Neumonía grave en la comunidad: ¿cuándo pensar en SAMR-AC? / Severe community pneumonia: when to think about CA-MRSA

ntroducción: Aunque la incidencia de neumonía adquirida en la comunidad (NAC) por Staphylococcus aureus meticilino-resistente adquirido en la comunidad (SAMR-AC) es inferior al 10%, por su elevada mortalidad debe considerarse en los pacientes graves.Objetivo: Identificar factores de riesgo asociados con SAMR-AC en pacientes con NAC grave. Material y métodos: Estudio observacional, retrospectivo, que analizó pacientes con NAC con diagnóstico etiológico ingresados en terapia intensiva en un hospital público entre 2006 y 2017.Resultados: Se incluyeron 250 episodios de NAC, 53 por SAMR-AC y 197 por otros agentes. Los pacientes con SAMR fueron más jóvenes (35,6±13,4 vs 43,1±12,4, p<0,001) y mostraron mayores tasas de infecciones de piel y estructuras relacionadas (IPER) (58,4% vs 2,0%, p<0,001), empiema (15,9% vs 5,0%, p=0,006), compromiso radiológico bilateral (81,1% vs 36,0%, p<0,001), promedio de score APACHE II basal (16,7±3,8 vs 13,2±4,3, p<0,001) y requerimiento de ventilación mecánica (VM) (33,9 vs 17,6 p=0,009). La tasa de mortalidad fue significativamente mayor para los pacientes con SAMR-AC (35,8% vs 11,1%, p<0,001). Las variables que se asociaron con SAMR-AC fueron IPER (OR 67,99, IC 5% 21,94-210,65), compromiso radiológico bilateral (OR 7,63, IC 95% 3,67-16,11), scoreAPACHE II ≥ 15 (OR 4,37, IC 95% 2,08-9,16), edad ≤ 35 años RESUMENTRABAJO COMPLETO(OR 3,60, IC 95% 1,77-7,29), empiema (OR 3,32, IC 95% 1,24-8,10) y VM (OR 2,85, IC 95% 1,36-5,86). Conclusión: En pacientes con NAC grave, la presencia de IPER, compromiso radiológico bilateral, score APACHE II ≥ 15, edad ≤ 35 años, empiema y VM se asociaron significativamente con mayor probabilidad de infección por SAMR-AC

ntroduction: Despite the incidence of community-acquired pneumonia (CAP) due to community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) being less than 10%, its presence should be considered in critical patients because of its high rate of mortality.Objectives: To identify risk factors associated with CA-MRSA in patients with severe CAP.Materials and method: A retrospective, observational study analysed episodes of etiological diagnosis in patients admitted in Intensive Care Unit in a public hospital between 2006 and 2017.Results: 250 episodes of NAC were included, among which 53 were caused by SAMR-AC and 197 by other agents. Patients with MRSA were the youngest (35.6±13.4 vs 43.1±12.4, p<0.001), and showed higher rates of skin and skin-structure infections (SSSI) (58.4% vs 2.0%, p<0.001), empyema (15.9% vs 5.0%, p=0.006), bilateral radiological compromise (81.1% vs 36.0%, p<0.001), average base-line APACHE II score (16.7±3.8 vs 13.2±4.3, p<0.001) and mechanical ventilation requirement rate (MV) (33.9 vs 17.6 p=0.009). The mortality rate was significantly higher than the one in CA-MRSA patients (35.8% vs 11.1%, p<0.001). The variables associated with CA-MRSA were SSSI (OR 67.99, IC 5% 21.94-210.65), bilateral radiological compromise (OR 7.63, IC 95% 3.67-16.11), APACHE II score ≥ 15 (OR 4.37, IC 95% 2.08-9.16), age ≤35 years (OR 3.60, IC 95% 1.77-7,29), empyema (OR 3.32, IC 95% 1.24-8.10) and MV (OR 2.85, IC 95% 1.36-5.86).Conclusion: The presence of SSSI, bilateral radiological compromise, APACHE II score ≥ 15, age ≤35 years, empyema and MV in patients with severe CAP was largely associated with higher probability of CA-MRSA infection

Tecidos de poliéster e suas implicações para confecção de jalecos / Polyester cloths and their implications for making white coats

A literatura científica reporta a contaminação microbiana dos jalecos utilizados por profissionais da saúde, no entanto não há consenso relacionando seu uso com a redução da exposição microbiana por risco ocupacional. O objetivo desta pesquisa foi avaliar tecidos de poliéster (oxford e microfibra) utilizados na confecção de jalecos, quanto à função de barreira física contra fluido e bactérias, nas perspectivas e desafios do controle de infecção na área da saúde. Trata-se de um estudo do tipo experimental / laboratorial in vitro realizado em três etapas. Na primeira etapa, os tempos de passagem do fluido através dos tecidos foram cronometrados e registrados em segundos desde o início do escoamento do fluido até as formações e quedas das últimas gotas. Na segunda etapa (microbiológica), inóculos padronizados das bactérias padrão de Staphylococcus aureus (ATCC 25923) e Pseudomonas aeruginosa (ATCC 27853) foram adicionadas ao fluido. Decorrida a passagem do fluido através dos tecidos, alíquotas de 50µL in natura e diluídas (10-1 a 10-5) foram semeadas na superfície de placas de Petri (60x15mm) com meios de cultura seletivos, incubadas a 37°C por 24h e o número de unidades formadoras de colônia das bactérias expresso por mililitro do fluido (UFC/mL). Na terceira etapa, as características estruturais dos tecidos e a retenção bacteriana foram analisadas por meio de microscopia eletrônica de varredura (MEV). Os dados obtidos foram submetidos aos testes de normalidade (Kolmogorov-Smirnov e Shapiro-Wilk) e, posteriormente, ao teste de U de Mann-Whitney por meio do software IBM SPSS Statistics (versão 25) e nível de significância ?=5%. A comparação entre as medianas dos tempos de passagem do fluido através dos tecidos de oxford e microfibra demonstrou diferença estatisticamente significante (p<0,001) independente das variáveis envolvidas (tecidos limpo ou limpo e passado, e tecidos autoclavado ou não autoclavado). Na etapa microbiológica, não foi observada diferença entre as medianas das cargas bacterianas dos tecidos de oxford e microfibra após a passagem do fluido com S. aureus (p=0,056) e P. aeruginosa (p=0,320). As análises por MEV permitiram evidenciar estruturas com formas irregulares e de cristal, bem como espaços (macroporos) entre os fios dos tecidos de oxford, que permitiram um menor tempo de passagem do fluido através do tecido. No entanto, não foi constatada a presença bacteriana na superfície dos tecidos. Em conclusão, diante dos dois tipos de tecidos utilizados na confecção de jalecos, o de microfibra apresentou maior tempo de passagem do fluido comparado ao de oxford, em decorrência das diferenças estruturais desses tecidos. Entretanto, a função de barreira física bacteriana após a passagem do fluido através dos tecidos não foi observada, o que reforça a necessidade de substituição do jaleco quando esse entra em contato com fluidos biológicos, visando à biossegurança: controle de contaminação/infecção na área da saúde

Scientific literature reports contamination of white coats used by health professionals, but there is not a consensus relating its usage to reduction of microbial exposure by occupational risk. The objective of this study was to evaluate Oxford and microfiber cloths used for making white coats, regarding its function as physical barrier to fluid and bacteria, in perspectives and challenges of infection control in health field. It is an in vitro experimental / laboratory study carried out in three stages. In the first stage, fluid passage times through the pieces of cloths were measured and registered in seconds since the beginning of fluid flow until formations and falls of the last drops. In the second stage (microbiological), standardized inocula of standard bacteria of Staphylococcus aureus (ATCC 25923) and Pseudomonas aeruginosa (ATCC 27853) were added to the fluid. After the passage of fluid through the pieces of cloths, in natura and diluted 50µL aliquots (10-1 to 10-5) were seeded on the surface of Petri dishes (60x15mm) with selective culture mediums, incubated at 37°C for 24h and the number of colony forming units of bacteria expressed by milliliter of fluid (CFU/mL). In the third stage, structural characteristics of cloths and bacterial retention were analyzed through scanning electron microscopy (SEM). The obtained data were submitted to normality tests (Kolmogorov-Smirnov and Shapiro-Wilk) and, later, to Mann-Whitney U test through IBM SPSS Statistics (version 25) software and ?=5% significance level. Comparison between medians of the fluid passage time through oxford and microfiber cloths showed statistically significant difference (p<0.001) independent of the involved variables (clean or clean and ironed cloths, and autoclaved or non-autoclaved cloths). In the microbiological stage, difference was not observed between medians of bacterial loads of Oxford and microfiber cloths after the passage of the fluid with S. aureus (p=0.056) and P. aeruginosa (p=0.320). The analyses by SEM allowed evidence structures with irregular and crystal shapes as well as gaps (macropores) between the threads of pieces of Oxford cloth, that allowed a shorter fluid passage time through the cloth. However, bacterial presence on the surface of cloths were not noticed. In conclusion, before the two types of cloths used for making white coats, the microfiber one presented longer fluid passage time compared to the Oxford one, due to the structural differences of these cloths. However, the functionality as bacterial physical barrier after fluid passage through the pieces of cloths were not observed, which reinforces the need to replace the white coat when it comes in contact with biological fluids, aiming at biosafety: contamination/infection control in health field

Resistência do Staphylococcus aureus à antimicrobianos: da suinocultura à saúde pública / Resistance of Staphylococcus aureus to antimicrobials: from swine to public health / Resistencia del Staphylococcus aureus a antimicrobianos: de la porcicultura a la salud pública

No cenário agroindustrial brasileiro a cadeia suinícola vem se destacando cada vez mais. A inserção no mercado internacional e as novas tecnologias aplicadas na prática de produção de suínos tem grande importância na economia do país. No entanto, algumas bactérias oportunistas estão presentes nas regiões nasais de suínos, sendo responsáveis por diversas alterações clínicas na suinocultura. Um dos principais patógenos que acomete esta espécie é o Staphylococcus aureus, responsável também por infeções nos seres humanos. O S. aureus possui características de virulência e resistência a diversos antibióticos, em especial à oxacilina, um antibiótico pertencente ao grupo ß-lactâmicos com ampla escala de utilização. A resistência do S. aureus à oxacilina está interligada a vários fatores, como a presença do gene mecA, que codifica a produção de uma proteína ligante e, assim, diminui a afinidade e a sensibilidade à ação de compostos antimicrobianos ß-lactâmicos. O uso errôneo de antibióticos é um dos fatores responsáveis por cepas resistentes e, a adição de melhoradores de desempenho nas rações de suínos, com a adição de antibióticos de forma preventiva pode favorecer e aumentar a existência de cepas multirresistentes, agravando ainda mais os dados já obtidos em pesquisas. A seleção destes genes resistentes causa preocupação à saúde coletiva, uma vez que indivíduos que tiveram contato com suínos e moradores residentes próximos as granjas apresentam cepas resistentes de S. aureus. Assim, a utilização de antibióticos de forma correta é fundamental para a redução dos índices de resistências à antibióticos..

Pig farming has been increasingly prominent in the Brazilian agroindustrial scenario. Its insertion in the international market and the use of new technologies applied to pig farming have been of great importance to the country's economy. Nevertheless, opportunistic bacteria present in the nasal regions of pigs are responsible for several clinical changes in the breeding of those animals. Staphylococcus aureus features among the main pathogens affecting that species, being also responsible for infections in humans. S. aureus is characterized by its virulence and resistance to several antibiotics, especially oxacillin, an antibiotic belonging to the ß-lactam group with a wide usage range. The resistance of S. aureus to oxacillin is linked to several factors, such as the presence of the mecA gene, which encodes the production of a binding protein and thus decreases the affinity and sensitivity to the action of ß-lactam antimicrobial compounds. Incorrect use of antibiotics is one of the factors responsible for generating resistant strains, and the addition of growth promoters in pig feeds with the addition of antibiotics as a form of prevention may favor and even increase the existence of multiresistant strains, further aggravating the current scenario, as expressed by data already obtained in research. The selection of these resistant genes is a matter of concern for collective health, since individuals that had contact with pigs and residents living near pig farms present S. aureus resistant strains. Thus, the correct use of antibiotics is pivotal for reducing the antibiotic resistance rates.

En el escenario agroindustrial brasileño la cadena porcina viene destacándose cada vez más. La inserción en el mercado internacional y las nuevas tecnologías aplicadas en la práctica de producción de cerdos, tiene gran importancia en la economía del país. Sin embargo, algunas bacterias oportunistas están presentes en las regiones nasales de cerdos, siendo responsables por diversas alteraciones clínicas en la porcicultura. Uno de los principales patógenos que acomete esta especie es el Staphylococcus aureus, responsable también por infecciones en los seres humanos. El S. aureus posee características de virulencia y resistencia a diversos antibióticos, en especial a la oxacilina, un antibiótico perteneciente al grupo ß-lactámicos con amplia escala de utilización. La resistencia del S. aureus a oxacilina está interconectada a varios factores, como la presencia del gen mecA, que codifica la producción de una proteína ligante y así disminuye la afinidad y la sensibilidad a la acción de compuestos antimicrobianos ß-lactámicos. El uso erróneo de antibióticos es uno de los factores responsables de cepas resistentes y, la adición de promotores de crecimiento en las raciones de cerdos, con la adición de antibióticos de forma preventiva, puede favorecer y aumentar la existencia de cepas multirresistentes, agravando aún más los datos ya obtenidos en investigaciones. La selección de estos genes resistentes causa preocupación a la salud colectiva, ya que individuos que tuvieron contacto con cerdos y residen cercano a las granjas presentan cepas resistentes de S. aureus. Así, la utilización de antibióticos de forma correcta es fundamental para la reducción de índices de resistencias a los antibióticos.

Intracellular reactive oxygen species production and phagocytosis of Staphylococcus aureus by milk neutrophils as tool to diagnose mastitis and identify susceptible dairy cows / Produção intracelular de espécies reativas de oxigênio e fagocitose de Staphylococcus aureus por neutrófilos lácteos como ferramentas para o diagnóstico da mastite e identificação de vacas leiteiras susceptíveis à mastite

The immune response capacity of the mammary gland plays a major role to determine if mastitis will or not be established. Thus, we hypothesize that a better understanding of polymorphonuclear neutrophil leukocyte (PMN) function will elucidate mechanisms that will improve our knowledge of how we could avoid an inflammatory process by increasing the immune capacity of the cow, and even further, to search for a tool to diagnose mastitis or a possible way to select and identify non-susceptible animals. The present study utilized 112 quarters from 28 Holstein dairy cows that were divided into quarters milk samples with somatic cell count (SCC) <2×105 cells mL-1 (n=72) and SCC >2×105 cells mL-1 (n=40). The percentages of milk PMNs and the levels of intracellular reactive oxygen species (ROS) and the phagocytosis of Staphylococcus aureus by milk neutrophils were evaluated by flow cytometry. Our results showed a higher percentage of neutrophils in quarter milk samples with high SCC (P=0.0003), and this group also had a significantly higher percentage of neutrophils that produced ROS (P=0.008). On the other hand, the phagocytosis intensity of S. aureus by milk neutrophils was higher in quarters with low SCC (P=0.003), suggesting a better mammary gland immunity against invading pathogens. Analyzing the results of the predictive values of the measured PMN functions, they cannot be used isolated as a good diagnosis test since none of them had a satisfactory sensitivity and specificity values, which was also confirmed by the Youden index values being far from one. In conclusion, the assessment of milk bovine neutrophil functions could improve our understanding of the cellular basis of mastitis. Although, the intracellular ROS production and S. aureus phagocytosis by milk neutrophil did not have high predictive values to detect intramammary infections, our results strengthen the idea that that poor bovine mammary gland neutrophil phagocytic ability may be associated with high SCC, and might be considered to identify susceptible dairy cows to mastitis.(AU)

A resposta imune da glândula mamária desempenha um papel importante ao determinar o estabelecimento da infecção. Desta forma, a melhor compreensão da função dos neutrófilos irá nos subsidiar conhecimentos, pelo qual podemos evitar o processo inflamatório pela otimização da resposta imune de bovinos leiteiros, e fornece ferramentas para diagnosticar a mastite ou um possível instrumento para identificar e selecionar animais resistentes à infecção intramamária, aumentando a produtividade do rebanho. O presente estudo utilizou 112 amostras provenientes de quartos mamários de 28 vacas Holandesas que foram divididos em amostras de leite com baixa (n=72; <2×105 células mL-1) ou alta (n=40; 2×105 células mL-1) contagem de células somáticas (CCS). A porcentagem de neutrófilos no leite, a produção intracelular de espécies reativas de oxigênio (ERO) e a fagocitose de Staphylococcus aureus pelos neutrófilos do leite foram avaliadas por citometria de fluxo. Os resultados do presente estudo demonstraram maior percentagem de neutrófilos (CH138+; P=0,0003) e percentagem de neutrófilos que produziram ERO (P=0,008) em amostras de leite com alta CCS. Por outro lado, a intensidade de fagocitose de S. aureus por neutrófilos em amostras de leite com baixa CCS (P=0,003), que demonstra maior atividade funcional destas células neste grupo. As funções neutrofílicas para o diagnóstico da mastite não apresentaram valores de sensibilidade e especificidade altos, que foram confirmados pelo índice Youden. Desta forma, conclui-se que a produção intracelular de ERO e fagocitose de S. aureus pelos neutrófilos do leite não apresentaram valores preditivos altos para detecção de mastite. Além disto, os resultados do presente estudo reforçam a ideia de neutrófilos do leite com menor capacidade fagocítica podem ser associados à alta CCS, e pode ser considerado como uma ferramenta para identificar animais mais susceptíveis à infecções intramamárias.(AU)

Detección y expresión de superantígenos y de resistencia antimicrobiana en aislamientos obtenidos de mujeres portadoras de Staphylococcus aureus que cuidan y alimentan niños / Detection and expression of superantigens and resistance in isolates from women carriers of Staphylococcus aureus who take care of and feed children

Resumen Introducción. Staphylococcus aureus coloniza mucosas y piel, y causa graves infecciones en el hombre y los animales. Es importante establecer el estatus de portadoras de cepas enterotoxigénicas de este microorganismo en manipuladoras de alimentos, con el fin de prevenir intoxicaciones alimentarias. Objetivo. Establecer las correlaciones entre los genes de enterotoxinas clásicas, el gen tsst-1, la producción de toxinas en cultivo y la resistencia antimicrobiana en aislamientos de S. aureus provenientes de manipuladoras de alimentos que cuidan niños en sus comunidades. Materiales y métodos. Se cultivaron muestras de las fosas nasales y las yemas de los dedos de las manos, y se identificó S. aureus empleando las pruebas de rutina y métodos automatizados. La extracción de ADN se hizo mediante el método de bromuro de cetil-trimetil-amonio (Cetyl-Trimethyl- Ammonium Bromide, CTAB) modificado. Para la detección de superantígenos se emplearon pruebas de reacción en cadena de la polimerasa (PCR) simple y múltiple, y para la de toxinas, estuches comerciales. Resultados. Se encontró que el 22,0 % de los aislamientos correspondía a portadoras de S. aureus: 17,0 % en los aislamientos de fosas nasales; 5,0 % en los de las manos y 6,7 % simultáneamente en los dos sitios. La prevalencia de superantígenos fue de 73,7 %. El genotipo más frecuente fue el sea-tsst-1, con 10,0 %. La resistencia a un solo antibiótico fue de 74,7 % y, a cuatro antibióticos, de 3,2 %; de los aislamientos, el 93,7 % correspondía a cepas productoras de betalactamasas. La detección de genes clásicos y de tsst-1 mediante PCR fue de 48,4 % y la de toxinas en el sobrenadante, de 42,1 %, con una correlación de 95,7 %. Las mayores correlaciones se establecieron entre las toxinas TSST-1 (22/22) y SEA (17/18). La correlación del gen tsst-1 con la proteína y la resistencia fue de 100 %. Todos los aislamientos con el genotipo sea-tsst-1 t fueron resistentes y productores de las toxinas. Conclusión. La tasa de aislamientos de S. aureus toxigénicos y resistentes obtenidos de mujeres que cuidan y preparan alimentos para niños fue de más de 70 %, lo que demostró su gran virulencia y la consecuente necesidad de aplicar estrictamente las normas higiénicas y sanitarias vigentes para evitar el riesgo de intoxicación alimentaria.

Abstract Introduction: Staphylococcus aureus colonizes mucous membranes and skin causing severe infections in humans and animals. It is important to determine carrier status of enterotoxigenic strains of this microorganism in food handlers to prevent food poisoning. Objective: To establish the correlations among classic enterotoxigenic genes, tsst-1 gene, the production of toxins in cultures and antimicrobial resistance in S. aureus isolates from women who handle the food, feed and take care of children in their communities. Materials and methods: Nasal swab and finger samples were cultured and S. aureus was identified using routine methods and automated systems. DNA extraction was done by the CTAB modified method, and superantigen detection by simple and multiplex PCR, while toxins were detected using commercial kits. Results: We found that 22.0% of subjects were S. aureus carriers: 17.0% corresponded to nose samples, 5.0% to hands and 6.7% to both nose and hands. The prevalence of superantigens was 73.7%. The most frequent genotype was sea-tsst-1 with 10%. Resistance to one antibiotic was 74.7%, and to four antibiotics, 3.2%; 93.7% of the isolates were betalactamase-positive. Classical genes and tsst-1 gene were detected by PCR in 48.4% of samples and toxins in supernatant were detected in 42.1% of them with 95.7% of correlation.The highest correlations were established for TSST-1 and SEA with 100% and 94.4%, respectively. The correlation of tsst-1 gene with toxin production and resistance was 100%. All isolates with genotype sea-tsst-1 were toxin-positive and resistant. Conclusion: The rate of toxigenic and resistant S. aureus isolates from women in charge of feeding and taking care of children was higher than 70%, which demonstrates its high virulence. This requires the strict application of hygienic and sanitary regulations in order to avoid the risk of food poisoning.

Analysis of colostrum IgA against bacteria involved in neonatal infections / Análise de IgA do colostro contra bactérias envolvidas em infecções neonatais

ABSTRACT Objective To describe e compare the specificity of IgA antibodies against bacteria extract of Klebsiella pneumoniae , Staphylococcus aureus , Escherichia coli , and Salmonella enteritidis . Methods Colostrum samples were aseptically collected in the first 12 hours after C-section delivery. The specificity of IgA against bacteria extracts was analyzed by the Western blot. Results The findings showed proteins of high molecular weight frequently detectable in the samples. S. aureus was the most frequently found bacterium in the samples (p<0.05). Approximately 93.8, 56.3, 62.5 and 60.4% of samples presented IgA reactive to S. aureus , K. pneumoniae , S. enteritidis, and E. coli, respectively. Roughly 40% of samples showed no IgA reactive to K. pneumoniae, S. enteritidis and E. coli . Conclusion Clinical evidence of the importance of breastfeeding for the immune protection of neonates was consistent with the observed immunological findings, since most samples showed IgA reactive against the species tested. The application and development of immunotherapies during pregnancy, focused on frequently detected antigens, could be an important tool to enhance the presence of IgA in colostrum.

RESUMO Objetivo Descrever e comparar a especificidade de anticorpos IgA de amostras de colostro contra extratos bacterianos de Klebsiella pneumoniae , Staphylococcus aureus , Escherichia coli e Salmonella enteritidis . Métodos As amostras de colostro foram coletadas assepticamente nas primeiras 12 horas após o nascimento por cesariana. A especificidade de IgA contra extratos de bactérias foi analisada por Western blot. Resultados Os achados mostraram proteínas de alto peso molecular frequentemente detectáveis nas amostras. S. aureus foi a bactéria mais encontrada nas amostras (p<0,05). Cerca de 93,8, 56,3, 62,5 e 60,4% das amostras apresentaram IgA reativa a S. aureus , K. pneumoniae , S. enteritidis e E. coli , respectivamente. Aproximadamente 40% das amostras não apresentaram IgA reativa contra K. pneumoniae , S. enteritidis e E. coli. Conclusão A evidência clínica da importância da amamentação para proteção imunológica ao recém-nascido foi consistente com os achados imunológicos observados, uma vez que a maioria das amostras mostrou IgA reativa contra as espécies testadas. A aplicação e o desenvolvimento de imunoterapias durante a gestação, focada nos antígenos frequentemente detectados, poderiam ser importantes instrumentos para aumentar a presença de IgA no colostro.

Influência da insulina sobre vias de sinalização envolvidas na peritonite provocada por inoculação de staphylococcus aureus em animais sadios e diabéticos / Influence of insulin on signaling pathways involved in peritonitis caused by inoculation of staphylococcus aureus in healthy and diabetic animals

Dentre tantas complicações do diabetes mellitus (DM), a infecção por bactérias comuns da microbiota superficial da pele como, por exemplo, a bactéria Gram-positiva Staphylococcus aureus, causadora de infecções como a peritonite, com altos índices de hospitalização e morte. A hipótese deste trabalho é a que o efeito da insulina na ativação das vias de sinalização MAPK, PKC e PI3K em peritonite induzida por S. aureus em animais diabéticos e não diabéticos possa regular a produção de citocinas. Foram utilizadas amostras de fígado, rim, linfonodos peritoniais e baço de animais oriundos de estudo anterior (Projeto FCF/USP-375), no qual animais diabéticos (aloxana, 42 mg/kg, i.v., 10 dias) e não-diabéticos com peritonite decorrente da infecção por S. aureus receberam uma dose de 4 UI e 1 UI de insulina NPH, respectivamente, por via subcutânea, 2 horas antes da infecção com S. aureus, e outras 3 doses de 2 UI e 0,5 UI às 17h00', respectivamente. A glicemia foi determinada no dia anterior, 10 dias após a injeção de aloxana e após os tratamentos com insulina. Em amostras de fígado, rim, linfonodo e baço dos animais supra citados foram avaliados a dosagem de citocinas (IL-1ß, IL-4, IL-10, TNF-α, CINC-1, CINC-2 e CINC-3) por ensaios de enzima-imunoensaio (ELISA); em homogenato de fígado foram avaliadas a expressão das moléculas das vias MAPK (fosfo P-38, fosfo ERK p42/44), PKC (fosfo PKC-α, fosfo PKC-δ) e PI3K (fosfo-AKT) pelo método de Western Blotting. Na avaliação do fígado, a insulina foi capaz de aumentar a concentração das citocinas IL-4 e TNF-α que apresentavam-se diminuídas em animais não diabéticos, em relação aos animais não diabéticos e não infectados, mas nos animais diabéticos, na infecção pela cepa N315, a insulina diminuiu a concentração de IL-4, que não estava alterada pela infecção, e não foi capaz de aumentar a concentração de IL-1ß que estava diminuída na infecção, em relação aos animais diabéticos e não infectados. Em linfonodos peritoniais de animais não diabéticos infectados pela cepa N315, a insulina diminuiu a produção de IL-1ß e IL-10, que não estavam alteradas na infecção, e diminuiu a concentração de IL-4, que estava aumentada na infecção, em relação aos animais não diabéticos e não infectados; em animais diabéticos, a insulina diminuiu a produção das citocinas IL-1ß e CINC-1, que estavam aumentadas, e aumentou a concentração de IL-10, que estava diminuída na infecção com a cepa N315, mas baixou a concentração de IL-4, em relação aos animais infectados, e na infecção pela cepa ATCC, a insulina aumentou a produção de IL-1ß, CINC-1 e CINC-3 dos animais tratados, em relação aos infectados e não tratados. Em baço, a insulina diminuiu a produção de IL-10 na infecção pela cepa ATCC tanto em animais não diabéticos quanto em animais diabéticos e, nesse último grupo, também aumentou a produção de CINC-3 em relação aos animais diabéticos não infectados; na infecção com a cepa N315, a insulina não aumentou a concentração de IL-1ß e TNF-α, que estavam diminuídas na infecção. Em rim, não houveram alterações significativas na produção de citocinas na infecção com nenhuma das cepas estudadas, nem para os grupos diabéticos, nem para os não diabéticos. Verificou-se que os animais diabéticos apresentam maior alteração tanto nas vias de sinalização estudadas quando na produção de citocinas pró-inflamatórias, quando comparados aos animais não diabéticos, na infecção por ambas as cepas de S. aureus estudadas. Assim, os resultados obtidos sugerem que o tratamento com insulina possa modular parcialmente a produção das citocinas IL-1ß, TNF-α e IL-10 no fígado e nos linfonodos peritoniais dos animais infectados principalmente pela cepa N315 de S.aureus, modulando parcialmente a expressão das moléculas da via de sinalização (MAPK e PKC), envolvidas na produção dessas citocinas

Among so many complications of diabetes mellitus (DM), infection by common bacteria of the superficial microbiota of the skin, for example, a gram-positive bacteria Staphylococcus aureus, causing infections like peritonitis, with high rates of hospitalization and death. The hypothesis of this study is that the effect of insulin on the activation of MAPK, PKC and PI3K signaling pathways in peritonitis induced by S. aureus in diabetic and non-diabetic animals may regulate the production of proinflammatory cytokines. Liver, kidney, peritonial lymph nodes and spleen samples of animals from the previous study (FCF / USP-375 Project) were used in this project; diabetic animals (alloxan, 42 mg / kg, iv, 10 days) and non-diabetic animals with peritonitis due to S. aureus infection received one dose of 4 IU and 1 IU of NPH insulin, respectively, subcutaneously, 2 hours before infection with S. aureus, and another 3 doses of 2 IU and 0.5 IU at 5:00 p.m., respectively. Blood glucose was determined the day before, 10 days after alloxan injection and after insulin treatments. In the liver, kidney, lymph node and spleen samples of the above-mentioned animals the cytokines (IL-1ß, IL-4, IL-10, TNF-α, CINC- 2 and CINC-3) by enzyme-immunoassay (ELISA) assays; we avaliated, by Western Blotting, the signaling pathways MAPK (phospho-P-38, phospho ERK p42 / 44), PKC (phospho PKC-α and phospho PKC-δ) and PI3K (phospho AKT) in liver, insulin was able to increase the concentration of cytokines IL-4 and TNF-α that were decreased in non-diabetic animals, in relation to non-diabetic and non-infected animals, but in diabetic animals, in strain N315, insulin decreased the concentration of IL-4, which was not altered by the infection, and was not able to increase the concentration of IL-1ß that was decreased in infection, relative to diabetic and uninfected animals. In peritonial lymph nodes from non-diabetic animals infected with the N315 strain, insulin decreased the production of IL-1ß and IL-10, which were not altered in the infection, and decreased the concentration of IL-4, which was increased in infection, in relation to non-diabetic and non-infected animals; in diabetic animals, insulin decreased IL-1ß and CINC-1 which were increased, and increased the concentration of IL-10, which was decreased in infection with strain N315, but decreased the concentration of IL-4 in Infected animals, and in infection by the ATCC strain, insulin increased the production of IL-1ß, CINC-1 and CINC-3 of treated animals over infected and untreated animals. In spleen, insulin decreased IL-10 production on infection by the ATCC strain in both non-diabetic and diabetic animals and, in this last group, also increased the production of CINC-3 in relation to uninfected diabetic animals; in infection with the N315 strain, insulin did not increased the concentration of IL-1ß and TNF-α, which were decreased in infection. In kidney, there were no significant changes in cytokine production in infection with any of the strains studied, neither for diabetic groups nor for non-diabetics. It was verified that diabetic animals present a greater alteration both in the signaling pathways studied and in the production of pro-inflammatory cytokines, when compared to non-diabetic animals, in the infection by both strains of S. aureus studied. Thus, the results suggest that insulin treatment may partially modulate the production of IL-1ß, TNF-α and IL-10 cytokines in the liver and in the peritonial lymph nodes of animals infected mainly with S. aureus strain N315, since they partially modulating the expression of signaling pathway molecules (MAPK and PKC), involved in the production of these cytokines

Passive acquisition of anti-Staphylococcus aureus antibodies by newborns via transplacental transfer and breastfeeding, regardless of maternal colonization

OBJECTIVE: To investigate the transmission of anti-Staphylococcus aureus (Sa) IgG, IgG1 and IgG2 via placental transfer and the transfer of IgA via the colostrum according to maternal Sa carrier status at delivery. METHODS: We evaluated anti-Sa IgG, IgG1 and IgG2 in maternal and cord sera and IgA in colostrum from a case (n=49, Sa+) and a control group (n=98, Sa-). RESULTS: Of the 250 parturients analyzed for this study, 49 were nasally colonized with S. aureus (prevalence of 19.6%). Ninety-eight non-colonized subjects were selected for the control group. The anti-Sa IgG, IgG1 and IgG2 levels and the IgG avidity indexes in the maternal and cord sera did not differ between the groups, with a low transfer ratio of anti-Sa IgG to the newborns in both groups. The anti-Sa IgG2 titers were significantly higher than the IgG1 titers in the maternal and cord sera. Inversely, the transfer ratios were higher for anti-Sa IgG1 compared with IgG2; however, no differences between the groups were detected. The Sa-specific IgA levels and avidity indexes in the colostrum were equivalent between groups. CONCLUSIONS: Maternal Sa nasal colonization at delivery is not associated with higher antibody levels in the mother or newborns. The high titers of anti-Sa IgG2 found in the cord serum indicate a greater reactivity with non-protein antigens, which may further contribute to the susceptibility to staphylococcal infections at birth. The presence of IgA in the colostrum with avidity to S. aureus reinforces the importance of breastfeeding shortly after birth.

Staphylococcal superantigen-specific IgE antibodies: degree of sensitization and association with severity of asthma / Anticorpos IgE específicos para superantígenos estafilocócicos: grau de sensibilização e associação com a gravidade da asma

ABSTRACT Objective: To determine the presence of staphylococcal superantigen-specific IgE antibodies and degree of IgE-mediated sensitization, as well as whether or not those are associated with the severity of asthma in adult patients. Methods: This was a cross-sectional study involving outpatients with asthma under treatment at a tertiary care university hospital in the city of Rio de Janeiro, Brazil. Consecutive patients were divided into two groups according to the severity of asthma based on the Global Initiative for Asthma criteria: mild asthma (MA), comprising patients with mild intermittent or persistent asthma; and moderate or severe asthma (MSA). We determined the serum levels of staphylococcal toxin-specific IgE antibodies, comparing the results and performing a statistical analysis. Results: The study included 142 patients: 72 in the MA group (median age = 46 years; 59 females) and 70 in the MSA group (median age = 56 years; 60 females). In the sample as a whole, 62 patients (43.7%) presented positive results for staphylococcal toxin-specific IgE antibodies: staphylococcal enterotoxin A (SEA), in 29 (20.4%); SEB, in 35 (24.6%); SEC, in 33 (23.2%); and toxic shock syndrome toxin (TSST), in 45 (31.7%). The mean serum levels of IgE antibodies to SEA, SEB, SEC, and TSST were 0.96 U/L, 1.09 U/L, 1.21 U/L, and 1.18 U/L, respectively. There were no statistically significant differences between the two groups in terms of the qualitative or quantitative results. Conclusions: Serum IgE antibodies to SEA, SEB, SEC, and TSST were detected in 43.7% of the patients in our sample. However, neither the qualitative nor quantitative results showed a statistically significant association with the clinical severity of asthma.

RESUMO Objetivo: Determinar a presença de anticorpos IgE específicos para superantígenos estafilocócicos e o grau de sensibilização mediada por esses, assim como se esses estão associados à gravidade da asma em pacientes adultos. Métodos: Estudo transversal incluindo asmáticos adultos em acompanhamento ambulatorial em um hospital universitário terciário no Rio de Janeiro (RJ). Os pacientes foram alocados consecutivamente em dois grupos de gravidade da asma segundo critérios da Global Initiative for Asthma: asma leve (AL), com asmáticos leves intermitentes ou persistentes, e asma moderada ou grave (AMG). Foram determinados os níveis séricos de anticorpos IgE antitoxinas estafilocócicas, e os resultados foram comparados por análise estatística. Resultados: Foram incluídos 142 pacientes no estudo: 72 no grupo AL (mediana de idade = 46 anos; 59 do sexo feminino) e 70 do grupo AMG (mediana de idade = 56 anos; 60 do sexo feminino). Na amostra geral, 62 pacientes (43,7%) apresentaram resultados positivos para dosagens de anticorpos IgE antitoxinas estafilocócicas: enterotoxina (TX) A, em 29 (20,4%); TXB, em 35 (24,6%); TXC, em 33 (23,2%); e toxic shock syndrome toxin (TSST), em 45 (31,7%). As médias das dosagens séricas de anticorpos IgE específicos anti-TXA, TXB, TXC e TSST foram, respectivamente, de 0,96 U/l, 1,09 U/l, 1,21 U/l, e 1,18 U/l. Não houve diferença estatisticamente significativa dos resultados qualitativos ou quantitativos entre os grupos. Conclusões: A presença de anticorpos IgE séricos anti-TXA, TXB, TXC e TSST, foi detectada em 43,7% nessa amostra de pacientes, mas não houve associação estatisticamente significativa entre seus resultados qualitativos ou quantitativos e gravidade clínica da asma.

Relationship between super antigenicity, antimicrobial resistance and origin of Staphylococcus aureus isolated / Relación entre superantigenicidad, resistencia antimicrobiana y origen de aislamientos de Staphylococcus aureus

Introduction: Staphylococcus aureus is a pathogen that causes food poisoning as well as hospital and community acquired infections. Objective: Establish the profile of superantigen genes among hospital isolates in relation to clinical specimen type, susceptibility to antibiotics and hospital or community acquisition. Methods: Eighty one isolates obtained from patients at Colombian hospital, were classified by antimicrobial susceptibility, specimen type and hospital or community acquired. The PCR uniplex and multiplex was used for detection of 22 superantigen genes (18 enterotoxins, tsst-1 and three exfoliative toxins). Results: Ninety five point one percent of isolates harbored one or more of the genes with an average of 5.6 genes. Prevalence of individual genes was variable and the most prevalent was seg (51.9%). Thirty nine genotypes were obtained, and the genotype gimnou (complete egc cluster) was the most prevalent alone (16.0%) and in association with other genes (13.6%). The correlation between presence of superantigens and clinical specimen or antimicrobial susceptibility showed no significant difference. But there was significant difference between presence of superantigens and the origin of the isolates, hospital or community acquired (p= 0.049). Conclusions: The results show the variability of the superantigen genes profile in hospital isolates and shows no conclusive relationship with the clinical sample type and antimicrobial susceptibility, but there was correlation with community and hospital isolates. The analysis of the interplay between virulence, epidemic and antibiotic resistance of bacterial populations is needed to predict the future of infectious diseases.

Introducción: Staphylococcus aureus, es un patógeno que causa intoxicación alimentaria e infecciones hospitalarias y comunitarias. Objetivo: Establecer el perfil de genes de superantígenos en aislamientos hospitalarios correlacionándolos con el tipo de muestra clínica, susceptibilidad antimicrobiana y origen hospitalario o comunitario. Métodos: Se analizaron 81 aislamientos de S. aureus de pacientes de un hospital colombiano. Fueron clasificadas por susceptibilidad antimicrobiana, tipo de muestra clínica y origen hospitalario o comunitario. Se detectó por PCR individual y múltiple 22 genes de superantígenos (18 enterotoxinas, una toxina del choque tóxico-1 y tres toxinas exfoliativas). Resultados: El 95.1% albergaban uno o más genes de superantígenos con un promedio de 5.6 genes. La prevalencia individual fue variable y el gen con mayor prevalencia fue seg (51.9%). Se obtuvieron 39 genotipos, y el genotipo gimnou (cluster egc completo) fue el de mayor frecuencia (16.0%) y asociado con otros genes (13.6%). La correlación de superantígenos frente a tipo de muestra clínica y susceptibilidad antimicrobiana no mostró diferencia estadística significativa, pero hubo diferencia significativa con el tipo de aislamiento hospitalario o comunitario (p= 0.049). Conclusiones: Los resultados muestran la diversidad genética en los aislados hospitalarios respecto a la presencia de superantígenos y no muestra una relación concluyente con el tipo de muestra clínica y susceptibilidad antimicrobiana pero sí con origen de los aislamientos comunitarios y hospitalarios. Un análisis de la interrelación entre la virulencia, epidemicidad y resistencia antimicrobiana de las poblaciones bacterianas es necesario para predecir el futuro de las enfermedades infecciosas.

Piomiositis tropical vs. leptospirosis / Tropical pyomyositis vs. leptospirosis

La piomiositis es una infección bacteriana aguda o subaguda del músculo esquelético, caracterizada por la formación intramuscular de uno o más abscesos. Presentamos un paciente con cuadro clínico sospechoso de Leptospirosis y que en el transcurso de su ingreso se le diagnostica la piomiositis tropical. Se describe la evolución del paciente, los estudios realizados y el tratamiento indicado por los especialistas.

Pyomyositis is an acute bacterial infection or subacute skeletal muscle characterized by intramuscular formation of one or more abscess. A patient with leptospirosis-suspected clinical condition is presented here. During the course of his hospitalization, he is diagnosed with tropical pyomyositis. Patient outcomes, studies and treatment prescribed by specialists are described.

Presence of Toll Like Receptor-2 in spleen, lymph node and thymus of Swiss albino mice and its modulation by Staphylococcus aureus and bacterial lipopolysaccharide.

Toll-like receptors (TLR) are a family of pattern recognition receptors identifying pathogen associated molecular patterns (PAMPs). They play a critical role in the innate immune response during the initial interaction between the infecting microorganism and phagocytic cells. Here, we verified the presence of TLR-2 in spleen, lymph node and thymus of Swiss albino mice and their modulation after infection with Staphylococcus aureus and Lipopolysaccharide (LPS) challenge. It was seen that TLR-2 gene transcribed to its respective mRNA on S. aureus infection, in thymus, spleen and lymph node of mice but their levels and mode of expression varied. When challenged with LPS no prominent changes in the expression of TLR-2 receptor was observed but its expression increased gradually with time in the thymus, spleen and lymph node of S. aureus infected mice. TLR-2 expression was also found enhanced in infected splenic macrophages. By studying the serum cytokine profile the functionality of the receptor was measured. The results indicate the presence of TLR-2 in thymus, spleen and lymph node of Swiss albino strain of mice and that they are modulated by S. aureus.

Nasal carriage of superantigen producing Staphylococcus aureus and its role in pathogenesis of allergic rhinitis and bronchial asthma

Staphylococcal enterotoxins can act as allergens and stimulate production of specific IgE with subsequent development of allergic manifestations. In addition, they act as superantigens that induce cytokine secretion with more increase of IL-4/IFN-gamma ratio causing augmentation of allergic reactions. Herein we tested the hypothesis that exposure to Staphylococccus aureus and its enterotoxins induces immunological changes that contribute to the pathogenesis of allergic rhinitis and bronchial asthma. This study included 45 air way allergic patients, and 45 controls. The following were done: intradermal allergy skin testing, invitro effect of staphylococcal enterotoxin B [SEB] on cytokine secretion from separated peripheral blood mononuclear cells, detection of nasal carriage of S. aureus and its enterotoxin production by ELISA and serum levels of total IgE, SEB-specific IgE and eosinophil cationic protein [ECP] were measured. We found that nasal carriage of enterotoxin producing S. aureus in allergic patients was significantly higher than in control. Blood eosinophilia, total IgEand ECP levels were significantly higher in S. aureus nasal carrier than non-carrier patients. On in vitro exposure of PBMCs to [SEB], IFN-gamma secretion was significantly less in patients than control and IL-4 secretion was significantly more in patients than control. SEB-specific IgE was detected in 15.6% of patients and not detected in control. There was a significant positive correlation between SEB-specific IgE level in patients and markers of severity of allergic reaction including blood eosinophilia, ECP and total IgE level. This study suggests that nasal carriage of enterotoxin producing S. aureus has a potential role in the development and severity of allergic airway diseases

Potencial antimicrobiano dos antissépticos de uso popular anapyon®, água rabelo® e malvatricin® sobre microrganismos do meio ambiente oral / Antimicrobial Potential of the Popular Antiseptics Anapyon®, Água Rabelo® and Malvatricin® against Oral Microorganisms

Objetivo: Verificar, ?in vitro?, o potencial antimicrobiano do Anapyon®, da Água Rabelo® e do Malvatricin® sobre microrganismos presentes na cavidade oral.Método: Para realização do experimento, utilizou-se o protocolo sequenciado durante quatro dias que avaliou, através da medida da densidade óptica, o potencial antimicrobiano dos fármacos nos microrganismos (Staphylococcus aureus, Candida tropicalis, Candida parapsilosis e Candida albicans), em suas formas planctônicas, apenas o Malvatricin® foi avaliado sobre as formas de biofilme por ser o único fármaco que apresentou resultados satisfatórios sobre as formas planctônicas. O estudo adotou como controle negativo a água destilada e controle positivo a Clorexidina®. Os resultados obtidos foram submetidos a uma análise estatística com os testes de Kruskal-Wallis e Mann-Whitney. Resultados: Observou-se, através da medida da densidade óptica, que apenas o Malvatricin® apresentou bons resultados na forma planctônica, sendo estes semelhantes ao controle positivo (clorexidina), considerado padrão nos ensaios antimicrobianos em Odontologia. Os resultados do Malvatricin® foram estatisticamente melhores quando comparados aos demais fármacos (Anapyon®, Água Rabelo®) e ao controle negativo. Este resultado foi semelhante para todos os microrganismos estudados: Staphylococcus aureus (p=0,002), Candida tropicalis (p=0,002), Candida parapsilosis (p=0,001) e Candida albicans (p<0,001). Desta forma, apenas o Mavatricin® foi testado para o microrganismo arranjado em biofilme. Observou-se, então, que para a C.albicans e para o S. aureus, houve diferença significativa entre clorexidina e Malvatricin® (p<0,05), com melhores resultados para o clorexidina. Para C. tropicalis, o Malvatricin® diferiu significativamente (p<0,05) da água destilada. Em relação a C.parapsilosis, nenhuma diferença foi observada em relação ao controle negativo (p=0,468). Conclusão: Apesar de alguns fármacos alternativos serem tidos como antimicrobianos, tais propriedades sobre células planctônicas e, principalmente, sobre biofilme foram observadas apenas para o Malvatricin®.

Objective: To evaluate in vitro the antimicrobial potential of Anapyon®, Água Rabelo and Malvatricin® against oral microorganisms.Method: The experiment used a four-day sequential protocol that evaluated by optical density measurements the antimicrobial potential of these products against Staphylococcus aureus, Candida tropicalis, Candida parapsilosis and Candida albicans in their planktonic forms. Only Malvatricin® was also evaluated against microbial biofilms because it was the only one to produce satisfactory results against the planktonic forms. Distilled water was used as negative control and Chlorhexidine® as positive control. The data were analyzed statistically by the Kruskal-Wallis and Mann-Whitney tests. Results: According to the optical density readings, only Malvatricin® was effective against the planktonic microorganisms and its results were similar to those of the positive control (Chlorhexidine), which is the gold standard antimicrobial agent in dental research. Malvatricin® presented significantly higher efficacy than the other antiseptics (Anapyon® and Água Rabelo®) and the negative control, and this result was similar for all tested microorganisms: S. aureus (p=0.002), C tropicalis (p=0.002), C. parapsilosis (p=0.001) and C. albicans (p<0.001). For this reason, only Malvatricin® was evaluated against the microorganisms arranged as biofilms. Chlorhexidine presented significantly better results (p<0.05) than Malvatricin® against C. albicans and S. aureus. When tested against C. tropicalis, Malvatricin® differed significantly (p<0.05) from distilled water, while against C. parapsilosis no significant difference (p=0.468) was observed in comparison with the negative control. Conclusion: Although some pharmaceutical products being considered anti-microbial, such properties against planktonic cells and especially the biofilms were observed only for Malvatricin®.

Trail to induce psoriatic skin lesion in the skin of BALB/C mice by injection of Staphylococcus aureus exotoxin

An In Vivo attempt to induce psoriatic lesions in the skin of BALB/C mice by injection of bacterial superantigen. Staphylococcus aureus that was isolated from skin lesions of psoriatic patients was subjected to gel filtration chromatography for extraction and purification of their exoproteins. The skin of BALB/C mice was injected by 0.2 ml of the extracted purified exo toxin. The induced lesions were markedly similar to that of human psoriatic lesions, although the histopathological changes were not completely mirrored to that of human psoriatic skin lesions. There is an important role of Staph. aureus exotoxin [superantigen] in induction, triggering and maintenance of psoriatic lesions

Biocompatibilidade e biodegradabilidade de micropartículas de poli-lactato-co-glicolato na ceratite infecciosa em coelhos / Biocompatibility and biodegradability of poly-latic-co-glycolatic microparticles in the infectious keratitis in rabbits

Avaliaram-se a biocompatibilidade e a biodegradabilidade do sistema de liberação controlada de poli-lactato-co-glicolato (PLGA) no tratamento com ciprofloxacina das ceratites por Staphylococcus aureus em coelhos. Foram utilizados 20 coelhos, distribuídos em quatro grupos (G). Os animais dos G1, G3 e G4 foram inoculados com 2,5µL da bactéria - 108UFC, no estroma corneano. Os do G2 não receberam a aplicação do inóculo. O tratamento foi realizado com solução salina básica para os animais do G1, micropartículas de PLGA contendo ciprofloxacina nos animais dos G2 e G4 e colírio de ciprofloxacina naqueles do G3. Suabe e biópsia da superfície ocular foram coletados para cultura. Apenas um animal do G1 apresentou cultura positiva para S. aureus. Exame histológico revelou a presença bacteriana em todos os animais do G1 e em dois animais do G3. Também foi constatada reação inflamatória no local da aplicação do sistema de liberação controlada. O tratamento com micropartículas de PLGA foi eficiente no tratamento de ceratites bacterianas, ao eliminar por completo a presença do S. aureus, mas entretanto não foi completamente biocompatível e biodegradável após cinco dias.

The biocompatibility and biodegradability of the controlled delivery system of Poly-Latic-Co-Glucolatic (PLGA) in the treatment of Staphylococcus aureus keratitis with ciprofloxacin in rabbits were evaluated. Twenty rabbits divided into four groups (G) were used. G1, G3 and G4 animals were inoculated with bacterial 2.5µL (108CFU) in the corneal stroma, and G2 animals did not receive the application of inoculum. The treatment was performed with basic saline solution in G1 rabbits, micro particles of PLGA containing ciprofloxacin in G2 and G4 animals, and ciprofloxacin eye drops in G3 rabbits. Swab and biopsy of the ocular surface were collected for culture. Only one animal in G1 had positive culture for S. aureus in the processed material. Histological examination showed a bacterial presence in all animals in G1 and two animals in G3. Inflammatory reaction was noted at the application site of the controlled release. Data analysis showed that treatment with micro particles of PLGA was effective in treating bacterial keratitis, completely eliminating the presence of S. aureus, but it was not being completely biocompatible and biodegradable after five days.

Distinct cytokine profiles of circulating mononuclear cells stimulated with Staphylococcus aureus enterotoxin A in vitro during early and late episodes of chronic osteomyelitis

We investigated the cytokine profile of peripheral mononuclear cells from chronic osteomyelitis (OST) patients following in vitro stimulation with staphylococcal enterotoxin A (SEA). We demonstrate that stimulation with SEA induced prominent lymphocyte proliferation and high levels of tumour necrosis factor (TNF)-α, interleukin (IL)-4 and IL-10 secretion in both OST and non-infected individuals (NI). Even though stimulation with SEA had no impact on IL-6 production in either patient group, the baseline level of IL-6 production by cells from OST patients was always significantly less than that produced by cells from NI. After classifying the osteomyelitic episodes based on the time after the last reactivation event as "early" (1-4 months) or "late" osteomyelitis (5-12 months), we found that increased levels of TNF-α and IL-4 in combination with decreased levels of IL-6 were observed in the early episodes. By contrast, increased levels of IL-10, IL-2 and IL-6 were hallmarks of late episodes. Our data demonstrate that early osteomyelitic episodes are accompanied by an increased frequency of "high producers" of TNF-α and IL-4, whereas late events are characterised by increased frequencies of "high producers" of IL-10, IL-6 and IL-2. These findings demonstrate the distinct cytokine profiles in chronic osteomyelitis, with a distinct regulation of IL-6 production during early and late episodes.

Specific IgE against staphylococcal enterotoxin [superantigens] in allergic rhinitis: an independent risk factor for severe bronchial asthma

The study aimed to investigate whether IgE to Staphylococcus aureus enterotoxins might be relevant to disease severity in adult asthmatic patients. Specific IgE antibody concentrations in serum against enterotoxins, grass pollen [GP], and house dust mite [HDM] allergens and total IgE levels were measured in 69 adult control subjects, 152 patients with non-severe asthma, and 166 patients with severe asthma. Severe asthma was defined as inadequately controlled disease despite high-dose inhaled corticosteroids plus at least 2 other controller therapies, including oral steroids. Statistical analysis demonstrated Enterotoxin IgE positivity which was significantly greater in patients with severe asthma [59.67%] than in healthy control subjects [13% P< .001]. Twenty-one percent of patients with severe asthma showing positive enterotoxin IgE were considered non atopic. Also statistical analyses demonstrated significantly increased risks for enterotoxin IgE-positive subjects to have severe asthma [95%] versus enterotoxin IgE-negative subjects. The presence of GP or house dust IgE antibodies was not associated with either significantly increased risk for asthma or severity. Oral steroid use and hospitalizations were significantly increased in patients with positive enterotoxin IgE and non-atopic asthma. GP IgE was associated with a higher FEV1 percent predicted value and enterotoxin IgE was associated with a lower FEV1 percent predicted value. Staphylococcal enterotoxin IgE antibodies, but not IgE against inhalant allergens, are risk factors for asthma severity. We hypothesize that the presence of enterotoxin IgE in serum indicates the involvement of Staphylococcal superantigens in the pathophysiology of patients with severe bronchial asthma

Determinación de staphylococcus aureus meticilino resistente de la comunidad (Sarm-com) en dos hospitales de Guatemala / Determination of methicillin resistant staphylococcus aureus community (Sarm-com) in two hospitals in Guatemala

El objetivo de este trabajo fue determinar cepas de Stapylococcus aureus meticilino resistente de la comunidad (SARM-com) en aislamientos provenientes de infecciones de la piel de pacientes del Hospital Roosevelt y hospital nacional Pedro de Betancourt de Guatemala. Para ello se realizó un estudio exploratorio de tipo descriptivo el cual consistió en un muestreo de 12 semanas en el laboratorio de microbiología del hospital Roosevelt y del hospital nacional Pedro de Betancourt. Se recolectaron las cepas que cumplieron con los siguientes criterios: haber sido identificadas como S. aureus, que presentaran resistencia a todos los betalactámicos, por medio de la resistencia a oxacilina y como resistencia variable a macrólidos y lincosamidas...

Empleo de inmunoterapia en pacientes con infección producida por Staphylococcus aureus / Immunotherapy employment in patient with infection produced by Staphylococcus aureus

La infección cutánea por Staphylococcus aureus constituye en estos momentos un problema de salud en nuestra población, por su elevada frecuencia, resistencia a la terapia antibiótica y por sus complicaciones. Se realizó un ensayo clínico, fase II, controlado, abierto y aleatorizado, con el objetivo de demostrar el efecto terapéutico y seguridad de la autovacuna como tratamiento de la estafilococia. Se incluyeron 457 pacientes con diagnóstico de Staphylococcus aureus en lesiones de piel, y se dividieron en dos grupos. El grupo A (237 pacientes), recibió la aplicación de la autovacuna obtenida a partir del microorganismo aislado en cada sujeto, y el grupo B (220 pacientes), recibió tratamiento antibiótico según resultados del antibiograma. Con la aplicación de la autovacuna, se obtuvo un 82 por ciento de curación, y sólo el 10 por ciento de los pacientes tuvo reaparición de forúnculos en el intervalo de 6 meses posterior a la terminación del tratamiento. Sin embargo, con la aplicación de la antibioticoterapia se observó un 12 por ciento de curación y un 75 por ciento de reaparición de forúnculos en ese intervalo de tiempo. La autovacuna resultó ser más eficaz en el tratamiento de la infección bacteriana por Staphylococcus aureus que los antimicrobianos, además de ser una inmunoterapia bien tolerada por la mayoría de los paciente

The skin infection by Staphylococcus aureus is currently a health problem in our population, because of its high frequency, resistance to the antibiotic therapy and its complications. We carried out a randomized, open, controlled, phase II clinical trial, with the objective of demonstrating the therapeutic effect and safety of the autovaccine as a treatment of the Staphylococcus infections. 457 patients with a diagnosis of Staphylococcus aureus in skin lesions were included, and they were divided in two groups. Group A (237 patients), received the autovaccine obtained form the micro organism isolated in each subject, and group B (220 patients), received antibiotic treatment according to the antibiogram results. With the application of the autovaccine, we obtained 82 per cent of healing, and only 10 per cent of the patients had the reappearance of furuncles in an interval of 6 months after finishing the treatment. However, with the application of the antibiotic therapy there was 12 per cent of healing and 75 per cent of reappearance of the furuncles in the mentioned time interval. The autovaccine was more effective in the treatment of the bacterial infection by Staphylococcus aureus that the antimicrobial agents besides being a good tolerated immunotherapy for most of the patients