Amplificación directa de ADN de Bordetella pertussis purificado de hisopados nasofaríngeos por un método de bajo costo, rápido (60-segundos) y libre de equipos / Direct amplification of Bordetella pertussis DNA purified from nasopharyngeal swabs by a low-cost, fast (60-second), and equipment-free method

RESUMEN Objetivo. Desarrollar y evaluar un método de bajo costo basado en celulosa para la purificación rápida y amplificación directa de ADN de Bordetella pertussis de hisopados nasofaríngeos. Materiales y métodos. Se prepararon discos de celulosa y se evaluaron diferentes parámetros (buffers de lisis/lavado, número de discos y elución de ADN). El método se acopló a una amplificación directa por PCR en tiempo real (qPCR) y se estimó el rendimiento utilizando hisopados nasofaríngeos que fueron positivos (n=100) y negativos (n=50) para ADN B. pertussis por qPCR, comparado con el método basado en columnas de sílice. Se calculó el grado de concordancia, sensibilidad, especificidad, valor predictivo positivo (VPP) y valor predictivo negativo (VPN). Se evaluó la factibilidad del método rápido para ser acoplado a un ensayo colorimétrico de amplificación isotérmica mediada por lazo (LAMP). Resultados. El método rápido con un disco de celulosa y buffer de lisis y lavado conteniendo PVP-40 y Tween 20, respectivamente, mostró una mayor capacidad para purificar ADN amplificable de B. pertussis. El método tuvo una sensibilidad de 89,0% (IC95%, 80,2%-94,9%) y una especificidad de 98,5% (IC95%, 92,1%-100,0%), con un buen grado de concordancia (Kappa=0,867; IC95% 0,788 - 0,946), respecto al método referencial. Los VPP y VPN fueron 98,6% (IC95%, 92,7,2%-100,0%) y 88,2% (IC95%, 78,7%-94,4%), respectivamente. Se evidenció una amplificación exitosa por LAMP, y se obtuvieron resultados comparables con el método por columnas de sílice. Conclusión. El método desarrollado es simple, de bajo costo y libre de equipos para la obtención rápida (60 segundos) de ADN en el punto de atención, y puede ser implementado en diversas técnicas moleculares orientados al diagnóstico oportuno y al estudio epidemiológico de tos ferina.

ABSTRACT Objective. To develop and evaluate a low-cost cellulose-based method for rapid purification and direct amplification of Bordetella pertussis DNA from nasopharyngeal swabs. Materials and methods. We prepared cellulose discs and evaluated different parameters (lysis/wash buffers, number of discs and DNA elution). The method was coupled to a direct real-time PCR (qPCR) amplification and the performance was estimated using nasopharyngeal swabs that were positive (n=100) and negative (n=50) for B. pertussis DNA by qPCR, compared to the silica column-based method. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and the degree of agreement. The feasibility of the rapid method to be coupled to a loop-mediated isothermal amplification colorimetric assay (LAMP) was evaluated. Results. The rapid method, with a cellulose disk and lysis and wash buffer containing PVP-40 and Tween 20, respectively, showed a greater capacity to purify amplifiable DNA from B. pertussis. The method had a sensitivity of 89.0% (95%CI: 80.2%-94.9%) and a specificity of 98.5% (95%CI: 92.1%-100.0%), with a good degree of agreement (Kappa=0.867; 95%CI: 0.788 - 0.946), compared to the reference method. The PPV and NPV were 98.6% (95%CI: 92.7.2%-100.0%) and 88.2% (95%CI: 78.7%-94.4%), respectively. Successful amplification by LAMP was evident, and comparable results were obtained with the silica column method. Conclusion. The developed method is simple, low-cost and equipment-free for rapid (60 seconds) DNA collection at the point of care, and can be implemented in various molecular techniques aimed at the timely diagnosis and epidemiological study of pertussis.

Occurrence of the vanA gene in Staphylococcus epidermidis from nasopharyngeal secretion of Health-Care Workers, Recife, Brazil

Abstract INTRODUCTION: The increasing reports of vancomycin-resistant Staphylococcus strains (VRS) haves caused concern worldwide, from the laboratory detection to patient management. This study aimed to identify the occurrence of VRS strains among healthcare professionals from a university hospital. METHODS: A total of 102 Staphylococcus sp. isolates from healthcare professionals, obtained in a previous study were evaluated according to standard techniques for VRS detection. RESULTS: After screening inoculation of plates containing 6µg/ml of vancomycin, 19 resistant isolates were identified. The susceptibility profile to other antimicrobials revealed 18 multidrug resistant isolates. The minimum inhibitory concentration (MIC) was determined by E-test and broth microdilution. According to E-tests, of 19 isolates grown in BHI-V6, four isolates presented MIC ≥ 128 µg/ml, seven with MIC ranging from 4 to 8 µg/ml, and eight with MIC ≤ 2µg/ml. By broth microdilution, 14 isolates presented MIC ≤ 2 µg/ml and five with MIC ≥ 16µg/ml. The presence of the gene vanA was determined by PCR in the five resistant isolates, and this gene was detected in one of the strains. Furthermore, among the 19 strains, the gene mecA was found in 13 (39,4%) isolates, including the strain carrying the gene vanA. CONCLUSIONS: Based on these results, we highlight the presence of one strain carrying both vanA and the mecA genes, as well as multidrug-resistant strains colonizing healthcare professionals, and their importance as potential vectors to spread strains carrying resistance genes in the hospital environment.

Portación de Staphylococcus aureus enterotoxigénico tipo A, en frotis nasofaríngeos en manipuladores de alimentos / Carriage of Staphylococcus aureus among food service workers

Background Staphylococcus aureus produces 11 serotypes of endotoxins that may cause food poisoning. Aim To determine the prevalence of type A enterotoxigenic Staphylococcus aureus carriage among food service workers in Chillan, Chile. Material and Methods Pharyngeal swabs were obtained from 100 food service workers and were cultured in Agar plates. After identifying the presence of Staphylococcus aureus, DNA was extracted to identify type A toxin by conventional PCR. Results Thirty eight percent of samples were colonized with Staphylococcus aureus. Among these, 26% were toxin A producers. Conclusions Half of the sampled workers carried Staphylococcus aureus and a quarter of these produced type A enterotoxin.

Evaluation of Haemophilus influenzae type b carrier status among children 10 years after the introduction of Hib vaccine in Brazil

The aim of the present study was to assess the prevalence of Haemophilus influenzaetype b (Hib) nasopharyngeal (NP) colonisation among healthy children where Hib vaccination using a 3p+0 dosing schedule has been routinely administered for 10 years with sustained coverage (> 90%). NP swabs were collected from 2,558 children who had received the Hib vaccine, of whom 1,379 were 12-< 24 months (m) old and 1,179 were 48-< 60 m old. Hi strains were identified by molecular methods. Hi carriage prevalence was 45.1% (1,153/2,558) and the prevalence in the 12-< 24 m and 48-< 60 m age groups were 37.5% (517/1,379) and 53.9% (636/1,179), respectively. Hib was identified in 0.6% (16/2,558) of all children in the study, being 0.8% (11/1,379) and 0.4% (5/1,179) among the 12-< 24 m and 48-< 60 m age groups, respectively. The nonencapsulate Hi colonisation was 43% (n = 1,099) and was significantly more frequent at 48-< 60 m of age (51.6%, n = 608) compared with that at 12-< 24 m of age (35.6%, n = 491). The overall resistance rates to ampicillin and chloramphenicol were 16.5% and 3.7%, respectively; the co-resistance was detected in 2.6%. Our findings showed that the Hib carrier rate in healthy children under five years was very low after 10 years of the introduction of the Hib vaccine.

Functional low vision in adults from Latin America: findings from population-based surveys in 15 countries / Baja visión funcional en adultos de América Latina: resultados de las encuestas poblacionales realizadas en 15 países

OBJECTIVE: To review data on functional low vision (FLV) (low vision-visual acuity (VA) < 6/18 (<20/60) to > perception of light (PL+) in the better eye-that is untreatable and uncorrectable) in adults aged 50 years or older from published population-based surveys from 15 countries in Latin America and the Caribbean. METHODS: Data from 15 cross-sectional, population-based surveys on blindness and visual impairment (10 national and five subnational) covering 55 643 people > 50 years old in 15 countries from 2003 to 2013 were reanalyzed to extract statistics on FLV. Eleven of the studies used the rapid assessment of avoidable blindness (RAAB) method and four used the rapid assessment of cataract surgical services (RACSS) method. For the 10 national surveys, age-and sex-specific prevalence of FLV was extrapolated against the corresponding population to estimate the total number of people > 50 years old with FLV. RESULTS: Age- and sex-adjusted prevalence of FLV in people > 50 years old ranged from 0.9% (Guatemala, Mexico, and Uruguay) to 2.2% (Brazil and Cuba) and increased by age. The weighted average prevalence for the 10 national surveys was 1.6%: 1.4% in men and 1.8% in women. For all 10 national studies, a total of 509 164 people > 50 years old were estimated to have FLV. Based on the 910 individuals affected, the main causes of FLV were age-related macular degeneration (weighted average prevalence of 26%), glaucoma (23%), diabetic retinopathy (19%), other posterior segment disease (15%), non-trachomatous corneal opacities (7%), and complications after cataract surgery (4%). CONCLUSIONS: FLV is expected to rise because of 1) the exponential increase of this condition by age, 2) increased life expectancy, and 3) the increase in people > 50 years old. These data can be helpful in planning and developing low vision services for the region; large countries such as Brazil and Mexico would need more studies. Prevention is a major strategy to reduce FLV, as more than 50% of it is preventable.

OBJETIVO: Analizar los datos de las encuestas poblacionales publicadas provenientes de 15 países de América Latina y el Caribe sobre baja visión funcional (BVF) (baja visión, desde una agudeza visual [AV] inferior a 6/18 [20/60] hasta > percepción de luz (PL+), en el mejor ojo, no tratable ni corregible) en adultos de 50 años de edad o mayores. MÉTODOS: Con objeto de extraer información estadística en materia de BVF, se volvieron a analizar los datos de 15 encuestas transversales poblacionales sobre ceguera y deficiencia visual realizadas del 2003 al 2013 (10 a escala nacional y cinco subnacio-nales) que abarcaron a 55 643 personas de > 50 años de edad en 15 países. Once de los estudios emplearon el método de Evaluación Rápida de la Ceguera Evitable y cuatro utilizaron el método de Evaluación Rápida de de Catarata y Servicios Quirúrgicos. Al analizar las 10 encuestas nacionales, se extrapoló la prevalencia específica por edad y sexo de la BVF frente a la población correspondiente, con objeto de calcular el número total de personas de > 50 años de edad con BVF. RESULTADOS: La prevalencia de la BVF ajustada por edad y sexo en personas de > 50 años de edad varió desde 0,9% (en Guatemala, México y Uruguay) a 2,2% (en Brasil y Cuba) y aumentó con la edad. La prevalencia promedio ponderada en las 10 encuestas nacionales fue de 1,6%: 1,4% en hombres y 1,8% en mujeres. Al considerar los 10 estudios nacionales en su conjunto, se calcularon un total de 509 164 personas de > 50 años de edad con BVF. Con base en las 910 personas afectadas, las principales causas de BVF fueron la degeneración macular relacionada con la edad (prevalencia promedio ponderada de 26%), el glaucoma (23%), la retinopatía diabética (19%), otras enfermedades del segmento posterior del ojo (15%), las opacidades corneales no tracomatosas (7%) y las complicaciones posteriores a la cirugía de la catarata (4%). CONCLUSIONES: Se prevé que la BVF aumente como consecuencia de 1) el aumento exponencial de esta afección con la edad, 2) la mayor esperanza de vida, y 3) el aumento de personas de > 50 años de edad. Estos datos pueden ser útiles para planificar y extender los servicios de atención a la disminución de la agudeza visual en la Región; países extensos, como Brasil y México, requerirían nuevos estudios. La prevención constituye una estrategia muy importante para reducir la BVF, ya que más de 50% de los casos se pueden prevenir.

Influence of the socioeconomic status on the prevalence of malocclusion in the primary dentition

OBJECTIVE: To assess the influence of socioeconomic background on malocclusion prevalence in primary dentition in a population from the Brazilian Amazon. METHODS: This cross-sectional study comprised 652 children (males and females) aged between 3 to 6 years old. Subjects were enrolled in private preschools (higher socioeconomic status - HSS, n = 312) or public preschools (lower socioeconomic status - LSS, n = 340) in Belém, Pará, Brazil. Chi-square and binomial statistics were used to assess differences between both socioeconomic groups, with significance level set at P < 0.05. RESULTS: A high prevalence of malocclusion (81.44%) was found in the sample. LSS females exhibited significantly lower prevalence (72.1%) in comparison to HSS females (84.7%), particularly with regard to Class II (P < 0.0001), posterior crossbite (P = 0.006), increased overbite (P = 0.005) and overjet (P < 0.0001). Overall, malocclusion prevalence was similar between HSS and LSS male children (P = 0.36). Early loss of primary teeth was significantly more prevalent in the LSS group (20.9%) in comparison to children in the HSS group (0.9%), for both males and females (P < 0.0001). CONCLUSION: Socioeconomic background influences the occurrence of malocclusion in the primary dentition. In the largest metropolitan area of the Amazon, one in every five LSS children has lost at least one primary tooth before the age of seven. .

OBJETIVO: avaliar a influência da condição socioeconômica na prevalência de má oclusão na dentição decídua em uma população amazônica. MÉTODOS: esse estudo transversal compreendeu 652 crianças, de ambos os sexos, entre 3 e 6 anos de idade. Os indivíduos estavam matriculados na pré-escola na rede privada de ensino (alto nível socioeconômico; n = 312) ou, rede pública (baixo nível socioeconômico; n = 340), em Belém, no Pará. O teste chi-quadrado e estatística binominal foram usados para avaliar as diferenças entre os grupos socioeconômicos, com nível de significância considerado em p < 0,05. RESULTADOS: foi observada uma alta prevalência de má oclusão (81,44%) na amostra examinada. As meninas das escolas públicas exibiram uma prevalência significativamente menor (72,1%) em comparação às das escolas privadas (84,7%), principalmente com relação à prevalência da má oclusão de Classe II (p < 0,0001), mordida cruzada posterior (p = 0,006), sobremordida (p = 0,005) e sobressaliência (p < 0,0001). De maneira geral, a prevalência de má oclusão foi similar entre as crianças do sexo masculino dos dois grupos (p = 0,36). A perda precoce de dente decíduo foi significativamente mais prevalente no grupo com menor nível socioeconômico (20,9%) quando comparada à de crianças nas escolas privadas (0.9%), em ambos os sexos (p < 0,0001). CONCLUSÃO: a condição socioeconômica influencia a ocorrência de má oclusão na dentição decídua. Na maior metrópole da Amazônia, uma em cada cinco crianças do grupo com baixo nível socioeconômico perdeu, no mínimo, um dente decíduo antes dos sete anos. .

Clinical significance of different bacterial load of Mycoplasma pneumoniae in patients with Mycoplasma pneumoniae pneumonia

OBJECTIVE: This retrospective study was conducted to investigate the clinical significance of differentMycoplasma pneumoniae bacterial load in patients with M. pneumoniae pneumonia (MP) in children. METHODS: Patients with MP (n=511) were identified at the Children's Hospital Affiliated to Soochow University database during an outbreak of MP between January 2012 and February 2013. RESULTS: Comparing patients with high and low bacterial load those with higher loads were significantly older (p<0.01) and had fever significantly more frequently (p=0.01). Presence of wheezing at presentation was associated with low bacterial load (p=0.03). Baseline positive IgM was present in 93 (56.4%) patients with high bacterial load compared to 46 (27.8%) patients with low bacterial load (p<0.001). Co-infection with viruses was found significantly more frequent among patients with low bacterial load (24.2%) than those with high bacterial load (8.5%) [p<0.001]. Bacterial co-infection was also more frequently detected among patients with low bacterial load (22.4%) than in those with high bacterial load (12.1%) [p=0.01]. CONCLUSION: M. pneumoniae at a high bacterial load could be an etiologic agent of respiratory tract disease, whereas the etiologic role of MP at a low bacterial load remains to be determined. .

Clinical and epidemiological aspects related to the detection of adenovirus or respiratory syncytial virus in infants hospitalized for acute lower respiratory tract infection / Aspectos clínicos e epidemiológicos relacionados à detecção de adenovírus ou vírus sincicial respiratório em crianças hospitalizadas por doença aguda do trato respiratório inferior

OBJECTIVE: To characterize and compare clinical, epidemiological, and laboratory aspects ofinfants with acute lower respiratory infection (ALRI) associated with the detection of adenovirus(ADV) or respiratory syncytial virus (RSV). METHODS: A preliminary respiratory infection surveillance study collected samples of nasopharyngeal aspirate (NPA) for viral research, linked to the completion of a standard protocol, from children younger than two years admitted to a university hospital with ALRI, between March of 2008 and August of 2011. Polymerase chain reaction (PCR) was used for eight viruses: ADV, RSV, metapneumovirus, Parainfluenza 1, 2, and 3, and Influenza A and B. Cases with NPA collectedduring the first 24 hours of admission, negative results of blood culture, and exclusive detection of ADV (Gadv group) or RSV (Grsv group) were selected for comparisons. RESULTS: The preliminary study included collection of 1,121 samples of NPA, 813 collected in thefirst 24 hours of admission, of which 50.3% were positive for at least one virus; RSV was identifiedin 27.3% of cases surveyed, and ADV was identified in 15.8%. Among the aspects analyzed inthe Gadv (n = 58) and Grsv (n = 134) groups, the following are noteworthy: the higher meanage, more frequent prescription of antibiotics, and the highest median of total white blood cellcount and C-reactive protein values in Gadv. CONCLUSIONS: PCR can detect persistent/latent forms of ADV, an aspect to be considered wheninterpreting results. Additional studies with quantitative diagnostic techniques could elucidatethe importance of the high frequency observed. .

OBJETIVO: Caracterizar e comparar aspectos clínicos, epidemiológicos e laboratoriais delactentes com evidências de infecção aguda do trato respiratório inferior (IATRI) associada à detecção do adenovírus (ADV) ou do vírus sincicial respiratório (VSR). MÉTODOS: Um estudo preliminar de vigilância de infecções respiratórias desenvolveu coleta de aspirado nasofaríngeo (ANF) para pesquisa viral, vinculada ao preenchimento de protocolo padrão, de menores de dois anos internados com quadro de IATRI em hospital universitário, entre março de 2008 e agosto de 2011. Utilizou-se técnica da reação em cadeia da polimerase (PCR) para oito vírus: ADV, VSR, metapneumovírus, parainfluenza 1, 2 e 3 e influenza A e B. Foram selecionados para comparações os casos com ANF coletado nas primeiras 24 horas da admissão, resultado de hemocultura negativo e detecção exclusiva de ADV (grupo Gadv) ou VSR (grupo Gvsr). RESULTADOS: O estudo preliminar incluiu coleta de 1.121 amostras de ANF, sendo 813 coletadas nas primeiras 24 h da admissão, das quais 50,3% foram positivas para ao menos um dos vírus, com VSR em primeiro lugar, em 27,3%, e ADV em segundo, em 15,8% dos casos pesquisados. Dentre os aspectos analisados nos grupos Gadv (n = 58) e Gvsr (n = 134), destacaram-se a média da idade mais elevada, maior frequência da prescrição de antibióticos e medianas mais elevadas para contagem total de leucócitos e valores da proteína C-reativa no Gadv. CONCLUSÕES: A PCR utilizada pode detectar formas persistentes/latentes de ADV, aspecto aser considerado ao interpretar os resultados. Estudos complementares com técnicas diagnósticas quantitativas, por exemplo, poderiam evidenciar a importância da elevada frequência verificada. .

Resistencia antibiótica de streptococcus pneumoniae en portadores nasofaríngeos sanos de siete regiones del Perú / Antibiotic resistance of streptococcus pneumoniae among healthy nasopharyngeal carriers in seven regions of Peru

Objetivos. Determinar el patrón de susceptibilidad antibiótica de cepas de Streptococcus pneumoniae aisladas de portadores nasofaríngeos sanos menores de 2 años de siete regiones del Perú. Materiales y métodos. Entre el 2007 y 2009 se tomaron muestras de hisopado nasofaríngeo a 2123 niños sanos entre 2 y 24 meses de edad en los consultorios de crecimiento y desarrollo (CRED) y vacunación de hospitales y centros de salud de Lima, Piura, Cusco, Abancay, Arequipa, Huancayo, e Iquitos. Se determinó la resistencia a diez antibióticos mediante la prueba de disco-difusión de las cepas de neumococo aisladas. Resultados. Se aislaron 572 cepas. Se encontró altas tasas de resistencia a cotrimoxazol (58%); penicilina (52,2% no-sensibles); tetraciclina (29,1%); azitromicina (28,9%), y eritromicina (26,3%). La resistencia a cloranfenicol fue baja (8,8%). Se encontró 29,5% de multirresistencia. La resistencia a la azitromicina y a la penicilina fue diferente en las siete regiones (p<0,05), hallándose el mayor porcentaje de cepas no-sensibles a penicilina en Arequipa (63,6%), mientras que el menor fue en Cusco (23,4%). Conclusiones. Los elevados niveles de resistencia encontrados para penicilina, cotrimoxazol y macrólidos en cepas de neumococo aisladas de portadores sanos en todas las regiones estudiadas, y su asociación con uso previo de antibióticos, representan un importante problema de salud pública en nuestro país. Esto resalta la necesidad de implementar, a nivel nacional, estrategias para disminuir el uso irracional de antibióticos, sobre todo en la población pediátrica. Es necesario complementar los datos de resistencia a penicilina con la determinación de la concentración mínima inhibitoria para hacer las recomendaciones terapéuticas respectivas.

Objectives. To determine the pattern of antibiotic susceptibility of isolated Streptococcus pneumoniae strains of healthy nasopharyngeal carriers younger than 2 years in seven regions of Peru. Materials and methods. Between 2007 and 2009, nasopharyngeal swab samples were collected among 2123 healthy children aged 2-24 months in growth and development medical practices (CRED) and vaccination offices of hospitals and health centers in Lima, Piura, Cusco, Abancay, Arequipa, Huancayo, and Iquitos. The resistance to ten antibiotics through disk diffusion sensitivity testing of isolated pneumococcus strains was determined. Results. 572 strains were isolated. High rates of resistance to co-trimoxazole (58%), penicillin (52.2% non-sensitive); tetracycline (29,1%); azithromycin (28,9%), and erythromycin (26,3%). Resistance to chloramphenicol was low (8.8%). Multiresistance was found at 29.5%. Resistance to azithromycin and penicillin was different in all seven regions (p<0,05), the highest percentage of non-sensitive strains being found in Arequipa (63,6%), whereas the lowest percentage was found in Cusco (23.4%). Conclusions. High levels of resistance found to penicillin, co-trimoxasole and macrolides in isolated pneumococcus strains of healthy carriers in all studied regions, and their association to a previous use of antibiotics, represent a significant public health problem in our country. This emphasizes the need to implement nationwide strategies to reduce the irrational use of antibiotics, especially among children. It is necessary to complement data of resistance to penicillin with the determination of minimal inhibitory concentration to make proper therapeutic recommendations.

Aislamientos bacterianos de muestras respiratorias de pacientes pediátricos con fibrosis quística y su distribución por edades / [Bacterial isolates from respiratory samples of pediatric patients with cystic fibrosis and their distribution by ages].

The bacterial isolates from respiratory samples of 50 pediatric patients with cystic fibrosis, their distribution by ages and antimicrobial resistance pattern as well as the intermittence of isolations and coinfections, were investigated. Staphylococcus aureus was isolated in 72

of patients, followed by Pseudomonas aeruginosa (58

), and the Burkholderia cepacia complex (12

). The frequency of resistance of P. aeruginosa isolates to ß-lactam antibiotics was low (13.8

). Fifty percent of S. aureus isolates was methicillin-resistant, and 57.1

of H. influenza was ampicillin resistant due to ß-lactamase production. In children under 4 years-old, S. aureus was predominant, followed by P. aeruginosa and H. influenzae. This order of predominance was observed in all the groups studied, except in that of children between 10 and 14 years-old. Stenotrophomonas maltophilia and Achromobacter xylosoxidans isolates were intermittent and accompanied by other microorganisms. Finally, we observed a great variety of bacterial species, which imposes stringent performance requirements for microbiological studies in all respiratory samples of these patients.

Primary Nasopharyngeal Tuberculosis.

Tuberculous infection of the upper respiratory tract is an uncommon clinical condition and in that nasopharyngeal involvement is struck with rarity per se. This condition is often prevalent in people of low socioeconomic strata living in endemic areas, especially in developing countries. It has a silent and indolent course and most commonly mimicks nasopharyngeal carcinoma in its clinical presentation. In absence of concurrent pulmonary involvement, it is often misdiagnosed or diagnosed only after the biopsy has been taken. Nevertheless, high index of suspicion is required on part of the clinician to diagnose this comparatively rare entity.

[Identification of serological groups A, B, C, W135, Y, X Neisseria meningitidis carriers by multiplex PCR in the nasopharynx of students in Kashan during 2011-2012]

Neisseria meningitidis [N. meningitidis] is a pathogen which colonizes in the nasopharynx without any clinical manifestations. Among the 13 different serological groups, only the serogroups A, B, C, W135, Y, X play a major role in disease development. This study aimed to determine N. meningitidis cases carrying these serological groups using the multiplex PCR method in the nasopharynx of students in Kashan schools. This cross-sectional study was conducted on 1289 students in Kashan during 2011-2012. Samples were collected from the students' nasopharynx using a sterile swab and cultured on a selective medium. Strains were identified through biochemical tests. Then the serological groups were determined using the multiplex PCR method. One-hundred and fifteen [8.9%] out of 1289 students were N.meningitidis carriers; 75 [65.2%] male and 40 [34.8%] female. There was a significant difference between gender and the rate of carriers [P=0.032]. The highest rate of carriers [12.3%] was in the 15 to 19 year age group. There was a significant relationship between the rate of carriers and increase in the number of family members [P<0.001]. In this study, only the serological groups B [8 cases] and C [107 cases] were detected. Since the serological group C is involved in the outbreak and there is no vaccine currently available for the serological group B to prevent the infection, detection of these serological groups can be important

Macrolide Resistance of Mycoplasma pneumoniae and Its Detection Rate by Real-Time PCR in Primary and Tertiary Care Hospitals

BACKGROUND: This study aimed to evaluate the prevalence of Mycoplasma pneumoniae in primary and tertiary care hospitals and its macrolide resistance rate. METHODS: Nasopharyngeal swabs were collected from 195 pediatric patients in primary and tertiary care hospitals from October to November 2010. The AccuPower MP real-time PCR kit (Bioneer, Korea) was used for the detection of M. pneumoniae. Direct amplicon sequencing was performed to detect point mutations conferring resistance to macrolides in the 23S rRNA gene. RESULTS: Among the 195 specimens, 17 (8.7%) were M. pneumoniae positive, and 3 of the strains (17.6%) obtained from these 17 specimens displayed the A2063G mutation in 23S rRNA. Three macrolide-resistant M. pneumoniae isolates were isolated from patients hospitalized at the primary care hospital. The positive rates of M. pneumoniae for the primary and tertiary care hospitals were 12.1% (15/124) and 2.8% (2/71), respectively (P=0.033). CONCLUSIONS: The positive rate of M. pneumoniae in the primary care hospital was higher than that in the tertiary care hospital. Simultaneous detection of M. pneumoniae and macrolide-resistant mutation genes in the 23S rRNA by real-time PCR is needed for rapid diagnosis and therapy of M. pneumoniae infections.

Portación y caracterización de Staphylococcus aureus en manipuladores de alimentos / Carriage and characterization of Staphylococcus aureus in food handlers

Staphylococcus aureus es una causa de intoxicaciones alimentarias por su capacidad de producir enterotoxinas. Los manipuladores de alimentos que portan S. aureus productores de enterotoxinas pueden provocar intoxicaciones alimentarias. Se estudiaron muestras tomadas de fosas nasales de 88 manipuladores de alimentos en la provincia de Misiones. El 37,5 % de los individuos analizados eran portadores de S. aureus. Mediante técnicas de amplificación (PCR), se detectaron genes que codifican la producción de enterotoxinas en 13 de los 33 aislamientos obtenidos (39,4 %) y en el 14,7 % de los manipuladores. De estos aislamientos, 10 portaban el gen sea y 3 el gen sec. El estudio de sensibilidad a los antibióticos mostró un 100 % de sensibilidad a teicoplanina, gentamiclna y rifampicina; 2 aislamientos fueron resistentes a clindamicina y a eritromicina y 4 resultaron resistentes a la meticilina. Estos resultados son un alerta e indicarían la necesidad de desarrollar medidas racionales para reducir el riesgo potencial de intoxicaciones alimentarias.

Staphylococcus aureus causes food poisoning due to its ability to produce enterotoxins. Food handlers carrying enterotoxin-producing S. aureus can contaminate food, thus leading to food poisoning. Samples were obtained from 88 food handlers in the Province of Misiones, Argentina. S. aureus was isolated from nasal swaps and PCR amplification was performed for genes encoding staphylococcal enterotoxins. A total of 37.5 % food handlers were positive for S. aureus. Expression of enterotoxin genes was found in 13 of the 33 (39.4 %) S. aureus isolates studied, accounting for 14.7 % of food handlers. Gene sea was detected in 10 isolates followed by gene sec in 3 isolates. All isolates were susceptible to teicoplanin, gentamicin and rifampicin. Four isolates were resistant to methicillin whereas 2 isolates were resistant to clindamycin and erythromycin. These results constitute a critical alert and indicate the need for developing rational measures to reduce the potential risk of food poisoning.

Comparison of Sputum and Nasopharyngeal Swab Specimens for Molecular Diagnosis of Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila

BACKGROUND: Differentiation of atypical pathogens is important for community-acquired pneumonia (CAP). In this study, we compared sputum and nasopharyngeal swabs (NPS) for use in detection of Mycoplasma pneumoniae (MP), Chlamydophila pneumoniae (CP), and Legionella pneumophila (LP), using Seeplex PneumoBacter ACE Detection Assay (PneumoBacter; Seegene). METHODS: Sputum and NPS specimens were collected from patients in 15 hospitals. DNA was extracted from sputum using QIAamp DNA Stool Mini Kit (Qiagen) and from NPS using easyMAG (bioMerieux). Both types of specimens were evaluated by multiplex PCR using PneumoBacter. To determine the diagnostic performance of this assay, sputum samples were also tested using BD ProbeTec ET Atypical Pneumonia Assay (APA; Becton Dickinson). RESULTS: Among 217 sputum and NPS, 20 (9.2%), 2 (0.9%), and 0 sputum were positive for MP, LP, and CP, respectively, whereas 8 (3.7%) NPS were positive for MP. The sputum APA test yielded 186, 206, and 204 interpretable results for MP, LP, and CP, respectively. Of these, 21 (11.3%) were positive for MP, 2 (1.0%) were positive for LP, and 0 samples were positive for CP. Compared to APA, the sensitivity and specificity of the sputum assay for MP were 95.2% and 100.0%, respectively, whereas for the NPS assay, these were 38.1% and 93.9%. Sputum testing was more sensitive than NPS testing (P=0.002). For LP and CP diagnosis, PneumoBacter and APA tests agreed 100%. CONCLUSIONS: Specimen type is crucial and sputum is preferred over NPS for simultaneous detection of MP, LP, and CP using multiplex PCR in CAP.

Changes in Serotype Distribution and Antibiotic Resistance of Nasopharyngeal Isolates of Streptococcus pneumoniae from Children in Korea, after Optional Use of the 7-Valent Conjugate Vaccine

We investigated serotype distribution and antimicrobial resistance of pneumococcal carriage isolates from children after optional immunization with the 7-valent pneumococcal conjugate vaccine (PCV7) in Korea. From June 2009 to June 2010, 205 (16.5%) pneumococcal isolates were obtained from 1,243 nasopharyngeal aspirates of infants and children at Seoul National University Children's Hospital, Korea. Serotype was determined by Quellung reaction and antibiotic susceptibility was tested by E-test. The results were compared to previous studies done in the pre-PCV7 period. In this study, the most common serotypes were 6A (15.3%), 19A (14.7%), 19F (10.2%), 35B (7.3%), and 6D (5.6%). The proportion of PCV7 serotypes decreased from 61.9% to 23.8% (P < 0.001). The overall penicillin nonsusceptibility rate increased from 83.5% to 95.4% (P = 0.001). This study demonstrates the impact of optional PCV7 vaccination in Korea; the proportion of all PCV7 serotypes except 19F decreased while antimicrobial resistant serotypes 6A and 19A further increased.

Reemplazo de serotipos de Streptococcus pneumoniae en niños con vacuna conjugada antineumocóccica 7V en México / Streptococcus pneumoniae serotype replacement in nasopharyngeal colonization in children vaccinated with PCV7 in Mexico

OBJETIVO: Evaluar el efecto de la inmunización con vacuna neumocóccica conjugada 7 valente (VCN7), sobre la colonización nasofaríngea por S. pneumoniae (SPN). MATERIAL Y MÉTODOS: Se estudiaron dos grupos con diferente esquema de vacunación: grupo I (2-6 meses de edad) 3+1, grupo II (7-11 meses) 2+1, con refuerzo a los 15 meses de edad. Se realizaron cultivos nasofaríngeos antes de cada inmunización y posterior al refuerzo; se analizó de forma global y pareada las proporciones de los niños colonizados por SPN, serotipos vacunales, no vacunales y resistencia a la penicilina. RESULTADOS: Se incluyeron 183 niños; 93 en el grupo I y 90 en el grupo II. En el grupo I disminuyeron los serotipos vacunales en la 3ª muestra. En el grupo II aumentaron los serotipos no vacunales y disminuyeron los serotipos vacunales antes del refuerzo. En ambos grupos hay una tendencia a disminuir la resistencia a penicilina. CONCLUSIÓN: La VCN7 ocasiona un reemplazo de serotipos en la colonización nasofaríngea antes del refuerzo.

OBJECTIVE: To assess the impact of pneumococcal conjugate vaccine (PCV7) immunization on pneumococcal nasopharyngeal colonization with S. pneumoniae (SPN). MATERIAL AND METHODS: We studied two groups with different vaccination schedules, group I (2-6 months of age) 3+1 and group II (7 -11 months) 2+1, with a booster at 15 months. Nasopharyngeal cultures were obtained before administering each vaccination dose and after booster. Paired and global analyses were carried out of the proportions of children colonized by SPN, vaccine serotype, no vaccine serotype and resistance to penicillin. RESULTS: A total of 183 children were enrolled; 93 in group I and 90 in group II. In group I, there was a decrease in vaccine serotypes in the third sample. In group II, there was an increase in non-vaccine serotypes and a decrease in vaccine serotypes before booster. Both groups showed a trend toward decreased resistance to penicillin. CONCLUSION: PCV7 caused serotype replacement in nasopharyngeal colonization before the booster.

Effect of opium smoking cessation on the nasopharyngeal microbial flora

To determine the effect of opium smoking cessation on the frequency and type of microorganisms in the nasopharynx of opium smokers. This cross-sectional study was performed in the Psychiatry, and Ear, Nose, and Throat Departments, Moradi Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran from June to November 2008, Nasopharyngeal cultures were taken from 50 opium smokers before, and 2-3 months after cessation of opium smoking. Potential pathogens were identified. Patients were not advised to change their number of cigarettes, and we used methadone for the substitution of opium. Eight potential pathogens were isolated from nasopharyngeal cultures obtained from 43 individuals before opium smoking cessation, and 4 were recovered from 33 individuals after cessation [p=0.03]. Streptococcus pneumoniae, Staphylococcus saprophyticus, Streptococcus alpha hemolytic, and Staphylococcus aureus were not found in the second culture. The most sensitivity to antibiotics was for ceftriaxone [84%], ciprofloxacin [74%], and cloxacillin [72%], and the most resistance for amoxicillin [26%] and the least resistance for chloramphenicol. Some potential pathogens decrease or are even absent after opium cessation. Opium smoking affects the nasopharyngeal flora