pathogens such as Streptococcus Viridans, Staphylococcus aureus (S aureus), coagulase negative Staphylococcus and Corynebacterium sp, but that has not been defined exactly the constancy of the same, can be presented variations of this. In turn, this is aggravated by the lack of adherence to treatment by patients and other conditions such as the same contagion or predisposition of the medium (sweating, high temperatures, poor hygiene, etc.), which facilitate the capacity of said Microorganism to become more resistant, increase its population and thus increase the pathogenicity through the codification of a exotoxin called Valentín Panty. To prove the methodology that was carried out through a transversal descriptive analysis of the cases treated at the Mariano Hospital and Luciano de La Vega in order to fulfil the objective of correlating causality and Effect (AU)

Emergence of methicillin-resistant Staphylococcus aureus from clonal complex 398 with no livestock association in Brazil

CC398 is a livestock-associated Staphylococcus aureus. However, it has also been isolated from humans with no previous contact with livestock. A surveillance of methicillin-resistant S. aureus colonisation among children attending public day care centres and hospitals in Niterói and Rio de Janeiro, Brazil, between 2011 and 2013, resulted in the isolation of six cases of CC398 from individuals with no previous exposure to livestock. These isolates showed a high frequency of the erm(C) gene (4/6, 66.7%) with induced resistance to clindamycin, and a relatively high frequency of SEs and lukS/lukF genes. These results suggest the emergence of a non-LA-CC398 in Brazil.

Widespread nasal carriage of Mycobacterium lepraeamong a healthy population in a hyperendemic region of northeastern Brazil

A case-control study was conducted to determine the presence ofMycobacterium lepraeDNA in nasal secretions of leprosy cases and nonleprosy individuals in Fortaleza, Brazil. It included 185 cases identified by physicians at the Dona Libânia National Reference Centre for Sanitary Dermatology (CDERM). A control group (Co) (n = 136) was identified among individuals from CDERM not diagnosed as leprosy cases. To augment the spatial analysis of M. leprae specific repetitive element (RLEP) positive prevalence, an external group (EG) (n = 121), a convenience sample of healthy students, were included. Polymerase chain reaction for the RLEP sequence was conducted for all participants. Prevalence of RLEP positivity for cases and Co were 69.2% and 66.9%, respectively, significantly higher than for EG (28.1%), and reported elsewhere. Male sex, belonging to a lower socioeconomic status (D/E), history of a previous contact with a case and being older, were associated with being a leprosy case. Our geographical analysis demonstrated that the bacillus is widespread among the healthy population, with clusters of RLEP positive multibacillary cases concentrated in distinct areas of the city. Our results suggest that in endemic areas, as in Fortaleza, surveillance for both nonhousehold leprosy contacts and members of the general population living in cluster areas should be implemented.

Mannitol-negative methicillin-resistant Staphylococcus aureus from nasal swab specimens in Brazil

The isolation of mannitol-negative methicillin-resistant Staphylococcus aureus from nasal swabs is reported. Among the 59 isolates, 9 (15%) isolates were mannitol-negative; all of these isolates were categorized as staphylococcal cassette chromosome mec (SCCmec) type IVa. This report emphasizes that mannitol fermentation on mannitol salt agar should not be used as the sole criterion when screening nasal swab specimens for S. aureus.

Osteitis and mucosal inflammation in a rabbit model of sinusitis / Osteíte e inflamação mucosa em um modelo experimental de rinossinusite

INTRODUCTION: Several experimental studies have shown osteitis after the onset of sinusitis, supporting the idea that bone involvement could participate in the dissemination and perpetuation of this inflammatory disease. However, procedures commonly performed for the induction of sinusitis, such as antrostomies, can trigger sinusitis by themselves. OBJECTIVE: To evaluate osteitis in an animal model of sinusitis that does not violate the sinus directly and verify whether this is limited to the induction side, or if it affects the contralateral side. METHODS: Experimental study in which sinusitis was produced by inserting an obstructing sponge into the nasal cavity of 20 rabbits. After defined intervals, the animals were euthanized and maxillary sinus samples were removed for semi-quantitative histological analysis of mucosa and bone. RESULTS: Signs of bone and mucosal inflammation were observed, affecting both the induction and contralateral sides. Statistical analysis showed correlation between the intensity of osteitis on both sides, but not between mucosal and bone inflammation on the same side, supporting the theory that inflammation can spread through bone structures, regardless of mucosal inflammation. CONCLUSION: This study demonstrated that in an animal model of sinusitis that does not disturb the sinus directly osteitis occurs in the affected sinus and that it also affects the contralateral side. .

INTRODUÇÃO: Diversos estudos experimentais evidenciam osteíte após estabelecimento de sinusite, corroborando para a ideia de que o envolvimento ósseo poderia participar na disseminação e perpetuação do processo inflamatório. Porém procedimentos realizados para indução da doença nestes modelos, como antrostomias, podem, por si só, desencadear osteíte. OBJETIVO: Avaliar osteíte em um modelo de rinossinusite em que não ocorre manipulação sinusal e verificar se esta é limitada ao lado de indução, ou se acomete o lado contralateral. MÉTODO: Estudo experimental em que induziu-se rinossinusite em 20 coelhos, por meio de obliteração temporária com esponja de uma das cavidades nasais. Amostras de tecido sinusal foram submetidas à análise histológica semiquantitativa, após sacrifício dos animais em intervalos regulares. RESULTADOS: Foram observados sinais de inflamação óssea e mucosa mais intensa no lado de indução, mas também contralateral. Testes estatísticos evidenciaram correlação entre a osteíte de ambos os lados, porém não entre inflamação óssea e mucosa de um mesmo lado, apoiando a teoria de que a inflamação poderia se disseminar através do tecido ósseo, independente da inflamação mucosa. CONCLUSÃO: O presente estudo evidenciou a existência de osteíte, tanto no lado de indução quanto no contralateral, em modelo experimental em que não ocorre manipulação sinusal. .

Silibinin improves palmitate-induced insulin resistance in C2C12 myotubes by attenuating IRS-1/PI3K/Akt pathway inhibition

The present study investigated the effect of silibinin, the principal potential anti-inflammatory flavonoid contained in silymarin, a mixture of flavonolignans extracted from Silybum marianum seeds, on palmitate-induced insulin resistance in C2C12 myotubes and its potential molecular mechanisms. Silibinin prevented the decrease of insulin-stimulated 2-NBDG (2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)amino]-2-deoxy-D-glucose) uptake and the downregulation of glutamate transporter type 4 (GLUT4) translocation in C2C12 myotubes induced by palmitate. Meanwhile, silibinin suppressed the palmitate-induced decrease of insulin-stimulated Akt Ser473 phosphorylation, which was reversed by wortmannin, a specific inhibitor of phosphatidylinositol-3-kinase (PI3K). We also found that palmitate downregulated insulin-stimulated Tyr632 phosphorylation of insulin receptor substrate 1 (IRS-1) and up-regulated IRS-1 Ser307 phosphorylation. These effects were rebalanced by silibinin. Considering several serine/threonine kinases reported to phosphorylate IRS-1 at Ser307, treatment with silibinin downregulated the phosphorylation of both c-Jun N-terminal kinase (JNK) and nuclear factor-κB kinase β (IKKβ), which was increased by palmitate in C2C12 myotubes mediating inflammatory status, whereas the phosphorylation of PKC-θ was not significantly modulated by silibinin. Collectively, the results indicated that silibinin prevented inhibition of the IRS-1/PI3K/Akt pathway, thus ameliorating palmitate-induced insulin resistance in C2C12 myotubes.

Higher frequency of methicillin resistant bacteria in children with familial mediterranean fever

To investigate resistant microorganisms in nasal mucosa of children with Familial Mediterranean Fever. The study was conducted from March to May 2013 at Mustafa Kemal University, Turkey, and comprised children with Familial Mediterranean Fever and healthy controls. All subjects had no history of antibiotic or local and/or systemic steroid use within the preceding 2 weeks. Nasal swab samples were obtained from all the subjects. Strain identification was done by using standard methods. SPSS 13 was used for statistical analysis. Of the 151 subjects in the study, 73[48.34%] were cases and 78[51.65%] were controls. Among the cases, there were 26[35.6%] girls, while among the controls, there were 40[51.3%] girls [p=0.052]. The mean age of the cases was 7.78 +/- 3.34 years [range: 3-15 years], while it was 8.15 +/- 2.71 years [range: 3-16] among the controls [p=0.208]. Methicillin-resistant coagulase-negative staphylococcus and methicillin-resistant staphylococcus aureus were isolated in both the groups. The growth rate of resistant bacteria was 63% [n=46] in the cases, in the controls [p=0.003; odds ratio [OR]: 2.7; 95% confidence interval [CI]: 1.4-5.2]. Among the controls, history of hospitalisation increased the risk for the presence of resistant bacteria by 7.7 fold [OR: 7.7; 95% CI: 1.4 - 40.4]. Higher rates of resistant bacteria showed that they were at risk of comorbidities related to antibiotic resistance

Sanitary quality, occurrence and identification of Staphylococcus sp: in food services

Sanitary conditions are essential for the production of meals and control of the presence of pathogensis important to guarantee the health of customers. The aim of this study was to evaluate the sanitary quality of food services by checking the presence of thermotolerant coliforms, Staphylococcus sp. and evaluate the toxigenic potential from the latter. The analysis was performed on water, surfaces, equipment, ready-to-eat foods, hands and nasal cavity of handlers in seven food services. The water used in food services proved to be suitable for the production of meals. Most food, equipment and surfaces showed poor sanitary conditions due to the presence of thermotolerant coliforms (60.6%). Twenty-six Staphylococcus species were identified from the 121 Staphylococcus isolates tested. Staphylococci coagulase-negative species were predominant in the foods, equipment and surfaces. In food handlers and foods, the predominant species was Staphylococcus epidermidis. Twelve different genotypes were found after PCR for the classical enterotoxin genes. The seb gene (19.8%) was the most prevalent among all Staphylococcus sp. Both coagulase-positive and coagulase-negative Staphylococci showed some of the genes of the enterotoxins tested. We conclude that there are hygienic and sanitary deficiencies in the food services analyzed. Although coagulase-positive Staphylococci have not been present in foods there is a wide dispersion of enterotoxigenic coagulase-negative Staphylococci in the environment and in the foods analyzed, indicating a risk to consumer health.

Genetic analysis of mecA gene and detection of homologue pbpD in Stahylococcus sciuri group

Oxacillin/methicillin-resistance is related to the mecA and its regulatory genes mecR1 and mecI. Its origin is still unknown, although evidences support that it is related to CNS, once mecA and a homologue gene, pbpD, were both detected in Staphylococcus sciuri species group. The present work evaluated 210 samples of skin and ear swabs from rodents and 60 nasal swabs from equines of Army Biologic Institute, Rio de Janeiro. Pheno- and genotypic characterization provided 59.52% (25/42) and 78.57% (11/14) S. lentus and S. sciuri, respectively. It was observed that although all S. sciuri isolates tested positive for pbpD, there was no correlation with oxacillin-resistance. On the other hand, isolates tested positive for mecA gene also presented phenotypic oxacillin-resistance in at least one assay. The alignment of the mecA gene showed that the nucleotide sequences were sorted into 2 different groups, one comprising the bovine strains and the other containing human and equine strains.

Nasal carriage and antimicrobial susceptibility of Staphylococcus aureus among medical students at the HRH Princess Maha Chakri Sirindhorn Medical Center, Thailand: a cross sectional study

To determine the epidemiology of the nasal carriage of Staphylococcus aureus and its susceptibility pattern among preclinical medical students at the HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University. Nasal swabs were taken from 128 preclinical medical students prior to working at the hospital. Susceptibility testing of S. aureus was performed using Kirby Bauer's disc diffusion method. Of the 128 participants, 38/128 [29.7%; 95% confidence interval [CI] = 21.8%, 37.6%] were carriers of S. aureus. No methicillin-resistant S. aureus was detected by the cefoxitin disk diffusion test. Resistance of S. aureus to erythromycin, clindamycin, tetracycline, chloramphenicol and fusidic acid was observed at the following rates: 63.2% [95% CI; 47.8%, 78.5%], 63.2% [95% CI; 47.8%, 78.5%], 34.2% [95% CI; 19.1%, 49.3%], 2.6% [95% CI; -2.5%, 7.7%] and 2.6% [95% CI; -2.5%, 7.7%], respectively. There was no statistically significant correlation between nasal carriage of S. aureus and possible risk factors. The prevalence of asymptomatic nasal carriage of S. aureus was higher than reported by previous literature in Thailand, and S. aureus isolates exhibited relatively high resistance to erythromycin and clindamycin

Unveiling healthy carriers and subclinical infections among household contacts of leprosy patients who play potential roles in the disease chain of transmission

Leprosy transmission still occurs despite the availability of highly effective treatment. The next step towards successfully eliminating leprosy is interrupting the chain of transmission of the aetiological agent, Mycobacterium leprae. In this investigation, we provide evidence that household contacts (HHCs) of leprosy patients might not only have subclinical infections, but may also be actively involved in bacilli transmission. We studied 444 patients and 1,352 contacts using anti-phenolic glycolipid-I (PGL-I) serology and quantitative polymerase chain reaction (qPCR) to test for M. leprae DNA in nasal swabs. We classified the patients according to the clinical form of their disease and the contacts according to the characteristics of their index case. Overall, 63.3% and 34.2% of patients tested positive by ELISA and PCR, respectively. For HHCs, 13.3% had a positive ELISA test result and 4.7% had a positive PCR test result. The presence of circulating anti-PGL-I among healthy contacts (with or without a positive PCR test result from nasal swabs) was considered to indicate a subclinical infection. DNA detected in nasal swabs also indicates the presence of bacilli at the site of transmission and bacterial entrance. We suggest that the concomitant use of both assays may allow us to detect subclinical infection in HHCs and to identify possible bacilli carriers who may transmit and disseminate disease in endemic regions. Chemoprophylaxis of these contacts is suggested.

Colonização fúngica em recém-natos de muito baixo peso: um estudo de coorte / Fungal colonization in newborn babies of very low birth weight: a cohort study

OBJETIVOS: Conhecer o perfil de colonização fúngica e os fatores de risco associados em recém-nascidos prematuros. MÉTODOS: Coorte prospectiva, de 01/04/10 a 31/04/11, com 44 pacientes admitidos na unidade de terapia intensiva neonatal, nascidos na maternidade do hospital, com peso menor que 1.500 g. Na admissão, coletaram-se dados sobre pré-natal e parto. Informações clínico-laboratoriais, swabs nasal, retal e hemocultura periférica foram coletados nos dias 1, 7, 10 e 14 de permanência na unidade de terapia intensiva neonatal e, então, a cada 7 dias até alta ou óbito. Para análise estatística, utilizou-se teste qui-quadrado, exato de Fisher, curva de Kaplan-Meier e modelo de regressão logística. RESULTADOS: A incidência de colonização foi de 13,5/1.000 pacientes/dia. A de candidemia foi de 0,9/1.000 paciente/dia. A média de internamento foi de 30,5 dias (±20,27), sendo o início da colonização, em média, aos 11,13 dias (±8,82). O parto vaginal foi um fator de risco independente para desenvolvimento de colonização fúngica ao longo da internação [p = 0,042; odds ratio = 4,38; intervalo de confiança de 95% (IC95%) = 1,13-16,99]. Da mesma forma, a leucocitose (> 30.000/mm3) na admissão foi um sinalizador para a presença concomitante de colonização (p = 0,048). A presença de displasia broncopulmonar tende a ser um fator de maior chance para desenvolvimento de colonização (p = 0,067). O sítio de colonização mais acometido foi a mucosa retal: 89,09 versus 10,9% da nasal. CONCLUSÃO: Parto vaginal e leucocitose acima de 30.000/mm3 na admissão foram fatores de risco para colonização fúngica no decorrer da hospitalização.

OBJECTIVES: To learn about the profile of fungal colonization and related risk factors in premature newborns. METHODS: Prospective cohort, from 04/01/2010 to 04/31/2011, with 44 patients admitted to the neonatal intensive care unit, born at the hospital maternity, weighing less than 1,500 g. On admission, data were collected on pre-natal care and childbirth. Clinical and laboratory information, nasal and rectal swabs, and peripheral blood cultures were collected on days 1,7,10 and 14 of stay in neonatal intensive care unit and then, every 7 days until discharge or death. For statistical analysis, we used chi-square test, Fisher exact test, Kaplan-Meier and logistic regression model. RESULTS: The incidence of colonization was 13.5/1,000 patients/day. The incidence of candidemia was 0.9/1,000 patients/day. The average hospitalization time was 30.5 days (± 20.27), and the onset of colonization occurred, in average, at 11.13 days (±8.82). Vaginal delivery was found to be an independent risk factor for the development of fungal colonization during hospitalization (p = 0.042, odds ratio = 4.38, 95% confidence interval [95%CI] = 1,13-16,99). Likewise, leukocytosis (> 30,000/mm3) on admission was an indicator for the simultaneous presence of fungal colonization (p = 0.048). The presence of bronchopulmonary dysplasia tends to be a factor of higher probability for the development of colonization (p = 0.067). The most affected colonization site was the rectal mucosa: 89.09 versus 10.9% of the nasal mucosa. CONCLUSION: Vaginal delivery and leukocytosis over 30,000/mm3 on admission were found to be risk factors for fungal colonization during hospitalization.

Intravenous device associated blood stream staphylococcal infection in paediatric patients.

Background & objectives: Intravenous device (IVD) associated nosocomial blood stream infections due to staphylococci are major cause of morbidity and mortality. The present study was carried out to assess the frequency of staphylococcal IVD associated infections in a paediatric ward of a tertiary case hospital. Prevalence of resistance to commonly used antimicrobials in hospital acquired staphylococcal isolates was also tested. Methods: Children admitted in paediatric wards with IVD for more than 48 h were enrolled. Blood, IVD tip at the time of removal, skin swab at the site of insertion of IVD and nasal swab were collected and cultured by standard protocol. All staphylococcal isolates from any source were analyzed for antimicrobial susceptibility by disk diffusion method. Genotyping matching of those staphylococcal isolates was done which were isolated from different sites of the same patient, but were phonotypically similar. Genotype of blood isolate was compared with genotype of isolate from nose/IVD/skin. Results: Staphylococcus aureus was the most frequent blood isolate (8.7%) followed by Candida (2.9%), coagulase negative staphylococci (CoNS 2.6%), Pseudomonas spp. (0.4%), Klebsiella spp. (0.3%) and Escherichia coli (0.1%). Isolation of microorganisms from blood was significantly higher in patients whose skin, IVD and nose were colonized by same microorganism (P<0.001). None of the staphylococcal isolate was found to be resistant to glycopeptides (vancomycin and teicoplanin). High penicillin and oxacillin resistance was present in both S. aureus (penicillin resistance; 76.8%, oxacillin resistance; 66.7%) and CoNS (penicillin resistance; 73.3%, oxacillin resistance; 60.0%). Among CoNS biotypes, S. haemolyticus was commonest blood isolate while S. epidermidis was commonest isolate from Skin/nose. Only 33.3 per cent of S. aureus blood stream infections and most of S. epidermidis and S. haemolyticus blood infections were IVD associated. Interpretation & conclusions: Staphylococci were the major causative agent of nosocomial blood stream infections. All episodes of septicaemia due to S. epidermidis and S. haemolyticus were IVD associated while only 1/3 of S. aureus septicaemia was IVD associated.

Estudo da mucosa nasal de contatos de hanseníase, com positividade para o antígeno glicolipídio fenólico 1 / Nasal mucosa study of leprosy contacts with positive serology for the phenolic glycolipid 1 antigen

A hanseníase é uma doença infecciosa de evolução crônica causada pelo Mycobacterium leprae que acomete com maior frequência a mucosa nasal. Esse acometimento independe da forma clínica da doença e pode ocorrer mesmo antes do aparecimento de lesões na pele ou em outras partes do corpo. Faz-se necessário a vigilância epidemiológica dos contatos de casos novos de hanseníase para o diagnóstico precoce da doença. OBJETIVOS: Identificar lesões específicas e precoces de hanseníase por meio de exame endoscópico, baciloscópico, histopatológico e da reação em cadeia da polimerase em Tempo Real da mucosa das cavidades nasais dos contatos domiciliares e peridomiciliares com sorologia positiva para o antígeno glicolipídio fenólico. MATERIAL E MÉTODOS: Estudo prospectivo transversal em 31 contatos de pacientes de hanseníase com sorologia positiva (PGL-1), 05 controles negativos e 01 positivo no período de 2003 a 2006. RESULTADOS: Entre os contatos soropositivos a PCR-RT foi positiva para a presença de DNA de M. leprae em 06 (19,35 por cento) destes e o maior número de cópias do genoma do bacilo foi encontrado no contato que adoeceu. CONCLUSÃO: Isoladamente os exames da mucosa nasal não permitiram o diagnóstico precoce da hanseníase, mas com a combinação de vários métodos, o exame dos contatos pôde ajudar na identificação da infecção subclínica e monitoramento daqueles que poderiam ter papel importante na transmissão da doença.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The disease more frequently affects the nasal mucosa and can occur independently of its clinical form or even before lesions on the skin or on other parts of the body. It is necessary to employ epidemiological surveillance of household contacts with new leprosy cases for early disease diagnosis. AIM: identify specific and early leprosy lesions through endoscopic, baciloscopy, histopathology exams, and real time polymerase chain reaction of the nasal cavity mucosa on household and peridomiciliary contacts with positive serology for the phenolic glycolipid 1 antigen. METHODOLOGY: Between 2003 at 2006 there was a prospective cross-sectional clinical study with 31 contacts with patients with leprosy with positive serology against PGL-1, 05 negative controls and 01 positive control. RESULTS: Between seropositive contacts, real-time PCR was positive for M. leprae DNA in 06 (19.35 percent) of them and the higher number of genome copies were found in contacts who became sick. CONCLUSION: Nasal mucosa tests alone did not enable the early diagnosis of Leprosy. However, through the combination of various methods, tests on the contacts can help identify subclinical infection and monitor the contacts that could be responsible for spreading the disease.

Colonización nasal bacteriana en población sana de la ciudad de Santiago de Chile: ¿existe portación de Staphylococcus aureus meticilino resistente comunitario? / Nasal bacterial colonization in healthy people of the city of Santiago of Chile: is there nasal carriage of community methicillin resistant Staphylococcus aureus?

Introducción: No existe consenso en cuanto a qué se considera flora nasal normal. Recientemente, ha emergido Staphylococcus aureus meticilino resistente comunitario (MRSA-com) en personas sin factores de riesgo conocido, produciendo una alarma sanitaria a nivel mundial. Objetivo: Determinar la colonización nasal bacteriana y evaluar la presencia de MRSA-com. Material y método: Estudio prospectivo descriptivo, entre octubre de 2007 y octubre de 2008, en población sana. Se realizó toma de muestra de secreción nasal, incubación e identificación bacteriana por métodos convencionales. Resultados: Población estudiada con promedio de edad 37,6 +/-15,8 años, 55 por ciento de sexo femenino, y 37,1 por ciento tabaquismo activo. Se obtuvo 73 por ciento de cultivos positivos. Se identificaron 18 especies bacterianas, siendo las más frecuentes Staphylococcus coagulasa negativo (53 por ciento) y Staphylococcus aureus (22,7 por ciento). Se detectó sólo un caso de MRSA, cuyo análisis genético fue negativo para demostrar su origen comunitario. Discusión: Existe una alta tasa de portación nasal de S coagulasa negativo y S aureus, similar a lo reportado por la literatura internacional. Pese a que la prevalencia encontrada para S aureus es la habitual, no se encontraron muestras positivas a MRSA-com. Lo anterior indica que aún no existe en Chile la diseminación de clones de MRSA-com.

Introduction: Doesn't exists agreement about normal nasal flora. Recently it has emerged community-associated methicillin-resistant Staphylococcus aureus in people without known rísk factors, producing a global health scare. Aim: Look for normal nasal flora and test the presence oí MRSA-com. Material ana method: Descriptive and prospective study, between October 2007 and October 2008, in healthy people. Was taken a sampling from nasal secretion, incubation and bacterial identification by conventional methods. Results: Studied population, average age 37.6 +/-15.8years, 55 percent témale and 37.1 percent active smoking. We obtained 73 percent of positive cultures. We identified 18 bacterial species, the most common was Staphylococcus coagulase-negative (53 percent) and Staphylococcus aureus (22.7 percent). Was detected only one case ofMRSA, and his genetic test was negative to prove community origin. Discusión: There is a high rate of nasal carriage of Staphylococcus coagulase-negative, like to that reponed by international literature. Although the prevalence found for S aureus is the usual, there were no MRSA-com positive samples. This indicates that in Chile there is still no spread of clones of MRSA-com.

Biofilme em rinossinusite crônica com polipose nasossinusal: estudo piloto / Biofilm in chronic sinusitis with nasal polyps: pilot study

Apatogenia da rinossinusite crônica não está completamente estabelecida e existem algumas explicações para essa doença, como a osteíte, os superantígenos, a hipersensibilidade mediada por fungos e, mais recentemente, o biofilme. Não existem publicações na língua portuguesa sobre biofilmes na rinossinusite crônica. Objetivo: Reproduzir um método para evidenciar a presença de biofilmes em pacientes com rinossinusite crônica com polipose nasossinusal. Material e método: Amostras de bula etmoidal de nove pacientes com rinossinusite crônica com polipose nasossinusal sem resposta ao tratamento clínico submetidos à cirurgia foram analisadas com microscopia eletrônica de varredura para evidenciar o biofilme. Desenho do estudo: Estudo de coorte contemporânea com corte transversal. Resultados: Observamos o biofilme em 55,56 por cento (5/9) dos pacientes, através da visualização da estrutura tridimensional, de estruturas esféricas envolvidas por uma matriz amorfa e dos canais de água. Conclusão: Reproduzimos um método de visualização de biofilme bacteriano através da microscopia eletrônica de varredura e evidenciamos a sua presença nos pacientes com rinossinusite crônica com polipose nasossinusal.

Chronic rhinosinusitis pathogenesis is not completely established and there are some explanations for this disease, such as osteitis, superantigens, fungal-mediated hypersensitivity and, more recently, biofilms. There are no reports in Portuguese about biofilms in chronic rhinosinusitis. AIM: To reproduce a method for visualization of biofilms in patients with chronic rhinosinusitis and nasal polyps. Patients and methods: Samples of ethmoid bulla of nine patients with chronic rhinosinusitis with nasal polyps without response to clinical treatment who underwent surgery were analyzed with scanning electron microscopy to evidence bacterial biofilms. Study design: A contemporary cross-sectional cohort study Results: In 55.56 percent (5/9) of the patients we observed biofilms by seeing three-dimensional structures, spherical structures surrounded by an amorphous matrix and water-channels. Conclusion: We reproduced a method for visualization of bacterial biofilms by scanning electron microscopy and evidenced its presence in chronic rhinosinusitis with nasal polyps.

Implications of bacterial biofilms in chronic rhinosinusitis

The recognition of sessile form of bacteria with particular features, known as biofilm, has given new insights to the understanding of pathogenesis of several chronic diseases, including Chronic Rhinosinusitis (CRS). In this article we review the main characteristics of biofilms, describe the current methods used to demonstrate biofilms in chronic rhinosinusitis and discuss the future directions of research in the field.

[Risk Factors of nasal carriage of methicillin-resistant staphylococcus aureus and its antibiotic susceptibility pattern in Namazi hospital healthcare workers in Shiraz, Iran]

Methicillin-resistant Staphylococcus aureus [MRSA] is a major nosocomial pathogen worldwide. The aim of this study was to determine the risk factors of nasal carriage of MRSA and its antibiotic susceptibility pattern among healthcare workers at Namazi Hospital [Shiraz-Iran]. In a cross-sectional study from July to November 2006, nasal swabs were taken from 600 stratified randomly selected health care workers. The isolates were identified as S. aureus based on morphology, gram stains, catalase test, coauglase test and DNase Agar. To differentiate Methicillinsusceptible S. aureus [MSSA] and Methicillin Resistant S. aureus [MRSA], agar screen plate was used. All methicillin-resistant isolates were examined for mecA genes existence by PCR performance. The sensitivity patterns of S.aureus isolates were determined by disc diffusion and E-test method. Nasal screening identified 186 [31%] S. aureus carriers of whom, 154 ones [82.8%] were MSSA and 32 ones [17.2%] were MRSA. There was no significant association between related risk factors and gender, age, years of healthcare service and level of education. In the univariate analysis, a statistically significant difference was found only based on occupation [P=0.032] between carriers of MSSA and MRSA. In multivariate analysis [logistic regression], having nursing occupation [p=0.012, OR=3.6, 95%CI=1.3-9.7] was independently associated with MRSA carriage. All of the MRSA strains were sensitive to mupirocin. This study revealed that having nursing occupation is independently associated with MRSA carriage since all S.aureus isolates were susceptible to mupirocin, topical mupirocin could be used successfully to eradicate nasal staphylococcal colonization and carriers

Deteccção do DNA de Mycobacterium leprae em secreção nasal / Detección del ADN de Mycobacterium leprae en secreción nasal / Detection of Mycobacterium leprae DNA in nasal swab

Estudos têm demonstrado alta sensibilidade da técnica da reação em cadeia de polimerase (PCR) na identificação do DNA do Mycobacterium leprae. Este estudo objetivou avaliar a sensibilidade da PCR na detecção do DNA do M. leprae em "swab" nasal de pacientes hansenianos e comparar os resultados com a baciloscopia e formas multibacilares (MBs) e paucibacilares (PBs). Foram coletadas amostras de secreção nasal de 24 pacientes hansenianos, conservadas em solução de lise um e dois. Os resultados da PCR foram altamente significativos (p<0.0000) e revelaram maior sensibilidade do que a baciloscopia, nas diversas formas clínicas. Contudo, são necessários ainda outros estudos, testando novos marcadores e conservantes, com o intuito de elevar a sensibilidade dessa técnica, em amostras de secreção nasal.

Studies have demonstrated high sensibility of the polimerase chain reaction (PCR) technique in the identification of the Mycobacterium leprae DNA . This study aimed to evalue the PCR sensibility at the detection of the M. leprae DNA in nasal swab of leprosy patients and to compare the results with the bacilloscopy and multibacillary (MBs) and paucibacilares (PBs) forms. Nasal secretion samples of 24 leprosy patients were collected, and were preserved in one and two lise's solution. The PCR results were highly significant (p <0.0000) and they revealed grater sensibility than bacilloscopy, in several clinical forms. Nevertheless, still different studies are necessary, testing new markers and preservatives, with the purpose of lifting up the sensibility of this technique, in nasal secretion samples.

Los estudios han demostrado una alta sensibilidad de la técnica de Reacción en Cadena de la Polimerasa (PCR) para identificar el ADN de Mycobacterium leprae. El objetivo del estudio fue evaluar la sensibilidad de la PCR en la detección de ADN de M. leprae en hisopo nasal de los pacientes hansenianos y comparar los resultados con la baciloscopía y las formas multibacilares (MBs) y paucibacilares (PBS). Se obtuvieron muestras de secreción nasal de 24 pacientes hansenianos, conservados en solución de lisis uno y dos. Los resultados de la PCR fueron muy significativas (p <0.0000) y mostró una mayor sensibilidad que la baciloscopía, en diferentes formas clínicas. Sin embargo, otros estudios son aún necesarios, el ensayo de nuevos marcadores y conservantes con el fin de aumentar la sensibilidad de esta técnica, en muestras de secreción nasal.

Bordetella pertussis en estudiantes adolescentes de la Ciudad de México / Bordetella pertussis em estudantes adolescentes da Cidade do México / Bordetella pertussis in adolescents students in Mexico City

OBJETIVO: Estimar la seroprevalencia a Bordetella pertussis en escolares y sus contactos escolares y familiares. MÉTODOS: Un total de 12.273 estudiantes de 12 a 15 años de edad, de 14 escuelas secundarias públicas de la Ciudad de México fueron estudiados durante los meses de Septiembre 2002 a Marzo 2003. Se tomó muestra de exudado nasofaríngeo en adolescentes con tos de más de 14 días de evolución. La infección fue confirmada por la técnica de reacción en cadena de polimerasa. Se realizó estudio de contactos escolares y familiares. RESULTADOS: La incidencia de tos fue de 5 para 1.000 estudiantes. De los 61 estudiantes con tos incluidos en la muestra, 20 (32,8 por ciento) fueron positivos para Bordetella. De los 152 contactos escolares, 16 (10,6 por ciento) resultaron positivos, y ocho tenían tos. Uno de esos contactos fue el director de una de las escuelas responsable de más del 60 por ciento de los casos positivos (12/20), quien también dio lecciones a diez de los estudiantes infectados. De los 29 familiares, ocho (27,6 por ciento) fueron positivos, pertenecientes a tres familias. CONCLUSIONES: Los resultados muestran que la frecuencia de la enfermedad fue similar al comunicado en la población adolescente de otros países. Sin embargo, este trastorno no tiene necesariamente signos clínicos de la tos persistente y está sujeto a la existencia de infectados asintomáticos con Bordetella.

OBJECTIVE: To estimate seroprevalence of Bordetella pertussis in students and their community. METHODS: A total of 12,273 adolescent students aged 12 to 15 years from 14 public high schools in Mexico City were studied from September 2002 to March 2003. Nasopharyngeal samples were collected from those adolescents with whooping cough for more than 14 days. Infection was confirmed using polymerase chain reaction (PCR). All students, school staff and family exposed to PCR-confirmed cases were tested. RESULTS: Whooping cough rate was 5 to 1,000 students. Of those students (61) who were identified with whooping cough for more than 14 days, 20 (32.8 percent) were positive to Bordetella pertussis. Of 152 people exposed (contacts) to these cases, 16 (10.6 percent) were positive and only eight (50 percent) had whooping cough. One of these exposed (contacts) was the principal of a school that had more than 60 percent positive cases (12/20) and who was also a teacher of 10 infected students. Of 29 family members tested, eight (27.6 percent) were positive and from three different families. CONCLUSIONS: The study results show a similar rate of whooping cough in adolescents as seen in other countries. Since persistent cough is not always clinically seen in all infected individuals, there may be asymptomatic cases of Bordetella infection.

OBJETIVO: Estimar a soroprevalência a Bordetella pertussis em escolares e seus contatos. MÉTODOS: Foram examinados 12.273 alunos entre 12 e 15 anos de idade, de 14 escolas secundárias públicas da Cidade do México, de setembro de 2002 a março de 2003. Amostras de exudado nasofaríngeo foram coletadas de adolescentes com tosse por mais de 14 dias. A infecção foi confirmada por reação em cadeia da polimerase. Todos os alunos e funcionários dos colégios dos casos confirmados por reação em cadeia da polimerase e seus familiares foram testados. RESULTADOS: A incidência de tosse foi de 5 para 1.000 alunos. Dos 61 alunos com tosse amostrados, 20 (32,8 por cento) foram positivos para Bordetella. Dos 152 contatos desses alunos, 16 (10,6 por cento) foram positivos, dos quais oito apresentavam tosse. Um desses contatos foi a diretora de uma das escolas responsável por mais de 60 por cento dos casos positivos (12/20), que também deu aulas a dez desses alunos infectados. Dos 29 familiares testados, oito (27,6 por cento) foram positivos, pertencentes a três famílias. CONCLUSÕES: Os resultados mostram que a freqüência do agravo foi semelhante à reportada na população adolescente em outros países. Todavia, este agravo não tem necessariamente manifestações clínicas de tosse persistente, sendo possível a existência de sujeitos assintomáticos infectados com Bordetella.