[Comparison of genetic patterns of E. coli strains isolated from patients with cystitis and pyelonephritis, using Pulsed Field Gel Electrophoresis]

Urinary tract infection [UTI] is one of the most frequently acquired bacterial infections caused by a large genetically heterogeneous group of Escherichia coli which are called uropathogenic E. coli [UPEC]. Cystitis and pyelonephritis are two most common symptoms seen in patients with UTI. The genetic diversity of this organism has hampered the identification of UTI strains and it is unclear whether all UPEC isolates are capable of causing both cystitis and pyelonephritis. Therefore, Careful selection of appropriate genotyping methods is mandatory. The most popular method is Pulsed Field Gel Electrophoresis [PFGE] that is used in the present study to evaluate the genetic patterns of UPEC. In this cross-sectional study a total of 90 E. coli strains consisting of 48 isolates causing pyelonephritis and 42 isolates causing cystitis in children were analyzed by PFGE and their corresponding patterns were compared. Sixty six PFGE profiles were obtained from the genome of E. coli strains by this genotyping method. Most strains exhibited twelve and thirteen bands and the patterns with eight or nineteen bands had the lowest rate. Genome size of strains was between 1610-4170 kbp. According to these results, it can be suggested that in some cases the strains causing pyelonephritis or cystitis have common patterns and different clinical symptoms could be attributed to different gene factors

Cólico renoureteral producido por gusano redondo (Ascaris lumbricoides) / Renoureteral colic produced by round worm (Ascaris lumbricoides)

Se presentó un caso de un paciente del sexo masculino de 57 años de edad que acudió al cuerpo de guardia de nuestro centro por presentar dolor intenso en región lumbar derecha con irradiación a flanco y genitales externos, acompañado de náuseas, vómitos y escalofríos, por lo que necesitó analgésico. Se estudió y se le orientó tratamiento médico. En su evolución a los 4 días expulsó parásito por uretra que fue llevado al laboratorio de parasitología. Se diagnostica Ascaris lumbricoides, y se le orienta tratamiento médico específico y estudios de laboratorio. Se hizo interconsulta con servicio de gastroenterología y el paciente ha evolucionado satisfactoriamente.

The case of a male patient aged 57 that received attention at the emergency department of our center for presenting acute pain on the right lumbar region that went to the flank and genitalia, accompanied with nausea, vomits and shills, that made necessary the administration of analgesics, was presented. The patient was studied and medical treatment was applied. At the four days of evolution the patient expelled a parasite through the urethra that was taken to the parasitology laboratory. Ascaris lumbricoides was diagnosed and specific medical treatment and lab studies were indicated. Interconsultation with the gastroenterology service was made and the patient has evolved satisfactorily.

Antibody isotypes in urethral swabs of symptomatic and asymptomatic men infected with trichomonas vaginalis

Trichomoniasis may be asymptomatic or symptomatic in both sexes. The outcome of infection depends on the virulence factors of T vaginalis, but these factors remain unclear. Genetic variability of the isolates and the host's immune response are likely to be key factors in that respect. Symptomatic and asymptomatic males infected with T. vaginalis were compared regarding the differences in antibody subclasses response in the urethral samples. In symptomatic cases there was a significant elevation in IgM, IgG1 and IgG2b levels in urethral samples, and a little, non-significant rise in IgG2a levels. However, there were no statistically significant differences between levels of IgA, IgG3 and IgG4. The results showed that specific IgG1 and IgM and to a lesser extent IgG2 may be involved in established symptomatic trichomoniasis in men, compared to asymptomatic ones

In vitro resistance to human platelet microbicidal protein among urethral staphylococcal and enterococcal isolates with its correlation with prostatitis.

The study was carried out to test the in vitro activity of human platelet microbicidal protein (hPMP) on most commonly isolated urethral pathogens and compare the same with clinical isolates from cases of chronic prostatitis (CP). Urethral isolates of Staphylococcus aureus (n=19), coagulase negative staphylococci (n=40) and Enterococcus faecalis (n=16) from patients with or without CP were tested. The hPMP susceptibility of bacterial strains was determined by exposing bacterial cells to serial dilutions of hPMP. A significantly higher proportion of CP-strains of coagulase negative staphylococci (91.3% vs 5.88%) was resistant to hPMP than was that of non-CP strains (P S.aureus studied, 77.8% were considered resistant to the bactericidal action of hPMP. All nine CP-strains of E.faecalis were highly resistant to hPMP. Most non-CP urethral isolates of S.aureus, coagulase negative staphylococci and E.faecalis were susceptible to the bactericidal action of hPMP, while CP isolates of all species were significantly more resistant to hPMP. Data from the present study may have significant implications in understanding the pathogenesis of CP.

Microbiota indígena de seres humanos / Indigenous microbiota of human beings

As superfícies do corpo humano são colonizadas por uma comunidade de organismos, principalmente bactérias, que constitui a microbiota indígena. A composição desta microbiota se altera ao longo da vida e é influenciada por diversos fatores, tais como dieta e status imunológico do hospedeiro. A microbiota pode agir de maneira benéfica ou, em algumas situações, pode ser prejudicial para o indivíduo. Podem ser distinguidas a microbiota residente, constituída por organismos específicos, encontrados, freqüentemente, em determinadas áreas e a microbiota transitória, que consiste de microrganismos provenientes do ambiente, que habitam a pele e as superfícies mucosas por horas ou poucas semanas. Trato gastrointestinal, vagina, cavidade oral e pele possuem a microbiota mais rica e diversificada do corpo humano. O conhecimento da constituição da microbiota indígena é extremamente relevante para os médicos, principalmente para orientar a interpretação de resultados de exames microbiológicos e a escolha da terapia antimicrobiana empírica mais adequada. Deve-se salientar que a microbiota geralmente é benéfica. Por esse motivo, é fundamental que se tenha consciência dos riscos do rompimento da homeostasia entre microbiota e hospedeiro.

Body surfaces are colonized by a community of organisms that are recognized as indigenous microbiota, that is mainly constituted by bacteria. Its constitution changes with time and is influenced by several conditions such as diet and the immune status of the individual, among others. There are now evidences that the microbiota could be beneficial or, in some instances, dangerous to human health. It could be classified as resident, composed by fixed organisms, frequently found in certain areas, or as transitory, consisting of organisms from the environment that inhabits skin and mucosa for hours to few weeks. The gastrointestinal tract, vagina, oral cavity and skin show the richest and most diverse microbiota of the human body. The knowledge of the constitution of the indigenous microbiota is extremely important for clinicians, mainly because it can help them to interpret results of microbiological tests and to choose appropriate empirical therapy. It should be pointed out that microbiota is, in general, harmless and beneficial; for these reason, physicians must keep in mind that the disruption of the homeostasis between microbiota and host should be avoided.

Infección por Chlamydia trachomatis en varones y su asociación con las alteraciones ginecológicas de su compañera sexual / Chlamydia trachomatis infection in men and its association to gynecologic alterations of his sexual mate

Objective.To determinate the frequency of Chlamydia trachomatis infection in male partners of infertile couples who attend to the infertility clinic at Instituto Nacional de Perinatologia, as well as to compare the clinical data and lifestyle between C. trachomatis-inifected and uninfected men to establish a possible association with gynecological damage in their sexual female partners. Methods. An open prospective study was performed in infertile couples, whose follow up was carried out at Instituto Nacional de Perinatologia between June 2000 and April 2001. Urethral and cervical swabs were obtained from each couple and the specimens were subjected to a C. trachomatis-specific liquid-phase hibridization test (PACE-2) and routine microbiological analysis. Semen analysis were also included. A relative risk (RR) test was done to analyze variables and square chi test was used to analize clinical and gynecological data from female partners and data from semen examination. Statistical differences were considered as significant when the p value was below 0.05. Results. C. trachomatis active infection was found in 14 out of 384 urethral swabs (3.6%). No significant alterations were observed in semen samples of C. trachomatis-infected men, as compared to non-infected individuals. Microbiological analyses of semen showed a significant isolation o/Mycoplasma sp (RR = 5.87, IC95% 1.4-24.7). Eight out of fourteen female partners of C. trachomatis-infected men were also infected with C. trachomatis (RR= 10.57, IC95% 5.67-19.7), Candida albicans was other pathogen isolated from 8/14 of those women (RR = 1.89, IC95% 1.17-3.05). Gynecological and obstetrical associations found among female partners of C. trachomatis-infected men were as follows: tubal adhesions in 10/14 (RR = 1.54, IC95% 1.08-2.18), salpingitis in 2/14 (RR = 2.2), history of ectopic pregnancies in 11/14 (RR =2.94, IC95% 1.01-8.53) and abnormal pregnancy loss in 9/14 (RR = 1.5). Conclusion. A low prevalence of C. trachomatis infection was observed among male partners of infertile couples as compared with other reports, but this discrepancy could be attributable to the specimen collection and diagnostic assay used. Otherwise, this data suggests that a chronic pathogen's antigenic stimulation may result in an increased formation of tubal adhesions and/or in ectopic pregnancies among female partners of C. trachomatis-infected individuals. Thus, preventive and control measures must be introduced into men's healthcare services, through laboratory and clinical examination, since these subjects are the main reservoirs of C trachomatis.

Objetivo. Determinar la frecuencia de infección por Chlamydia trachomatis y comparar la información clínica y el estilo de vida de varones con y sin infección por este patógeno, así como su asociación con las alteraciones ginecológicas que presenta su compañera sexual en un grupo de parejas que asisten a la Clínica de Infertilidad del Instituto Nacional de Perinatologia de la Ciudad de México. Métodos. Se realizó un estudio abierto, longitudinal y prospectivo en un grupo de parejas con diagnóstico de infertilidad, que fueron tratadas en el Instituto Nacional de Perinatologia durante el periodo de junio del 2000 a abril del 2001. Se recolectaron muestras uretrales y cervicales de cada pareja para el diagnóstico de C. trachomatis mediante la prueba de hibridación en fase líquida (PACE-2). También se recolectaron muestras de semen para el análisis de espermatobioscopia y se hicieron cultivos microbiológicos de rutina a las muestras cervicales y de semen. Los datos microbiológicos, clínicos y ginecológicos de los participantes fueron comparados por %z, el análisis de tendencia para proporciones fue usado para establecer el nivel de riesgo en las variables (RR). Las diferencias fueron consideradas estadísticamente significativas si p < 0.05. Resultados. Se analizaron un total de 384 muestras uretrales de varones, 14 presentaron infección activa por C. trachomatis (3.6%), Los datos de espermatobioscopia de los individuos positivos a C. trachomatis no mostraron alteraciones significativas con respecto al de varones no infectados con esta bacteria. El análisis microbiológico del semen mostró un número de aislamientos significativos de infección por Mycoplasma sp. (RR = 5.87, IC95% 1.40-24.70). En cuanto a las muestras cervicovaginales de mujeres con compañero sexual infectado por C. trachomatis, los patógenos aislados con mayor frecuencia fueron: Candida albicans en ocho de 14 (RR = 1.89, IC95% 1.17-3.05) y C. trachomatis en ocho de 14 (RR = 10.57, IC95% 5.67-19.7). Las asociaciones ginecológicas y obstétricas de la compañera sexual de varones positivos a C. trachomatis fueron adherencias tubáricas en 10 de 14 (RR = 1.54, IC95% 1.08-2.18), salpingitis en dos de 14 (RR = 2.2), antecedentes de embarazos ectópicos en 11 de 14 casos (RR = 2.94, IC95% 1.01-8.53) y abortos previos en nueve de 14 (RR = 1.5). Conclusión. Se observó una baja prevalencia de infección por C. trachomatis en los varones de mujeres infértiles en comparación con lo reportado por otros autores, esta diferencia puede estar dada por el método de diagnóstico y la toma del producto. Estos resultados sugieren que el estímulo constante del patógeno produce un aumento de adherencias tubáricas y embarazos ectópicos en las compañeras sexuales de los varones infectados con C. trachomatis. Por lo que una evaluación diagnóstica y de laboratorio deberá ser llevada a cabo en el varón como una medida de prevención y control para la infección por este patógeno, ya que estos individuos actúan como reservónos importantes de infección.

Relevant prevalence of Mycoplasma hominis and Ureaplasma urealyticum serogroups in HIV-1 infected men without urethritis symptoms

M. hominis and U. urealyticum are the better-known mycoplasma species pathogenic to the human genitourinary tract, causing mainly urethritis, bacterial vaginosis and pregnancy complications. In HIV-infected patients, the prevalence and role of these species is still not well known. The aim of this work was to determinate the prevalence of these species in this group of male patients (HIV group), in comparison to a group of men with clinical symptoms of urethritis (STD group). M. hominis was isolated from 7.5 per cent patients (8/106) and U. urealyticum from 18.9 per cent patients (20/106) from the HIV group, being among these 62.5 per cent and 85 per cent in significant concentrations, respectively. In the STD group these rates were 0.9 per cent (1/110) for M. hominis and 13.6 per cent (15/110) for U. urealyticum, being 100 per cent and 93.3 per cent in significant concentrations, respectively. We could demonstrate infection rates by these mycoplasma species in the HIV group as high as the one found in the STD one, what may indicate the occurrence of opportunistic infections in our population. This fact is discussed here because in immunosuppressed patients, specially M. hominis has been reported causing severe infections, even systemically.

Development of EIA for detection of Chlamydia trachomatis in genital specimens.

A double antibody sandwich enzyme immunoassay (EIA) for chlamydial antigen detection was developed using a monoclonal antibody against lipopolysaccharide (LPS) of Chlamydia trachomatis as a coating antibody. Polyclonal rabbit antiserum against partially purified antigen from elementary body (EB) antibody and horse-radish peroxidase conjugated goat anti-rabbit antibody were used as the primary and secondary antibody respectively. The developed EIA could detect protein of partially purified EB at the lowest concentration of 250 ng/ml. The assay was evaluated against the cell culture (CC), DNA hybridization assay (PACE2 system: Gen-Probe, San Diego, CA, USA) and a commercial enzyme immunoassay (kEIA) (Bioquest, NSW, Australia). The sensitivity, specificity, positive and negative predictive values of the developed EIA (dEIA) were 87, 96.2, 80, 97.7 for the specimens from females and 90.9, 90.7, 71.4, 97.5 for the specimens from males repectively. Cross reaction was not found with Escherichia coli, Acinetobacter anitratus, beta-Streptococcus group A, Enterobacter spp, Enterococcus, Lactobacillus spp, Neisseria spp, but it was found with Candida albicans and herpes simplex virus type 1. The developed EIA can be applied successfully for both genders, particularly males. The cost per test is less than those for CC, kEIA and PACE2.

Incidencia de E. Coli en infecciones urinarias / Incidence of E.coli in urinary infections

Se realizo un estudio bacteriològico en muestras de orina de pacientes atendidos en el Hospital San Gabriel durante el periodo comprendido entre mayo de 1994 a septiembre de 1995. El diagnòstico clìnico fuè ITU (Infecciòn del tarcto urinario); de dichas muestras, 414 evidenciaron una bacteria como microorganismo causal. El estudio realizado, demuestra a E. coli como agente causal màs frecuente en ITU (88,4 porciento), lo cual concuerda con reportes internacionales previos

Isolamento de Streptococcus agalactiae de gestantes na Regiäo Londrina-PR / Streptococcus agalactiae isolation in pregnants in the Region of Londrina-PR

O estreptococo do grupo B de Lancefield (EGB) é considerado a principal causa de infecçoes neonatais, com alta taxa de mortalidade (30 por cento) e seqüelas importantes nos sobreviventes. Neste trabalho decidimos identificar a prevalência de EGB na flora vaginal de gestantes da nossa regiao. Foram estudadas 100 gestantes atendidas no ambulatório e/ou pronto-socorro obstétrico do Hospital Universitário Regional do Norte do Paraná, em um período de três anos. As amostras obtidas das regioes peri-uretral e vaginal foram inoculadas em meio HPTH com 5 por cento de sangue de coelho desfibrinado, semeadas em ágar-sangue, submetidas à coloraçao de Gram, testadas quanto a produçao de catalase, crescimento em meio contendo NaCl a 6,5 por cento e prova de CAMP. Foi obtida prevalência de 15 por cento para a colonizaçao pelo EGB.

Carriage of Gardnerella vaginalis in the urethra of Indian men.

A total of 310 consecutive sexually active men attending sexually transmitted disease clinic of the Nehru Hospital, Chandigarh, were studied to assess the prevalence of G vaginalis. Non-gonococcal urethritis (NGU) was diagnosed in 53, acute gonococcal urethritis (AGU) in 20, psychosomatic disorders in 50 and genital ulcer disease in 187 patients. G. vaginalis was isolated in 11 patients (3.5%) only. Of these 11 isolates, 4(7.5%) were from patients with NGU, 2(10.0%) from men diagnosed to have AGU, 3(6%) from the patients with psychosomatic disorders and 2 isolates (1.7%) from patients with genital ulcer disease.

Microbiological study of urethritis in men attending a STD clinic.

A microbiological study of 275 male patients suffering from urethritis and 100 healthy male controls showed that Neisseria gonorrhoeae (130), Ureaplasma urealyticum (81), Staphylococcus aureus (38), and alpha and beta streptococci (34) were the common isolates. Specificity and sensitivity of the direct fluorescent antibody technique in the detection of N. gonorrhoeae in 130 urethral samples, were found to be 100 per cent. Penicillin (10 units/disc) resistance was found in 36.93 per cent of N. gonorrhoeae. Minimum inhibitory concentration of penicillin for 75 isolates of N. gonorrhoeae (including 5 beta lactamase producers) varied from 0.01-5 micrograms/ml with a 95 per cent confidence limit range of 0.26-0.61 microgram/ml. Most of the N. gonorrhoeae isolates tested were sensitive to norfloxacin and spectinomycin. Inclusion bodies of Chlamydia trachomatis were observed in 25 patients.

Detección de Chlamydia trachomatis en muestras uretrales mediante inmunofluorescencia directa / Detection of Chlamydia trachomatis in urethral samples by means of direct immunofluorescence

Em 82 doentes com uretrite foi pesquisada a presença de Chlamydia trachomatis, utilizando a prova da imunofluorescência direta, e de Neisseria gonorrhoeae, Mycoplasma e Ureaplasma, utilizando os métodos padröes. Ch trachomatis foi encontrada em 19.5 dos casos, sendo que em 11 deles (68,8) observou-se associaçäo entre Chlamydia e as outras bactérias pesquisadas. Nesses pacientes observou-se presença de secreçäo uretral escassa e de aspecto gelatinoso

Microbial flora of the urogenital tract in Saudi females

Urethral, Vaginal and cervical swabs from 91 urban healthy Saudi females were examined for micro-flora of the urogenital tract. Lactobacilli occurred mostly in the upper vagina and to a lesser extent in both the urethra and the cervix. Staph. epidermidis predominated in the urethra. Faecal bacteria [e.g. Streptococcus faecalis, E. coil, Entrococci and Bacteroids] were predominant in the urethra. 21% of females exhibited the presence of one type of bacteria whereas 34 and 20% exhibited the presence of two and three or more types of bacteria, respectively

Prevalênica de Chlamydia trachomatis em infecçöes uretrais e de colo de útero de pacientes da cidade de Bauru-SP, e comparaçäo entre os métodos de fluorescência direta e níveis de anticorpos séricos / Prevalency of Chlamydia tracomatis in uretheral and uterine cervix infections in patients from Bauru, SP, and comparison between direct fluorescence methods and levels of serum antibodies

Os autores abordam o assunto colocando as infecçöes clamídicas como um problema de saúde pública do país. Através de estudos com 461 indivíduos do sexo masculino e 71 do feminino, foram feitas correlaçöes com a literatura e observou-se que a situaçäo da cidade de Bauru, no que se refere a esta prevalência, é concordante com os dados de outras localidades. O estudo comparativo dos casos positivos através de duas metodologias de coleta e execuçäo mostra que os resultados säo concordantes, e propöe-se uma técnica relativamente fácil para ser usada na rotina de laboratórios clínicos

O problema da Neisseria gonorrhoeae produtora de penicilinase e sua possível ocorrência na cidade de Säo Paulo / The problem of penicillinase - producing Neisseria gonorrhoeae and its possible occurrence in the city of Sâo Paulo

A Neisseria gonorrhoeae produtora de penicilinase (NGPP) desde 1976 vem constituindo motivo de preocupaçäo para autoridades sanitárias. Nas regiöes africanas e sudeste asiático a NGPP é responsabilizada por mais de 10% dos casos de gonorréia e, em algumas localidades mais de 50%. Levantou-se a hipótese de que a NGPP pudesse apresentar quadro epidemiológico significante na cidade de Säo Paulo. Como avaliaçäo preliminar, procurou-se detectar a ocorrência entre os pacientes que procuraram espontaneamente o Serviço de Doenças Sexualmente Transmissíveis do Centro de Saúde "Geraldo Horácio de Paula Souza" da Faculdade de Saúde Pública da Universidade de Säo Paulo, entre 23 de abril de 1985 a 14 de outubro de 1986. Os resultados deste estudo preliminar registram a existência de NGPP na cidade de Säo Paulo, ocorrendo em 2,8% do conjunto estudado. Säo ainda observadas algumas características importantes, possivelmente ligadas ao fenômeno de manutençäo e propagaçäo destas cepas, o que proporcionou hipóteses quanto a possível situaçäo atual e futura da NGPP na cidade de Säo Paulo.