Serotipos prevalentes de Streptococcus mutans en América Latina / Prevalent serotypes of Streptococcus mutans in Latin America

La microbiota oral está conformada por diversas especies bacterianas que en condiciones normales desempeñan una función protectora del huésped; sin embargo, cuando existe un desequilibrio en el ecosistema, estos microorganismos son capaces de producir diversas manifestaciones como lo es el caso de la caries dental, enfermedad infecciosa producida principalmente por Streptococcus mutans, patógeno capaz de desmineralizar los tejidos duros del diente mediante la fermentación de hidratos de carbono obtenidos de la dieta. Se ha identificado en la pared celular de este microorganismo ocho serotipos que intervienen en la adhesión, agregación y coagregación bacteriana. En los seres humanos S. mutans presenta los serotipos c, e y f, siendo el serotipo c el más prevalente a nivel mundial, el cual se conoce que está asociado a pacientes sanos, a diferencia del e y f que son capaces de invadir las células endoteliales de las arterias coronarias. No obstante, en los últimos años se ha logrado identificar el serotipo k que de igual manera presenta alta capacidad de invadir el endotelio humano, actuando en la patogénesis de las enfermedades cardiovasculares. El objetivo de la presente revisión bibliográfica es lograr cuantificar los serotipos prevalentes de S. mutans en América Latina (AU)

The oral microbiota is made up of various bacterial species that under normal conditions perform a protective function of the host, however, when there is an imbalance in the ecosystem, these microorganisms are capable of producing various manifestations such as caries, an infectious disease. produced mainly by Streptococcus mutans, a pathogen capable of demineralizing the hard tissues of the tooth through the fermentation of carbohydrates obtained from the diet. Eight serotypes involved in bacterial adhesion, aggregation and coaggregation have been identified in the cell wall of this microorganism. In humans, S. mutans presents serotypes c, e, and f, serotype c being the most prevalent worldwide, which is known to be associated with healthy patients, unlike e and f, which are capable of invading the endothelial cells of the coronary arteries. However, in recent years it has been possible to identify serotype k, which also has a high capacity to invade the human endothelium, acting in the pathogenesis of cardiovascular diseases. The objective of this literature review is to quantify the prevalent serotypes of S. mutans in Latin America (AU)

Impact of PCV10 on pediatric pneumococcal disease burden in Brazil: time for new recommendations?

Abstract Objective: To describe the impact of the 10-valent pneumococcal conjugate vaccine on the pediatric burden of pneumococcal infections, carriage, serotype replacement, and antimicrobial resistance in Brazil since its introduction in 2010. Data source: A narrative review of English, Spanish, and Portuguese articles published in online databases and in Brazilian epidemiological surveillance databases was performed. The following keywords were used: Streptococcus pneumoniae, pneumococcal disease, conjugate vaccine, PCV10, antimicrobial resistance, and meningitis. Summary of the findings: Declines in hospitalization rates of all-cause pneumonia occurred in the target age groups and some age groups not targeted by vaccination early after the use of PCV10. Large descriptive studies of laboratory-confirmed pneumococcal meningitis and hospital-based historical series of hospitalized children with IPD have evidenced a significant impact on disease burden, in-hospital fatality rates, and admission to the intensive care unit before and after the inclusion of the vaccine. Impact data on otitis media is limited and inconsistent; the main benefit remains the prevention of complicated diseases. During the late post-vaccine years, a significant and progressive increase in high-level penicillin non-susceptibility pneumococci has been described. Since 2014 serotype 19A has been the leading serotype in all ages and was responsible for 28.2%-44.6% of all IPD in children under 5 yrs. Conclusions: PCV10 has performed a significant impact on IPD in Brazil since 2010, however, progress has been continuously hampered by replacement. Broader spectrum PCVs could provide expanded direct and indirect protection against ST19A and other additional serotypes of increasing importance if administered to children in the Brazilian National Immunization Program.

Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines

ABSTRACT Background: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. Methods: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others Results: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly.

An overview of dengue viral infection circulating in Pakistan

Background & objectives: Dengue virus (DENV) is an RNA virus that infects approximately 2.5 billion people around the world. The incidence of dengue fever has rapidly increased at an alarming rate in the last few years and has affected thousands of people in Pakistan. This review explores the prevalence, serotypes and pathogenesis of dengue virus circulating in Pakistan. Methods: A systematic review of observational studies published between 1994 and December 2019 was performed. All records of the confirmed outbreak of dengue fever in Pakistan were reviewed and articles containing no primary data were excluded. Results: Four identified serotypes of dengue virus (DENV 1-4) circulate in different regions of the world causing epidemics. The most prevalent serotype, which is still epidemic and dominant in Pakistan, is DENV-2. Many factors like over-population, rapid urbanization, travelling, lack of vector control in dengue endemic areas and inadequate health-care are responsible of dynamic and huge raise of dengue in Pakistan. Interpretation & conclusion: Currently there is no specific treatment for prevention of dengue virus. Recently some antiviral compounds were being tested to eradicate this disease. There is a need to develop an efficient and safe vaccine for all four serotypes to combat dengue viral infection globally and particularly in Pakistan.

Morbilidad materna extrema (near miss) por dengue grave. Reporte de un caso / Extreme maternal morbidity (near miss) for severe dengue. A case report

Resumen INTRODUCCION: El dengue es causado por un virus perteneciente a la familia Flaviviridae; existen cuatro serotipos relacionados: DENV-1, DENV-2, DENV-3, DENV-4 trasmitidos por picadura del mosquito hembra de las especies Aedes aegypti y Aedes albopictus. CASO CLÍNICO: Paciente de 19 años, con 36 semanas de embarazo por fecha de la última menstruación y diagnóstico de dengue por serología positiva (Ag-NS1) y trombocitopenia (68,000/mm3). El padecimiento se inició con fiebre de 38.0°C, de tres días de evolución acompañado de artralgias, mialgias, dolor retro ocular y contracciones uterinas. La paciente se ingresó al área de terapia intensiva debido a insuficiencia respiratoria (que ameritó ventilación mecánica invasiva), insuficiencia renal aguda y hematológica, posterior a cesárea. Ameritó reintervención quirúrgica por sangrado intrabdominal por trastornos de la coagulación. Durante su estancia hospitalaria requirió 50 concentrados plaquetarios, 8 concentrados eritrocitarios, 14 plasmas frescos y 4 aféresis plaquetarias. Después de 14 días de estancia hospitalaria se dio de alta por mejoría clínica. CONCLUSIÓN: Si no se actúa inmediatamente, el dengue grave es una causa de desenlace fatal madre-hijo. La identificación oportuna de las complicaciones agregadas a esta enfermedad en la embarazada denota la importancia de la prevención, el diagnóstico temprano y su tratamiento. De igual manera, es importante que en pacientes embarazadas con esta comorbilidad el servicio de Obstetricia intervenga oportunamente en la vigilancia pre y posquirúrgica.

Abstract BACKGROUND: Dengue is caused by a virus belonging to the Flaviviridae family, there are four related serotypes: DENV-1, DENV-2, DENV-3, DENV-4 transmitted by the bite of the female mosquito of the species Aedes aegypti and Aedes albopictus. CLINICAL CASE: 19-year-old female patient, 36 weeks pregnant by date of last menstrual period and diagnosed with dengue due to positive serology (Ag-NS1) and thrombocytopenia (68,000/mm3). The illness started with fever of 38.0°C, of three days of evolution accompanied by arthralgias, myalgias, retro ocular pain and uterine contractions. The patient was admitted to the intensive care unit due to respiratory failure (which required invasive mechanical ventilation), acute renal and hematologic failure, following cesarean section. She required surgical reintervention for intra-abdominal bleeding due to coagulation disorders. During her hospital stay she required 50 platelet concentrates, 8 erythrocyte concentrates, 14 fresh plasmas and 4 platelet apheresis. After 14 days of hospital stay he was discharged due to clinical improvement. CONCLUSION: If no immediate action is taken, severe dengue is a cause of fatal mother-child outcome. The timely identification of the complications associated with this disease in pregnant women highlights the importance of prevention, early diagnosis and treatment. Similarly, it is important that in pregnant patients with this comorbidity, the obstetrics service should intervene in a timely manner in pre- and post-surgical surveillance.

Antimicrobial susceptibility and serotypes of Neisseria meningitidis and Streptococcus pneumoniae in Sri Lanka: Experience from the National Reference Laboratory

Objective: To determine the antimicrobial susceptibility and serotypes of Neisseria (N.) meningitidis and Streptococcus (S.) pneumoniae in Sri Lankan patients. Methods: We retrospectively analyzed 11 blood culture specimens from suspected patients with invasive meningococcal disease and 26 S. pneumoniae clinical isolates. We tested 6 antimicrobials against N. meningitidis and 12 antimicrobials against S. pneumoniae. Meningococcal serogroup was determined by realtime PCR and Quellung serotyping was used for pneumococcal analysis. Results: N. meningitidis serogroup B was the most common in this study. Intermediate-susceptibility to penicillin was seen in 75.0% (6/8) of strains. Susceptibility to ciprofloxacin, levofloxacin and cotrimoxazole was 62.5% (5/8), 62.5% (5/8) and 87.5% (7/8), respectively. Excellent susceptibility was seen in cefotaxime and meropenem. In S. pneumoniae, the most common serotype was 19F in both invasive and non-invasive pneumococcal diseases. The majority of strains showed multidrug resistance. Penicillin non-susceptibility in non-meningeal strains were 13.6% and all meningeal strains were penicillin resistant. Erythromycin was highly resistant in both groups. Amoxicillin showed excellent susceptibility in non-invasive pneumococcal diseases strains. Linezolid, levofloxacin and vancomycin showed 100.0% susceptibility in all pneumococcal isolates. Conclusions: Implementation of vaccines should be considered, especially for children and high-risk populations. This may contribute to reducing pneumococcal and meningococcal invasive disease burden and help prevent emergence of antimicrobial resistant strains.

Detection of putative Salmonella enterica in retail chicken egg from a selected public market in the City of Manila

Background@#Salmonellosis is one of the most reported bacterial foodborne illnesses worldwide. Salmonella outbreaks are also prevalent in the Philippines, with egg-containing food and feces of chicken as implicated sources. The presence of Salmonella in eggshells and in egg content poses a significant threat to public health. Hence, this study aimed to determine the presence of S. enterica from different parts of chicken eggs sold in a public market in the City of Manila. @*Methodology@#A descriptive study design was employed to detect the presence of Salmonella spp. in different parts of retail chicken eggs. A total of 72 egg samples from 24 stalls were included. The methodology for isolation and identification of Salmonella followed the guidelines set by the US Food and Drug Administration as seen in the Bacteriological Analytical Manual with some additions and modifications. @*Results@#Contaminated eggs were found in 21 (87%) of the 24 stalls. A total of 29 (40%) out of 72 eggs were identified as the source of putative Salmonella isolates. Nineteen (66%) eggs had putative Salmonella isolates from the eggshell, while 7 (24%) had putative Salmonella isolates from the egg content. There were three (10%) eggs with both eggshell and egg content possibly contaminated with Salmonella. @*Conclusion@#The presence of putative Salmonella and Enterobacteriaceae highlight the need to strengthen food safety at the production and distribution levels of retail chicken eggs. There is also a need to establish a national surveillance system along with strengthened diagnostic capacity for S. enterica in the Philippines.

Co-Circulation of Dengue Serotypes in Coastal Andhra Pradesh, India - A Descriptive Study

Dengue is an acute febrile illness caused by mosquito-borne dengue viruses (DENV S) consisting of four serotypes (DENV 1 - 4) from flaviviridae family, genus flavivirus. These four are antigenically related serotypes designated as DEN V - 1, DEN V - 2, DEN V - 3 and DEN V – 4. In this context, the present study focuses on the circulating serotypes of dengue in coastal Andhra Pradesh. METHODSStudy was done at Andhra Medical College, Visakhapatnam, teaching hospital in Andhra Pradesh. Acute phase dengue serum samples were collected and tested for NS1 antigen and antihuman IgM antibodies by enzyme linked –immunosorbent assay (ELISA). NS1 positive samples were further serotyped by reverse transcriptase real time polymerase chain reaction (R RT - PCR). RESULTSA total of 796 serum samples were included in the study. 300 (37.7 % ) samples were positive for NS1 and IgM antibodies. 192 NS1 antigen positive samples were further processed for serotyping by r RT PCR. Among these samples 72 were negative by r RT PCR. DENV-2 (41 %) was the predominant serotype followed by DENV-4 (37 %), DENV-3 (12 %) and DENV-1 (10 %) in the descending order. CONCLUSIONSAll the four dengue serotypes are in co-circulation. Among all the four types, DENV-2 was predominant, followed by DENV-4. By knowing the predominant serotype in circulation, we can forecast dengue outbreaks and take necessary measures like control of vectors.

Trend of Dengue Viral Infection and Circulating Serotypes in Tripura, North East India.

One of the major causes of morbidity and mortality in tropical and subtropical regions is Dengue viral infection. This virus belongs to family flaviviridae comprising of four antigenically distinct serotypes DENV 1 - 4. A small number of studies conducted in North Eastern (NE) Region of India reported Dengue cases in Assam, Meghalaya, Nagaland, Manipur and Arunachal Pradesh. However, no studies have been conducted in the state of Tripura, with regard to pattern of Dengue viral infection and its circulating serotypes. Therefore, this study was undertaken to identify the serotypes circulating in Tripura. MethodsPatients with acute febrile illness were tested for detecting Dengue viral infection by MAC ELISA and / or NS1 detection test at Viral Research and Diagnostic Laboratory (VRDL), of a tertiary care centre in Tripura for a period of 3 years. All NS1 positive samples were further tested for presence of viral RNA by Reverse Transcriptase –PCR (RT - PCR) and serotyping was done using serotype specific primers. ResultsA total of 2515 acute febrile cases seen over a period of 3 years from 2014 to 2017 was tested for Dengue virus infection by serology. Out of 2515 of cases, 405 cases tested for NS1 antigen, where 10.61 % (43 / 405) was NS1 positive. The remaining 2110 cases were tested for IgM antibody MAC ELISA and 15.68 % (331 / 2110) was MAC ELISA positive. Out of all NS1 antigen positive cases 34.88 % of PCR positive and serotype characterisation showed DENV - 1 was predominant serotype followed by DENV - 2 and DENV - 4 respectively. ConclusionsThere is a rising trend of Dengue virus infection in Tripura with circulation of multiple serotypes. Moreover, cocirculation of multiple serotypes is a risk to the emergence of recombinant strains and also heterotypic infection in the near future might lead to development of DHF and DSS. Hence, molecular characterization of circulating serotypes may be helpful in addressing the probabilities of Dengue outbreak and possibilities of complications.

Frecuencia de Streptococcus pneumoniae aislados de enfermedad invasiva en Paraguay, serotipos y perfil de sensibilidad (2010-2018) / Frequency of Streptococcus pneumoniae isolated from invasive disease in Paraguay, serotypes and sensitivity profile (2010-2018)

Streptococcus pneumoniae sigue siendo una de las causas más importantes de morbilidad y mortalidad en niños y adultos alrededor del mundo. El objetivo del estudio fue describir la frecuencia de aislamiento de S. pneumoniae en enfermedad invasiva, distribución de serotipos y sensibilidad antimicrobiana en Paraguay (2010-2018). Se estudiaron 793 cepas de S. pneumoniae aisladas de pacientes de todas las edades con enfermedad invasiva en Paraguay, provenientes de los diferentes centros centinelas y colaboradores en el marco de la vigilancia de meningitis y neumonías, durante el periodo 2010-2018. La frecuencia general según diagnóstico resultó 74.9% de neumonías (n=594), 18.4% de meningitis (n=146) y 6.7% de sepsis (n=53). El serotipo 14 fue más frecuente con 174 aislamientos (22.0%), seguido del serotipo 19A con 84 aislamientos (10.6%), el serotipo 3 con 66 aislamientos (8.3%) y el 6A con 37 aislamientos (4.7%). En meningitis se registró una frecuencia general de resistencia a penicilina del 32,2% y de ceftriaxona del 1,4%. En los casos de no meningitis la resistencia a penicilina fue del 0,8% y ceftriaxona del 0,3%. Los resultados de serotipos y sensibilidad antimicrobiana proporcionarán información necesaria para la implementación de estrategias de prevención y tratamiento de la enfermedad neumocócica en nuestro país, por lo que es necesaria una vigilancia continua para evaluar la carga de enfermedad, los serotipos circulantes y el aumento de la resistencia a los antibióticos

Streptococcus pneumoniae remains one of the most important causes of morbidity and mortality in children and adults worldwide. The objective of the study was to describe the frequency of isolation of S. pneumoniae in invasive disease, serotype distribution and antimicrobial susceptibility in Paraguay (2010-2018). We studied 793 strains of S. pneumoniae isolated from patients of all ages with invasive disease in Paraguay, from different sentinel centers and collaborators in the framework of meningitis and pneumonia surveillance during the period 2010-2018. The general frequency according to diagnosis was 74.9% of pneumonia (n = 594), 18.4% of meningitis (n = 146) and 6.7% of sepsis (n = 53). Serotype 14 was more frequent with 174 isolates (22.0%), followed by serotype 19A with 84 isolates (10.6%), serotype 3 with 66 isolates (8.3%) and 6A with 37 isolates (4.70%). In meningitis, there was a general frequency of penicillin resistance of 32.2% and ceftriaxone of 1.4%. In cases of non-meningitis, penicillin resistance was 0.8% and ceftriaxone 0.3%. The results of serotypes and antimicrobial sensitivity will provide necessary information for the implementation of prevention strategies and treatment of pneumococcal disease in our country, therefore it is necessary to continue monitoring in order to assess the burden of the disease, circulating serotypes and increased antibiotic resistance

Differential replicative fitness of the four dengue virus serotypes circulating in Colombia in human liver Huh7 cells

ABSTRACT Dengue has been a significant public health problem in Colombia since the simultaneous circulation of the four dengue virus serotypes. The replicative fitness of dengue is a biological feature important for virus evolution and contributes to elucidating the behavior of virus populations and viral pathogenesis. However, it has not yet been studied in Colombian isolates. This study aimed to compare the replicative fitness of the four dengue virus serotypes and understand the association between the serotypes, their in vitro infection ability, and their replication in target cells. We used three isolates of each DENV serotype to infect Huh-7 cells at an MOI of 0.5. The percentage of infected cells was evaluated by flow cytometry, cell viability was evaluated by MTT assay, and the pathogenicity index was calculated as a ratio of both parameters. The replicative fitness was measured by the number of viral genome copies produced using quantitative PCR and the production of infectious viral progeny was measured by plaque assay. We showed that Huh-7 cells were susceptible to infection with all the different strain isolates. Nevertheless, the biological characteristics, such as infectious ability and cell viability, were strain-dependent. We also found different degrees of pathogenicity between strains of the four serotypes, representative of the heterogeneity displayed in the circulating population. When we analyzed the replicative fitness using the mean values obtained from RT-qPCR and plaque assay for the different strains, we found serotype-dependent behavior. The highest mean values of replicative fitness were obtained for DENV-1 (log 4.9 PFU/ml) and DENV-4 (log 5.28 PFU/ml), followed by DENV-2 (log 3.9 PFU/ml) and DENV-3 (log 4.31 PFU/ml). The internal heterogeneity of the replicative fitness within each serotype could explain the simultaneous circulation of the four DENV serotypes in Colombia.

Tipificación de serotipos del virus del papiloma humano de alto riesgo / Typification of high-risk human papilomavirus serotypes

Resumen: OBJETIVO: Identificar los serotipos más frecuentes de virus del papiloma humano mediante pruebas al azar en pacientes previamente diagnosticadas con cáncer cervicouterino. MATERIALES Y MÉTODOS: Estudio prospectivo y observacional, efectuado en pacientes con displasia cervical, atendidas en el Hospital Regional Materno Infantil de Alta Especialidad de Nuevo León, Monterrey, entre enero y marzo de 2016. Criterios de inclusión: pacientes mayores de 18 años, que acudieron a la unidad médica para seguimiento y control ginecológico, con reporte anormal en la prueba de Papanicolaou, confirmado por histopatología, mediante biopsia dirigida por colposcopia. Criterios de exclusión: mujeres con histerectomía total por indicación de enfermedad benigna, sin antecedente de neoplasia intracervical; mayores a 70 años después de 3 citologías cervicales negativas en la década previa; pacientes que recibieron quimioterapia, radioterapia u otros tratamientos farmacológicos y quienes acudieron a revisión médica durante su ciclo menstrual. Para el análisis de los datos se utilizó estadística descriptiva. RESULTADOS: Se registraron 30 pacientes. Las clasificaciones más frecuentes de neoplasia cervical fueron: NIC-1 (n = 15), NIC-2 (n = 9) y NIC-3 (n = 6). Todas las pacientes analizadas tuvieron, al menos, un serotipo de VPH de alto riesgo. Los serotipos identificados con mayor frecuencia fueron el 31 y 33 (n = 18). En 18 pacientes se encontraron 6 o más serotipos de VPH. De 15 pacientes con lesiones de alto grado, 8 tuvieron la asociación de serotipos 31 y 33, y en 6 se identificó un serotipo aislado (16 y 51). CONCLUSIONES: Los serotipos identificados con mayor frecuencia fueron el 31 y 33. Desafortunadamente, la vacuna nonavalente que protege contra los serotipos más frecuentes de VPH no se encuentra disponible en Latinoamérica.

Abstract: OBJECTIVE: To identify the most frequent serotypes of human papillomavirus through random testing of patients previously diagnosed with cervical cancer. MATERIALS AND METHODS: A prospective, observational study carried out in patients with cervical dysplasia, treated at the High Specialty Regional Maternal and Child Hospital of Nuevo León, Monterrey. Inclusion criteria: patients over 18 years of age, who attended the Dysplasia Clinic of the High Specialty Regional Maternal and Child Hospital for gynecological follow-up and control, with an abnormal result in the Papanicolaou test, confirmed by histopathology, by means of colposcopy-directed biopsy. Before the procedures (cervical cytology), Exclusion criteria: women with total hysterectomy due to indications of benign disease, without a history of intracervical neoplasia; older than 70 years after 3 negative cervical cytology in the previous decade; patients who received chemotherapy, radiotherapy or other pharmacological treatments and who received medical check-ups during their menstrual cycle. Descriptive statistics were used for data analysis. RESULTS: 30 patients were registered. The most frequent classification of cervical neoplasia was: CIN1 (n = 15), CIN2 (n = 9) and CIN3 (n = 6). All the patients analyzed had at least one high-risk HPV serotype. The most frequently identified serotypes were 31 and 33 (n = 18 of 30). 6 or more HPV serotypes were found in 18 patients. Of 15 patients with high-grade lesions, 8 had the association of serotypes 31 and 33, and in 6 an isolated serotype was identified (16 and 51). CONCLUSIONS: The most frequently identified serotypes were 31 and 33. Unfortunately, the nonavalent vaccine that protects against the most frequent serotypes of HPV is not available in Latin America.

Outbreaks of dengue in Central India in 2016: Clinical, laboratory & epidemiological study

Background & objectives: Dengue virus (DENV) causes outbreaks and sporadic cases in tropical and subtropical countries. Documenting intricacies of DEN outbreaks is important for future interventions. The objective of this study was to report clinical, laboratory and epidemiological features of DEN outbreaks reported in different districts of Central India in 2016. Methods: In 2016, outbreaks (n=4) suspected of DEN were investigated by rapid response team. Door-to-door fever and entomological surveys were conducted. Blood samples were collected and tested using NS1 or IgM ELISA; real-time reverse transcription-polymerase chain reaction was done to identify serotypes of DEN virus (DENV). NS1-positive samples were tested for the presence of IgG by ELISA. Clinical and demographic data were collected and analyzed. Results: Outbreaks occurred in both urban and rural areas in monsoon season and Aedes aegypti was identified as the vector. Fever, chills, headache and myalgia were the major symptoms; no fatality was recorded. Of the 268 DEN suspects, 135 (50.4%) were found serologically positive. DEN positivity was higher (n=75; 55.56%) among males and in the age group of 16-45 yr (n=78; 57.8%). DENV 3 followed by DENV 2 were detected as the major responsible serotypes. High attack rates (up to 38/1000) and low cumulative IgG prevalence (14.9%) were recorded in rural areas. Interpretation & conclusions: Our study showed that DENV 3 was the major serotype responsible for outbreaks that occurred in monsoon. High attack rates and lower number of secondary infections in rural areas indicated that DENV is emerging in rural parts of Central India. Early diagnosis at local level and timely intervention by mosquito control activities are needed to avoid such outbreaks in future.

Prevalence of Streptococcus agalactiae Serotypes Associated with Anogenital Colonization among Pregnant Women in Jos

Aim: The aim of this study was to determine the prevalence of GBS serotype distribution in Jos University Teaching Hospital.Materials and Methodology: This was a hospital based descriptive cross-sectional study of 300 women receiving health care at the Jos University Teaching Hospital between July 2017 and November 2017. Systematic sampling technique was employed in recruiting consenting subjects for this study. High vaginal and anorectal swabs were collected from each subject after obtaining their consent by signing a structured consent form. The identified Streptococcus agalactiae(GBS) isolates were serotyped using immuLex strep-B antisera from SSI Diagnostica, 2 Herredysvejen, DK-3400 Hillerod Demnark to identify the different serotypes. The results obtained were computed using SPSS version 21 Results: A total of 300 women obtaining health care in Jos University Teaching Hospital (JUTH) were enrolled in this study between the months of July, 2017 and November, 2017. In all, vaginal and anorectal swabs were taken from 200 pregnant women and 100 non-pregnant women. The age range of the study population was between 16 years to 48 years with a mean age of 31.9 year (SD ± 6.6). The prevalence rate among the study population was 6.3%. The colonization rate among pregnant and non-pregnant women was 6.5% and 6.0% respectively with no significant statistical difference. Serotype Ia was the commonest isolate responsible for 42.1% of the GBS isolates. Serotype III accounted for 31.6% of the isolates, followed by serotype V (15.8%). Serotype II was less common, responsible for only 10.5%.Conclusion: This study showed that GBS colonization rate among the study population was 6.3%. Approximately, 6.5% and 6.0% prevalence rate were found among pregnant and non-pregnant women respectively. Of all the GBS isolates, serotypes Ia, II, III, and serotype V were isolated with serotype Ia being the most prevalent serotype. This knowledge of serotype distribution will help in instituting serotype specific GBS vaccines for the prevention of GBS diseases in Jos.

Molecular studies on dengue viruses detected in patients from Central India

Purpose: Dengue viruses (DENVs), the causative agents of dengue (DEN), are classified into four serotypes and several genotypes. Identifying circulating serotypes and genotypes has clinical and epidemiological importance; however, limited information in this regard is available from Central India. This laboratory-based study was done to fill this lacuna. Materials and Methods: The samples collected in the acute phase of illness were subjected to DEN NS1 ELISA, and NS1-positive samples (n = 80) were subjected to serotyping; representative samples from each serotype were sequenced to identify genotypes. Results: Seventy-one (88.75%) samples could be serotyped. All the four DENV serotypes with dominance of DENV-3 (n = 33; 47%) were detected. DENV-4 was detected after a gap of 3 years. Cases with multiple DENV serotype infection were identified. Genotyping showed that DENV-1 belonging to genotype III, DENV-2 cosmopolitan (IV), DENV-3 genotype III lineage C and DENV-4 genotype I were in circulation in the year 2016. Conclusion: Our study documents the molecular characteristics of DENV circulating in the area. Detection of heterologous DENV serotype with dominance of DENV-3 emphasises the need for regular molecular monitoring.

The rare enterovirus c99 and echovirus 29 strains in Brazil: potential risks associated to silent circulation

Human enteroviruses (EVs) are associated with a wide spectrum of human diseases. Here we report the complete genome sequences of one EV-C99 strain and one E29 strain obtained from children suffering from acute gastroenteritis, without symptoms of enteroviral syndromes. This is the first report of EV-C99 in South America, and the second E29 genome described worldwide. Continuous surveillance on EVs is vital to provide further understanding of the circulation of new or rare EV serotypes in the country. The present study also highlights the capacity of EVs to remain in silent circulation in populations.

Pneumococcal vaccines

Streptococcus pneumoniae continues to take a heavy toll on childhood mortality and morbidity across the developing world. An estimated 10.6 million invasive pneumococcal diseases (IPDs) occur every year, with nearly 1 million deaths in children under 5 years of age. Introduction of vaccines in the childhood immunisation programme in developed world has brought down the incidence of the disease considerably. However, childhood immunocompromising illnesses including HIV have increased the risk of IPD several folds. There is also a growing concern on the increasing antibiotic resistance among these invasive strains to penicillin, other beta-lactams and macrolides, making treatment difficult and expensive. It is estimated that about 62% of IPD worldwide is caused by the 10 most common serotypes. Although the ranking of individual pneumococcal serotypes causing serious disease varies among nations, the 7� serotypes included in pneumococcal conjugate vaccines (PCVs) may prevent 50%�% of all paediatric pneumococcal diseases globally. The World Health Organization has recommended the use of PCV-10/13 in the national immunisation programmes (NIPs) of developing countries. Four doses of PCV-13 have been recommended by the US Association of Pediatrics and Centers for Disease Control and Prevention, at intervals of each 2 months for the first 6 months and by the 12th to 15th months after birth. This is expected to reduce the morbidity and mortality associated with IPD and simultaneously decrease colonisation with circulating antibiotic-resistant strains in immunized communities. Nevertheless, continued surveillance of antimicrobial resistance in non-vaccine serotypes is necessary to prevent the resurgence of resistance. Other virulence factors which are not serotype specific also need to be studied to overcome the drawbacks of serotype-specific pneumococcal vaccines. PCV-13 was launched during May 2017 under the NIP of five Indian states with the highest pneumococcal diseases in the country and is expected to be rolled out in the other parts of the country in the coming days.

Identification of prevalent dengue serotypes by reverse transcriptase polymerase chain reaction and correlation with severity of dengue as per the recent World Health Organization classification (2009)

Context: A definite link between distinct dengue serotypes and severe clinical manifestations has not been established yet. The WHO classification (2009) of dengue is more competent in diagnosing severe cases compared to traditional (1997) classification. Aims: This study aimed to identify prevalent dengue serotypes and to correlate the severity of dengue with the dengue virus (DENV) serotypes in target population as per the recent WHO classification (2009). Settings and Design: A retrospective comparative observational study was conducted from 1st January 2015 to 31st December 2015. Subjects and Methods: We tested 242 dengue NS-1 antigen ELISA-positive cases for serotyping by dengue reverse transcriptase-polymerase chain reaction (RT-PCR). Severity of each dengue case confirmed by RT-PCR was determined as per the recent WHO classification (2009). Results: On the basis of RT-PCR, dengue infection was confirmed in 135 (55.78%) patients. DEN-3 was the most common serotype found in 71 (52.6%) patients, followed by DEN-2 serotype with 44 (32.6%) patients. Nearly 2.22% cases of DEN-2 and 2.96% cases of DEN-3 serotype were having dengue with warning signs. Severe dengue was found in 2.22% cases of DEN-2 and 5.18% cases of DEN-3 serotypes. Thrombocytopenia, haemorrhagic manifestations and atypical presentations were found most commonly in DEN-3 followed by DEN-2 serotype. Coinfection with more than one serotype was observed in our study, with the most common coinfection pattern being DEN-2 and DEN-3 serotypes. Conclusions: DENV-3 and DENV-2 serotypes are prevalent in the region and are associated with a more serious clinical profile than other serotypes.

Co-circulation of four dengue serotypes at South Eastern Andhra Pradesh, India: A prospective study

Background: Dengue is one of the most important mosquito-borne viral diseases in the world. The emergence and spread of four dengue viruses (DENVs) (serotypes) represent a global pandemic. The four distinct serotypes are, namely, DENV-1, DENV-2, DENV-3 and DENV-4. Very few dengue serotyping studies have been reported from Andhra Pradesh. In this context, the present study focuses on the circulating serotypes of dengue in South-Eastern Andhra Pradesh. Methodology: Study was done at Sri Venkateswara Institute of Medical Sciences, a teaching hospital in Tirupati, Andhra Pradesh. Acute phase dengue serum samples were collected and tested for NS1 antigen and anti-human IgM antibodies by enzyme-linked immunosorbent assay (ELISA). NS1-positive samples were further serotyped by reverse transcriptase real-time polymerase chain reaction (rRT-PCR). Results: A total of 398 serum samples were received from clinically suspected dengue fever cases. Of these, 150 (37.7%) samples were positive for NS1 and/or IgM ELISA. The 96 NS1 antigen-positive samples were further processed for serotyping, of which 36 were negative by rRT-PCR. DENV-2 (41%) was the predominant serotype, followed by DENV-4 (37%), DENV-3 (12%) and DENV-1 (10%) in descending order. Conclusion: This study reports the all four dengue serotypes' co-circulation. This is the first report from South Eastern Andhra Pradesh. Amongst four, DENV-2 was predominant followed by DENV-4. The information of predominant serotypes can guide in forecasting dengue outbreaks and improving control measures of vectors thus may be helpful in the prevention of outbreaks.

Changing facades of Vibrio cholerae: An enigma in the epidemiology of cholera

Cholera, caused by the Gram-negative bacterium Vibrio cholerae, has ravaged humanity from time immemorial. Although the disease can be treated using antibiotics along with administration of oral rehydration salts and controlled by good sanitation, cholera is known to have produced mayhems in ancient times when little was known about the pathogen. By the 21st century, ample information about the pathogen, its epidemiology, genetics, treatment and control strategies was revealed. However, there is still fear of cholera outbreaks in developing countries, especially in the wake of natural calamities. Studies have proved that the bacterium is mutating and evolving, out-competing all our efforts to treat the disease with previously used antibiotics and control with existing vaccines. In this review, the major scientific insights of cholera research are discussed. Considering the important role of biofilm formation in the V. cholerae life cycle, the vast availability of next-generation sequencing data of the pathogen and multi-omic approach, the review thrusts on the identification of suitable biofilm-inhibiting targets and the discovery of anti-biofilm drugs from nature to control the disease.