Epidemiological Profile of Patients with Infective Endocarditis at three Tertiary Centers in Brazil from 2003 to 2017

Abstract Background Infective endocarditis (IE) is a disease with high morbimortality and an increasing incidence. With improved diagnosis and treatment, a number of epidemiological changes have been reported over time. Objectives We sought to describe the epidemiological profile, mortality predictors, and analysis of a possible microbiological transition in patients admitted to three tertiary centers in Brazil. Methods In this cross-sectional retrospective study, data from 211 patients with definite or probable IE were analyzed according to the modified Duke criteria between 2003 and 2017. The association between categorical variables was assessed using the chi-square or Fisher's exact test, and binary logistic models were built to investigate mortality. We considered p <0.05 statistically significant. Results The median age of the sample was 48 (33-59) years old, 70.6% were men, and the most prevalent pathogen was Staphylococcus spp. (19%). Mortality was 22.3%, with increasing age being the leading risk factor for death (p = 0.028). Regarding the location of the disease, native valves were the most affected site, with the aortic valve being more affected in men than women (p = 0.017). The mean number of cases of Staphylococcus spp. (τ = 0.293, p = 0.148) and Streptococcus spp. (τ = -0.078, p = 0.727) has remained stable over the years. Conclusion No trend towards reduced or increased mortality was evident between 2003 and 2017. Although Staphylococcus spp. were the most prevalent pathogen, the expected epidemiological transition could not be observed.

Multiple Brain Abscesses by an Air Gun Shot: A Case Report

Introduction Low-velocity penetrating brain injury is not prevalent. In some conditions such as childhood, and with the penetration of a pellet in weak spots of skull, low-velocity penetrating brain injury is expected; however, high-velocity projectiles have also been reported as the cause of severe brain injuries. One of the complications of penetrating brain injury is infection, in which different types ofmicroorganisms play a role. The Streptococcus genus is the leading cause of abscess formation in nontraumatic patients. Multiple brain abscesses are not common. Case Presentation A 10-year-old boy with penetrating brain injury caused by an air gun pellet, who developed signs and symptoms of high intracranial pressure 18 days after the trauma. After the imaging scans and the detection of multiple brain abscesses and severe brain edema, prompt surgical intervention was performed for all three lesions in a single operation. The culture of a pus specimen was positive for Streptococcus species, and, with adequate antibiotic therapy, the patient was discharged from the hospital in good condition. Conclusion Brain injurywith air gun shot is not prevalent. The penetration of a low-velocity air gun pellet in weak points of the skull (such as the orbit, the squamous portion of the temporal bone, and the cranial suture), specially in children, can cause significant brain injuries.

"Cell ELISA" como ferramenta auxiliar no controle da adenite equina / "Cell ELISA" as an auxiliary tool for the control of equine adenitis

Este trabalho relata o desenvolvimento e a avaliação de um ensaio imunoenzimático (ELISA) como ferramenta auxiliar no controle da adenite equina. Foi avaliada a presença de anticorpos anti-Streptococcus equi subsp. equi em equinos com doença clínica de garrotilho, portadores assintomáticos e potros vacinados. Equinos doentes demonstraram absorbâncias médias superiores (P<0,05) às médias observadas nas demais categorias examinadas. Equinos portadores assintomáticos apresentaram valores médios de absorbância superiores (P<0,05) aos animais com cultura negativa. Logo após a vacinação, potros apresentaram elevação nos níveis de anticorpos, seguida de um decréscimo nos níveis 90 dias após a segunda vacinação. O "Cell ELISA" foi eficiente para a detecção de anticorpos em equinos expostos a antígenos de S. equi, diferenciando-se de infecções por S. zooepidemicus. O "Cell ELISA" mostrou-se uma alternativa clínica para o diagnóstico indireto da adenite equina, diferenciando-se, entre equinos assintomáticos, os potenciais portadores da infecção. Os resultados observados em potros vacinados confirmam o potencial de utilização desse teste como ferramenta em programas de vacinação contra garrotilho pelo monitoramento de rebanhos pós-vacinação. Esses resultados sugerem que o "Cell ELISA" é uma promissora ferramenta auxiliar no controle da adenite equina.(AU)

This study reports the development and evaluation of the use of "Cell ELISA" as a tool for clinical interpretation for the control of strangles. The presence of anti-S. equi antibodies was evaluated in horses with strangles, in asymptomatic carriers and in vaccinated foals. Equine positive for strangle showed higher average of absorbance (P<0.05) when compared with the average for the other categories of horses studied. Asymptomatic S. equi equine carriers had higher average of absorbance (P<0.05) than equines with negative culture. After vaccination, foals presented an increase in antibody levels, followed by a decrease in antibody levels 90 days post the second vaccination. The "Cell ELISA" was efficient for the detection of antibodies in horses exposed to S. equi antigens, differentiating infections with S. zooepidemicus. Thus, the test might be a clinical tool for indirect diagnosis of the strangles, differentiating, between the asymptomatic horses, the potential carriers of infection. The results observed in vaccinated foals confirm the potential use of this test as an auxiliary instrument for strangles vaccination programs based in the serological monitoring of the herd after immunization. These results suggest that the "Cell ELISA" is a promising auxiliary tool in the control of equine adenitis.(AU)

Caracterización molecular de cepas invasivas de Streptococcus dysgalactiae subsp. equisimilis: estudio multicéntrico Argentina 2011-2012 / Molecular characterization of invasive Streptococcus dysgalactiae subsp. equisimilis. Multicenter study: Argentina 2011-2012

Streptococcus dysgalactiae subsp. equisimilis (SDSE) has virulence factors similar to those of Streptococcus pyogenes. Therefore, it causes pharyngitis and severe infections indistinguishable from those caused by the classic pathogen. The objectives of this study were: to know the prevalence of SDSE invasive infections in Argentina, to study the genetic diversity, to determine the presence of virulence genes, to study antibiotic susceptibility and to detect antibiotic resistance genes. Conventional methods of identification were used. Antibiotic susceptibility was determined by the disk diffusion and the agar dilution methods and the E-test. Twenty eight centers from 16 Argentinean cities participated in the study. Twenty three isolates (16 group G and 7 group C) were obtained between July 1 2011 and June 30 2012. Two adult patients died (8.7%). Most of the isolates were recovered from blood (60.9%). All isolates carried speJ and ssa genes. stG62647, stG653 and stG840 were the most frequent emm types. Nineteen different PFGE patterns were detected. All isolates were susceptible to penicillin and levofloxacin, 6 (26.1%) showed resistance or reduced susceptibility to erythromycin --#91;1 mef(A), 3 erm(TR), 1 mef(A) + erm(TR) and 1 erm(TR) + erm(B)--#93; and 7 (30.4%) were resistant or exhibited reduced susceptibility to tetracycline --#91;2 tet(M), 5 tet(M) + tet(O)--#93;. The prevalence in Argentina was of at least 23 invasive infections by SDSE. A wide genetic diversity was observed. All isolates carried speJ and ssa genes. Similarly to other studies, macrolide resistance (26.1%) was mainly associated to the MLS B phenotype.

Streptococcus dysgalactiae subsp. equisimilis (SDSE) posee factores de virulencia similares a Streptococcus pyogenes y, en consecuencia, produce faringitis e infecciones graves indistinguibles de las generadas por este patógeno clásico. Los objetivos del estudio fueron conocer la prevalencia de SDSE en infecciones invasivas en Argentina, estudiar su diversidad genética, determinar la presencia de genes de virulencia, ensayar su sensibilidad a los antibióticos y conocer los genes de resistencia. Se emplearon métodos convencionales de identificación. La sensibilidad se determinó por difusión, Etest y dilución en agar. Participaron 28 centros de 16 ciudades argentinas. Se obtuvieron 23 aislamientos (16 del grupo G y 7 del grupo C) desde el 1-7-2011 hasta el 30-6-2012. Se registraron 2 muertes en adultos (8,7%). La mayoría de los aislamientos fueron obtenidos de sangre (60,9%). Todos eran portadores de los genes speJ y ssa. Los genotipos más frecuentes fueron stG62647, stG653 y stG840. Se detectaron 19 pulsotipos distintos. Todos los aislamientos fueron sensibles a penicilina y levofloxacina, 6 (26,1%) presentaron resistencia o sensibilidad disminuida a eritromicina (1 mef--#91;A--#93;, 3 erm--#91;TR--#93;, 1 mef--#91;A--#93; + erm--#91;TR--#93; y 1 erm--#91;TR--#93; + erm--#91;B--#93;) y 7 (30,4%) fueron resistentes o tuvieron sensibilidad disminuida a tetraciclina (2 tet--#91;M--#93;, 5 tet--#91;M--#93; + tet--#91;O--#93;). La prevalencia anual en la Argentina fue de al menos 23 infecciones invasivas por SDSE y se observó una amplia diversidad genética. Todos los aislamientos presentaron los genes ssa y speJ. Como en otros estudios, la resistencia a macrólidos (26,1%) estuvo asociada, principalmente, al fenotipo MLS B.

Impetigo - review

Impetigo is a common cutaneous infection that is especially prevalent in children. Historically, impetigo is caused by either group A β-hemolytic streptococci or Staphylococcus aureus. Currently, the most frequently isolated pathogen is S. aureus. This article discusses the microbiologic and virulence factors of group A β-hemolytic streptococci and Staphylococcus aureus, clinical characteristics, complications, as well as the approach to diagnosis and management of impetigo. Topical agents for impetigo therapy are reviewed.

Phenotypic and genotypic characterization of Streptococcus uberis isolated from bovine subclinical mastitis in Argentinean dairy farms

The aim of this study was to investigate the phenotypic and genotypic characteristics of Streptococcus uberis isolated from subclinical mastitis (SCM) cases, and to examine the possible association between both characteristics. A total of 32 S. uberis were isolated from 772 quarter milk samples (SCM > 250,000 cells/ml) collected from 195 cows selected randomly from 18 dairy farms located in Argentina. The S. uberis strains were characterized phenotypically by the presence of virulence factors as plasminogen activator factor (PAF), hyaluronidase (HYA), capsule (CAP) and CAMP factor, and were further characterized genotypically by pulsed-field gel electrophoresis (PFGE). S. uberis strains expressed plasminogen activator factor, hyaluronidase or capsule (65.5 %, 56.3 %, 59.4 %, respectively), but only 25 % of isolates were CAMP factor positive. Thirteen different virulence profiles were identified on the basis of the combination of virulence factors. Eighteen PFGE patterns with 90% of similarity were identified among 32 S. uberis. A great diversity of virulence profiles and PFGE patterns were present among dairy farms. S. uberis strains with the same PFGE pattern showed different virulence profiles. Bovine S. uberis strains causing SCM included in the present study showed heterogeneity in regard to their phenotypic and genotypic characteristics, and the PFGE patterns are not associated with the virulence profiles.

Caracterización fenotípica y genotípica de Streptococcus uberis aislados de mastitis bovina subclínica en tambos de Argentina. El objetivo de este estudio fue investigar las características fenotípicas y genotípicas de Streptococcus uberis aislados de casos de mastitis subclínica (MSC) y examinar la posible asociación entre ambas características. Un total de 32 cepas de S. uberis fueron aisladas de 772 muestras de leche de cuartos mamarios (MSC > 25 0000 células/ml) colectadas de 195 vacas seleccionadas al azar pertenecientes a 18 tambos lecheros localizados en Argentina. Las cepas de S. uberis fueron caracterizadas fenotípicamente sobre la base de la presencia de factores de virulencia tales como el factor activador del plasminógeno (FAP), la hialuronidasa (HIA), la cápsula (CAP) y el factor CAMP. Además, fueron caracterizadas genotípicamente por electroforesis de campos pulsados (PFGE). Las cepas de S. uberis expresaron el factor activador del plasminógeno, la hialuronidasa o la cápsula (65,5 %, 56,3 % y 59,4 %, respectivamente), pero solo el 25 % fueron CAMP positivas. Sobre la base de la combinación de los factores de virulencia se identificaron 13 perfiles de virulencia diferentes. Asimismo, se identificaron 18 patrones de PFGE con un 90 % de similitud entre las 32 cepas de S. uberis. Se presentó una gran diversidad de perfiles de virulencia y patrones de PFGE entre los tambos. Cepas con el mismo patrón de PFGE presentaron perfiles de virulencia diferentes. Las cepas de S. uberis causantes de MSC en bovinos incluidas en el presente estudio mostraron heterogeneidad con respecto a sus características fenotípicas y genotípicas, y los patrones de PFGE no estuvieron asociados con los perfiles de virulencia.

Bacterial biofilm formation, pathogenicity, diagnostics and control: An overview.

Bacterial biofilms are complex, mono- or poly-microbialn communities adhering to biotic or abiotic surfaces. This adaptation has been implicated as a survival strategy. The formation of biofilms is mediated by mechanical, biochemical and genetical factors. The biofilms enhance the virulence of the pathogen and have their potential role in various infections, such as dental caries, cystic fibrosis, osteonecrosis, urinary tract infection and eye infections. A number of diagnostic techniques, viz., bright-field microscopy, epifluorescence microscopy, scanning electron microscopy, confocal laser scanning microscopy and amplicon length heterogeneity polymerase chain reaction, have been employed for detection of these communities. Researchers have worked on applications of catheter lock solutions, a fish protein coating, acid shock treatment, susceptibility to bacteriophages, etc., for biofilm control. However, we need to rearrange our strategies to have thorough insight and concentrate on priority basis to develop new accurate, precise and rapid diagnostic protocols for detection and evaluation of biofilm. Above all, the strict compliance to these techniques is required for accurate diagnosis and control.

Faringoamidalite estreptocócica: comparação entre diagnóstico clínico e microbiológico / Streptococcal pharyngitis: comparison between the clinical and microbiological diagnosis

Introdução: Faringoamidalite é queixa frequente nos pronto-socorros pediátricos, com presença do Streptococcus pyogenes em 20 por cento dos casos. Os sinais e sintomas clínicos são insuficientes para diferenciar quadros virais dos bacterianos. Os métodos microbiológicos, teste rápido(TR) e cultura orofaringe(CO) são indispensáveis para diagnóstico e redução de antibióticos...

Introductions: Pharyngitis is a common complaint in the emergency room for children, with the presence of Streptococcus pyogenes in 20 per cent of the cases. The clinical signs and symptoms are insufficient to differentiate viral from bacterial infections. The microbiological methods, rapid test (RT) and oropharynx cultura (OC), are essential for diagnosis and for reducing the use of antibiotics...

Endocarditis infecciosa por Streptococcus dysgalactiae subsp equisimilis / Infective endocarditis by Streptococcus dysgalactiae subsp equisimilis

La infección por Streptococcus dysgalactiae subsp equisimilis es causa frecuente de faringitis, artritis e infecciones de piel y tejidos blandos; excepcionalmente se ha descrito como causa de endocarditis infecciosa. Se presenta el caso de un paciente masculino de 42 años quien ingresa al Hospital Vargas de Caracas con fiebre, astenia, dolor en hombro derecho con limitación funcional y dolor en hipocondrio derecho; a las 48 horas se evidencia soplo mesosistólico en foco mitral, hemorragias en astillas y lesiones de Janeway, por lo que se plantea Endocarditis Infecciosa, y se inicia tratamiento con Vancomicina + Gentamicina. Los hemocultivos muestran crecimiento de Streptococcus equisimilis en ambos frascos; el ecocardiograma transtorácico evidencia una vegetación en valva posterior de válvula mitral. Luego de 48 horas de inicio de tratamiento remite la fiebre. El ecocardiograma control a los 14 días mostró la desaparición de la vegetación en la válvula mitral. El paciente recibió tratamiento por 6 semanas

Streptococcus dysgalactiae subsp equisimilis is frequent in patients with pharyngitis, arthritis and skin infections; it rarely causes infective endocarditis. We describe a 42 year-old male patient complaining of fever, malaise, right shoulder pain and right upper quadrant pain who was admitted to the Hospital Vargas, Caracas, Venezuela. After 48 hours his physical examination revealed mesosystolic murmur at the apex, splinter hemorrhages and Janeway lesions, suggestive of Infective Endocarditis Blood cultures identified Streptococcus equisimilis; transthoracic echocardiogram revealed a vegetation over the posterior leaflet of mitral valve; the patient was treated with Vancomycin + Gentamycin. After 48 hours of treatment the fever subsided. A transthoracic echocardiogram after 14 days showed no vegetations. The patient was treated during 6 weeks

Antibioticoterapia para infecções por bactérias gram-positivas no paciente grave / Antibioticotherapy for gram-positive bacteria infections in serious patient

O aumento importante do número de infecções causadas por bactérias Gram-positivas e o surgimento de resistência aos antibióticos destinados a tratar estas infecções são motivos de preocupação das autoridades internacionais em infecção hospitalar. O presente artigo tem como objetivo revisar os principais antibióticos utilizados para o tratamento destes agentes, como oxacilina, vancomicina, teicoplanina, linezolida, quinupristina-dalfopristina, daptomicina e tigeciclina.

Estreptococos cariogénicos predominantes, niveles de infección e incidencia de caries en un grupo de escolares: estudio exploratorio / Predominant cariogenic Streptococcus, infection level and caries incidence in a group of schoolchildren: en exploratory study

Objetivo: Estudiar la distribución de estreptococos cariogénicos, niveles de infección y su asociación con la incidencia de caries. Metodología: Sesenta escolares (8 y 10 años), seguidos durante 18 meses. Se registró caries, niveles bacterianos de estreptococos en muestras de placa; por medio de análisis bioquímico se hizo la tipificación bacteriana, se calculó la incidencia de caries en el molar muestreado. Resultados: El 80 por ciento de los estreptococos correspondieron al grupo mutans (40 por ciento S. sobrinus, 32 por ciento S. mutans, 5 por ciento S. rattus y 3 por ciento S. cricetus). El 20 por ciento restante correspondió a otros estreptococos (S. salivarius, S. mitis y S. sanguis). El 55 por ciento de los niños presentó conteos 105 ufc/mL en placa y el 30 por ciento desarrolló caries en el molar estudiado. Un modelo de regresión logística múltiple de pasos sucesivos mostró asociación entre la bacteria predominante y los niveles de infección (P < 0.01). No se demostró asociación entre bacteria predominante e incidencia de caries (P > 0.05). Sin embargo con el mismo modelo ponderado según los niveles de infección, mostró una asociación significativa (P < 0.0018). Conclusión: La asociación de cepas de estreptococos con la incidencia de caries en niños es dependiente del nivel de infección

Infecciones articulares / Joint infections

La infección articular sigue siendo un motivo relativamente frecuente de consulta, tanto en los Servicios de Urgencia como en las consultas del médico general. De ahí que el diagnóstico precoz y la derivación oportuna para el inicio de un tratamiento mixto que considera el uso adecuado de esquemas antibióticos asociado a aseo quirúrgico, son cruciales en su manejo y pronóstico -que aun no se encuentra exento de complicaciones incluso de mortalidad en algunos pacientes con enfermedades predisponentes-. En esta revisión se realiza un análisis referente al diagnóstico y tratamiento oportuno que a menudo requiere de la participación de distintos especialistas para un mejor resultado en beneficio de la funcionalidad articular y/o de una complicación de mayor riesgo para el paciente.

Vulvovaginitis bacteriana en la prepúber / Bacterial vulvovaginitis in prepubertal girl

Considerando la alta incidencia de vulvovaginitis en la consulta de ginecología pediátrica y de adolescentes, y los aspectos únicos de la microbiología y endocrinología de la paciente prepúber se presenta una revisión de la literatura con lo más relevante de los últimos 5 años, en lo que se refiere a epidemiología, etiología, diagnóstico y tratamiento de la vulvovaginitis bacteriana específica de la niña prepúber. No existe claridad acerca de la microflora vaginal normal, lo cual dificulta en gran medida la interpretación de muestras. De acuerdo con la evidencia actual podemos decir que ante la vulvovaginitis específica de la prepúber debemos tener en consideración como principales agentes causales: patógenos respiratorios, epidérmicos y entéricos; higiene defectuosa, cuerpos extraños, irritantes, enfermedades dermatológicas vulvares, defectos anatómicos y abuso sexual. Streptococcus hemolitico del grupo A y Haemophilus influenzae son patógenos prevalentes.

Patogénesis de la endocarditis infecciosa / Pathogenesis of infectious endocarditis

Se discuten los mecanismos moleculares que llevan a la formación de las lesiones más características de la Endocarditis Infecciosa, en especial, la formación de vegetaciones y los diferentes mediadores involucrados provenientes de los gérmenes causales.

Detección de títulos de Antiestreptolisina o (AELO) en una población pediátrica y rural de Antioquia / Antistreptolysin O titre detection in a rural pediatric population

Introducción: la fiebre reumática, complicación no supurativa de la amigdalofaringitis causada por Streptococcus del Grupo A (SGA), es un problema de salud pública principalmente en niños de 6 a 15 años. 15 por ciento a 20 por ciento de la población es portadora del agente causal, lo cual es un factor importante de diseminación de la infección en comunidades. En Antioquia se reportan 800 – 1000 casos de pacientes con fiebre reumática al año, quienes consultan por presentar signos y síntomas sugestivos del diagnóstico, pero los casos cuya clínica es bizarra pasan desapercibidos agravando las secuelas. La detección de Antiestreptolisinas O revela la frecuencia de la infección por SGA en grupos de riesgo. Objetivos: determinar AELO en muestras de sangre tomadas en papel de filtro. Determinar la frecuencia de títulos de AELO en niños de 6 a 14 años. Metodología: se estudiaron 506 muestras de sangre en papel de filtro de niños de 6 a 14 años procedentes de diferentes regiones de Antioquia del banco de muestras del Instituto Colombiano de Medicina Tropical. Los títulos de AELO fueron medidos en el eluido de la muestra utilizando reactivos Difco. Resultados: de las 506 muestras estudiadas, 154 (30.4 por ciento) presentaron títulos de AELO ≥320, 71 (14 por ciento) tuvieron títulos ≥ 640. Discusión: la determinación de AELO en muestras de sangre en papel de filtro facilitan y disminuyen costos en estudios poblacionales conservando las características de la técnica. La frecuencia de títulos elevados de AELO en el grupo estudiantil revela que la infección SGA en Antioquia es importante, las complicaciones y secuelas permanecen desconocidas

Infecciones tisulares por streptococcus B-hemolítico grupo A en Hospital Regional de Talca / Tissue infections caused by group A B hemolytic streptococcus in a regional chilean hospital

Background: A resurgence of group A õ hemolytic Streptococcus infections such as fasciitis, cellulitis and Strptococcal Toxic Syndrome has been observed recently. Aim: To study the clinical features of patients with group A õ hemolytic Streptococcus infections in a regional hospital. Patients and methods: Retrospective review of medical records of patients notified as having a group A õ hemolytic Streptococcus tissue infection, between 1994 and 1999. Results: twenty four patients were notified in the period as having a group A õ hemolytic Streptococcus infection and 18 (13 male, mean age 39 tears old) had tissue involvement. Eleven patients had a fasciitis (61 percent), six had a cellulitis (33 percent) and 14 patients (77 percent), a Streptococcal Toxic Shock Syndrome. Eight patients died during hospital stay. The infection portal of entry was identify in 13 patients (the skin in 10 and intramuscular injections in three). Deceased patients had a longer lapse of disease before admission than patients discharged alive (5(range 3h-7 days) and 2.1 (range 6h-5 days) respectively). In seven patients a quick serological test, designed for pharyngeal infections was performed and it was positive in five. Blood cultures were positive in seven patients and in 11, the germ was isolated from the lesions. Conclusions: As the early diagnosis of group A õ hemolytic Streptococcus tissue infections has a prognostic value, the population should be instructed to recognize early signs and symptoms of these infections

Production of bacteriocin-like inhibitory substances (BLIS) by Streptococcus salivarius strains isolated from the tongue and throat of children with and without sore throat

"Streptococcus salivarius" strains, isolated from children with and without sore throat, were tested for bacteriocin production against "Streptococcus pyogenes. "S. salivarius" strains producing bacteriocin-like inhibitory substances (BLIS) against "S. pyogenes" were more frequently found in children without sore throat by the presence of BLIS-positive "S. salivarius" strains