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.

Frequência de genes codificadores de toxinas em Staphylococcus aureus isolados de leite de tanques expansão comunitários / Frequency of toxin-encoding genes in Staphylococcus aureus isolated from community milk tanks

A capacidade de produção de toxinas pelo Staphylococcus aureus no leite e produtos derivados está relacionado com surtos de intoxicação alimentar. Objetivou-se nesta pesquisa, estudar a ocorrência de genes que codificam para enterotoxinas estafilocócicas (sea, seb, sed, seg, seh e sei) e toxinas α e ß hemolítica (hla e hlb) em S. aureus isolados de 53 amostras de leite de tanques expansão comunitários no Estado de Alagoas, Brasil. Foram identificados 27 isolados (50,94%) como S. aureus pela amplificação do gene nuc. 13/27 isolados (48,1%) foram positivos para pelo menos um gene das enterotoxinas estudadas, sendo as frequências dos genes sea 33,3%, seh 18,5%, sei 11,1% e sed 7,4%; não entanto não foram identificados os genes seb e seg nestas bactérias. Para as toxinas hemolíticas, 51,9% dos isolados portavam ambos genes (hla e hlb), sendo a frequência para o gene hla de 81,5% e para o gene hlb de 51,9%. A frequência de genes das toxinas avaliadas é alta o que constitui um risco potencial para a saúde pública em especial, as enterotoxinas por serem termoestáveis e estarem asssociados com surtos de intoxicação alimentar.(AU)

The capacity of toxin production by Staphylococcus aureus in milk and dairy products is associated with food poisoning outbreaks. The objective of this research was to study the frequency of genes encoding staphylococcal enterotoxin (sea, seb, sed, seg, seh and sei) and α and ß hemolytic toxins (hla and hlb) in S. aureus isolates from 53 milk samples from community tanks in the State of Alagoas, Brazil. Twenty-seven isolates (50.94%) were identified as S. aureus by nuc gene amplification; 13/27 isolates (48.1%) were positive for at least one gene of the studied enterotoxins and the frequency of genes sea was 33.3%, seh 18.5%, sei 11.1% and sed 7.4%; the seb and sec genes have not been identified in the bacteria. For the hemolytic toxins, 51.9% of isolates harbored both genes (hla and hlb), the frequency of hla gene was 81.5% and 51.9% for the hlb gene. The evaluated toxin-encoding gene frequency is high and constitutes a potential risk for public health, especially staphylococcal enterotoxin genes; because they are heat-stable enterotoxins and have been associated with food poisoning.(AU)

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.

Correlación entre la detección de superantígenos y resistencia a oxacilina en aislamientos hospitalarios de Staphylococcus aureus / Correlation between detection of superantigens and oxacillin resistance of Staphylococcus aureus in hospital isolates

Objetivo: Establecer la correlacion entre la deteccion de superantigenos (MSSA) y la susceptibilidad a oxacilina de Staphylococcus aureus (MRSA) en aislamientos hospitalarios. Materiales y métodos: En 81 aislamientos de Staphylococcus aureus de origen hospitalario, la susceptibilidad a oxacilina se establecio por un sistema automatizado y la deteccion de 22 genes de superantigenos fue realizada mediante PCR individual y multiple. Resultados: La MRSA fue del 38,3%. Todos los aislamientos MRSA portaban uno o mas genes de superantigenos; y el 92% de MSSA. El numero de genotipos fue variable, pero un hallazgo relevante fue que el cluster egc solo fue detectado en MRSA (48,4%). Los genes no clasicos mas detectados en MRSA fueron sem (53,1%) y seg (28,4%); y sem (37%) y seq (30,9%) para MSSA. El gen sec clasico (13,6%) fue mas prevalente en MSSA, y en MRSA, los clasicos fueron de muy baja frecuencia. Para todos los genes, los genes seg , sej , sen , seo y seq mostraron diferencias estadisticamente significativas entre los aislamientos MRSA y MSSA. Conclusión: Este estudio no permitio sacar conclusiones concluyentes para establecer la relacion entre la deteccion de superantigenos y la susceptibilidad a oxacilina (MRSA vs. MSSA). Aunque, el numero de genotipos fue variable, la presencia del cluster egc solamente en aislamientos MRSA es un hallazgo interesante, y en posteriores estudios se podria determinar la importancia del cluster egc.

Objective: To establish the relationship between the detection of superantigens (MSSA) and Staphylococcus aureus resistance to oxacillin in hospital isolates. Material and methods: In 81 isolates of Staphylococcus aureus of hospital origin, an oxacillin susceptibility test was performed by an automated system and 22 superantigenic genes were obtained using single and multiplex PCR. Results: The MRSA was 38.3%. All MRSA isolates carried one or more genes for superantigens and 92.0% of MSSA. The numbers of genotypes for the 2 groups were variable, but the most important finding was that the egc cluster was detected only in MRSA (48.4%). The non-classic genes more often detected in MRSA were sem (53.1%) and seg (28.4%); in MSSA they were sem (37.0%) and seq (30.9%). The gen classic sec (13.6%) was more prevalent in MSSA and in MRSA; the classic genes were very low in frequency. For all genes, the genes: seg , sej , sen , seo and seq showed statistically significant differences between MRSA and MSSA isolates. Conclusion: This study did not reveal a clear relationship between the detection of superantigens and oxacillin susceptibility (MRSA vs. MSSA). Although the number of genotypes varied, the presence of egc cluster only in the MRSA isolate was an important finding. Further studies are needed to establish the importance of the egc cluster.

De genes de toxinas pirogénicas y toxinas exfoliativas en aislamientos clínicos de staphylococcus aureus en colombia

Introducción: staphylococcus aureus está asociado con graves enfermedades sistémicas causadas por superantígenos (toxinas pirogénicas y exfoliativas). Métodos: 100 aislamientos clínicos de S. aureus se identificaron por método automatizado y PCR, la prevalencia de genes de superantígenos por PCR múltiple y las correlaciones mediante la prueba exacta de Fischer. Resultados: en 38 aislamientos se observó que la prevalencia de los genes de enterotoxinas, toxina del síndrome de choque tóxico y toxinas exfoliativas fue 44%, 7% y 4%, respectivamente. La única correlación significativa (p = 0,045) fue entre la presencia de los genes de superantígenos y los aislamientos hospitalarios. Conclusiones: existe una alta prevalencia de genes de enterotoxinas y una baja de genes de toxinas exfoliativas y del síndrome de choque tóxico en aislamientos de S. aureus en esta población. Esta es la primera investigación que presenta datos de prevalencia de superantígenos en Colombia, y proporciona nueva información para América Latina.

Introduction: staphylococcus aureus is associated with serious systematic diseases caused by super antigens (pyogenic and exfoliating toxins). Methods: 100 clinical isolations for S. Aureus were identified by automatic methods and PCR, the prevalence of super antigen genes by multiple PCR and the correlations thru the Fischer exact test. Results: 38 isolation cases were observed and the prevalence of the enterotoxin genes, toxins of the syndrome of toxic shock and exfoliating toxins was 44%, 7% and 4% respectively. The only significant correlation found (p=0.045) was between the presence of the super antigen genes and the clinical isolations. Conclussion: there is a high prevalence of enterotoxin genes and a low prevalence of exfoliating genes and the syndrome of toxic shock in isolation of S.Aureus in this population. This is the first investigation that yields data of prevalence of super antigens in Colombia and provides new information for Latin America.

Introdução: staphylococcus aureus está associado a graves enfermidades sistêmicas causadas por superantígenos (toxinas pirogênicas e esfoliativas). Métodos: cem isolamentos clínicos de S. aureus foram identificados por método automatizado e PCR, a prevalência de penas de superantígenos por PCR múltiplos e correlações mediante a prova exata de Fischer. Resultados: em 38 isolamentos observou-se que a prevalência dos genes de en-terotoxinas, toxina da síndrome de choque tóxico e toxinas esfoliativas foi 44%, 7% e 4%, respectivamente. A única correlação significativa (p = 0,045) foi entre a presença dos genes de superantígenos e os isolamentos hospitalares. Conclusões: existe uma alta prevalência de genes de enterotoxinas e uma baixa de genes de toxinas esfoliativas e da síndrome do choque tóxico em isolamento de S. aureus nessa população. Esta é a primeira pesquisa que apresenta dados de prevalência de superantígenos na Colômbia e propicia nova informação para América Latina.

Células T y sus receptores αß y γδ en biopsias de pacientes con enfermedad periodontal / T cells and its receptords and αß and γδ in biopsies from patients with periodontal disease

El propósito de este estudio es determinar la presencia y localización de las células T y de sus receptores αβ y γδ en biopsias de tejido gingival de pacientes con enfermedad periodontal. Se evaluaron 60 biopsias de 12 pacientes, 4 con diagnostico de periodontitis agresiva, 4 con periodontitis crónica y 4 con gingivitis, las cuales fueron procesados para su análisis histológico, inmunohistoquímico e histomorfometrico. Al analizar los resultados por diagnostico los marcadores que mas predominaron fueron, en Gingivitis CD3, CD8 y TCR γδ en tejido conectivo. En Periodontitis crónica CD3, CD8 y TCR γδ en epitelio oral y CD4 el cual presentó una expresión homogénea en los tejidos analizados. En periodontitis agresiva CD3 y CD8 en epitelio crevicular, con una distribución similar entre CD4 y CD8 tanto en epitelio oral como en tejido conectivo y TCR γδ en conectivo. En cuanto a las cadenas variables del TCR Vβ los más expresados en las diferentes patologías estudiadas fueron el 6.7, 8.1 y 12 a nivel del tejido conectivo. Los estudios sobre la expresión de estas familias parecen indicar que es otra vía de activación a tener en cuenta dentro del modelo de la patogenia de la enfermedad y que debe ser estudiado en modelos longitudinales en pacientes con pérdida de inserción progresiva.

T the purpose of this study is identifying the presence and localization of T cells and their receptor αβ and γδ in biopsies of gingival tissue in patients with periodontal disease. 60 biopsies were evaluated in 12 patients, 4 patients with diagnosis of gingivitis, 4 patients with chronic periodontitis and 4 with aggressive periodontitis, which were processed for the histological, immunohistochemical and histomorphometric analysis. The results by diagnosis showed that in gingivitis the more predominant markers were CD3, CD8 and TCR γδ in connective tissue. In chronic periodontitis the markers with bigger expression were CD3, CD8 and TCR γδ in oral epithelium and CD4 that showed a homogeneous behavior in the analized tissues. In aggressive periodontitis CD3 and CD8 in surcular epithelium, TCR γδ in connective tissue and CD4 and CD8 with a similar distribution in oral epithelium and connective tissue. In relation with variable chains of TCR Vβ, the most predominat in the different diagnosis were 6.7,8.1 and 12 in connective tissue. The investigations about the expression of these families indicate that it can be other important via of activation in the pathogenesis of periodontal disease and it should be study in longitudinal models in patients with progressive loss of attachment level.