Post-surgical mediastinitis due to carbapenem-resistant Enterobacteriaceae: Clinical, epidemiological and survival characteristics.

Invasive infections due to carbapenem-resistant Enterobacteriaceae (CRE), including polymyxin-resistant (PR-CRE) strains, are being increasingly reported. However, there is a lack of clinical data for several life-threatening infections. Here we describe a cohort of patients with post-surgical mediastinitis due to CRE, including PR-CRE. This study was a retrospective cohort design at a single cardiology centre. Patients with mediastinitis due to CRE were identified and were investigated for clinically relevant variables. Infecting isolates were studied using molecular techniques. Patients infected with polymyxin-susceptible CRE (PS-CRE) strains were compared with those infected with PR-CRE strains. In total, 33 patients with CRE mediastinitis were studied, including 15 patients (45%) with PR-CRE. The majority (61%) were previously colonised. All infecting isolates carried blaKPC genes. Baseline characteristics of patients with PR-CRE mediastinitis were comparable with those with PS-CRE mediastinitis. Of the patients studied, 70% received at least one agent considered active in vitro and most patients received at least three concomitant antibiotics. Carbapenem plus polymyxin B was the most common antibiotic combination (73%). Over 90% of patients underwent surgical debridement. Overall, in-hospital mortality was 33% and tended to be higher in patients infected with PR-CRE (17% vs. 53%; P=0.06). In conclusion, mediastinitis due to CRE, including PR-CRE, can become a significant challenge in centres with CRE and a high cardiac surgery volume. Despite complex antibiotic treatments and aggressive surgical procedures, these patients have a high mortality, particularly those infected with PR-CRE.

Habitat use by Centropomus undecimalis in a rocky area of estuarine beach in north-east Brazil.

The influence of habitat, diel period, tidal phase and moon phase on the spatial distribution of Centropomus undecimalis was investigated at the mouth of the Timbo estuary, north-east Brazil. Underwater visual censuses were conducted in three areas comprising a mix of mud, sand and beach rock substrata; with one of the areas having additional structural complexity in the form of unused wooden debris. The area with debris housed significantly higher densities of juvenile and adult C. undecimalis whereas sub-adults were more abundant in an area lacking the wooden debris. Juvenile abundance was greatest during the day, whereas sub-adult and adults were more abundant at night. There were significant interactions between habitat, diel period, tidal phase and moon phase for all ages of C. undecimalis. These results emphasize the need to account for a range of environmental factors when planning for the conservation of estuarine and coastal habitats.

Seasonal and spatial ontogenetic movements of Gerreidae in a Brazilian tropical estuarine ecocline and its application for nursery habitat conservation.

The density and biomass of different ontogenetic phases (juvenile, sub-adult and adult) of the two most important sympatric Gerreidae species in the Goiana Estuary, north-east Brazil, are described in order to determine the patterns of estuarine habitat use and to identify nursery grounds. Eugerres brasilianus and Eucinostomus melanopterus were the most abundant gerreids in the main channel and adjacent estuarine beach habitats. Eugerres brasilianus is abundant in the main channel, whereas E. melanopterus is most common in the beach habitats. Significant interaction in density and biomass of juvenile and sub-adult size classes of E. brasilianus was found between season and area. In addition, E. brasilianus adults and E. melanopterus sub-adults differed significantly in density and biomass between areas of the estuary. Both the upper estuary, during the late dry season, and the middle estuary, during the early rainy season, functioned as nursery habitats for E. brasilianus. During the early rainy season and dry season, the beaches were a nursery for the E. melanopterus. The concentration of these ontogenetic phases was mainly related to the dissolved oxygen and salinity gradients of the estuary, which drive not only gerreid movement between estuarine habitats but also moves the habitats. This study reinforces the importance of conserving the habitats of the Goiana Estuary so that species such as gerreids can complete their life cycle in the face of pressure from anthropogenic activities, such as mangrove forest deforestation, overfishing, fish contamination by plastic ingestion and domestic effluent disposal.

Changes in the composition of ichthyoplankton assemblage and plastic debris in mangrove creeks relative to moon phases.

Lunar influence on the distribution of fish larvae, zooplankton and plastic debris in mangrove creeks of the Goiana Estuary, Brazil, was studied over a lunar cycle. Cetengraulis edentulus, Anchovia clupeoides and Rhinosardinia bahiensis were the most abundant fish larvae (56·6%), independent of the moon phase. The full moon had a positive influence on the abundance of Gobionellus oceanicus, Cynoscion acoupa and Atherinella brasiliensis, and the new moon on Ulaema lefroyi. The full and new moons also influenced the number of zoeae and megalopae of Ucides cordatus, protozoeae and larvae of caridean shrimps, and the number of hard and soft plastic debris, both <5 and >5 mm. Micro and macroplastics were present in samples from all 12 creeks studied, at densities similar to the third most abundant taxon, R. bahiensis. Cetengraulis edentulus and R. bahiensis showed a strong positive correlation with the last quarter moon, when there was less zooplankton available in the creeks and higher abundance of microplastic threads. Anchovia clupeoides, Diapterus rhombeus, U. lefroyi and hard microplastics were positively associated with different moon phases, when calanoid copepods, Caridean larvae and zoeae of U. cordatus were highly available in the creeks. Cynoscion acoupa, G. oceanicus and A. brasiliensis were strongly associated with the full moon, when protozoeae of caridean shrimps and megalopae of U. cordatus were also highly available, as were hard and soft macroplastics, paint chips (<5 mm) and soft microplastics. The results reinforce the role of mangrove creeks as nursery habitats. The moon phases influenced the distribution of fish larvae species, zooplankton and plastic debris by changing their compositions and abundances in the mangrove creeks of the Goiana Estuary when under the influence of different tidal current regimes.

Post-surgical mediastinitis due to carbapenem-resistantEnterobacteriaceae: Clinical, epidemiological and survivalcharacteristics

Invasive infections due to carbapenem-resistant Enterobacteriaceae (CRE),including polymyxin-resistant(PR-CRE) strains, are being increasingly reported. However, there is a lack of clinical data for several life threatening infections. Here we describe a cohort of patients with post-surgical mediastinitis due to CRE,including PR-CRE. This study was a retrospective cohort design at a single cardiology centre. Patients with mediastinitis due to CRE were identified and were investigated for clinically relevant variables. Infecting isolates were studied using molecular techniques. Patients infected with polymyxin-susceptible CRE(PS-CRE) strains were compared with those infected with PR-CRE strains. In total, 33 patients with CRE mediastinitis were studied, including 15 patients (45%) with PR-CRE. The majority (61%) were previously colonised. All infecting isolates carriedblaKPC genes. Baseline characteristics of patients with PR-CRE mediastinitis were comparable with those with PS-CRE mediastinitis. Of the patients studied, 70% received atleast one agent considered active in vitro and most patients received at least three concomitant antibiotics. Carbapenem plus polymyxin B was the most common antibiotic combination (73%). Over 90% of patients underwent surgical debridement. Overall, in-hospital mortality was 33% and tended to be higherin patients infected with PR-CRE (17% vs. 53%; P = 0.06). In conclusion, mediastinitis due to CRE, includingPR-CRE, can become a significant challenge in centres with CRE and a high cardiac surgery volume. Despite complex antibiotic treatments and aggressive surgical procedures, these patients have a highmortality, particularly those infected with PR-CRE...

Feeding ecology and seasonal diet overlap between Stellifer brasiliensis and Stellifer stellifer in a tropical estuarine ecocline.

Seasonal freshwater discharge was important for defining habitat utilization by different ontogenetic phases of Stellifer brasiliensis and Stellifer stellifer along the estuarine ecocline. The middle estuary was important as a nursery and feeding ground for young-of-the-year, and a feeding ground for sub-adults and adults of both species. These species are zoobenthivorous, but during their life cycle and between different habitats and seasons, their trophic guild can change to opportunist and zooplanktivore. During the late rainy season in the lower estuary, all phases of both species, except juveniles of S. brasiliensis and adults of S. stellifer, showed a niche overlap indicating similarity in prey utilization. The diet composition was qualitatively similar, showing an evident niche overlap of intra and interspecific competition among the Stellifer spp. Although the niches of these species appeared to significantly overlap, some resource partitioning patterns were apparent. The niche overlap was significantly reduced due to the seasonal difference in habitat use and prey consumption along the ecocline of the estuary by different ontogenetic phases. The ingestion of blue nylon fragments by both species was observed and quantified.

Temporal patterns in the intertidal faunal community at the mouth of a tropical estuary.

The use of intertidal sandy beaches by fish and macrocrustaceans was studied at different temporal scales at the mouth of a tropical estuary. Samples were taken along the lunar and diel cycles in the late dry and rainy seasons. Fish assemblage (number of species, density and biomass), crustaceans and wrack biomass, showed significant interactions among all studied factors, and the combination of moon phase and diel cycle, resulting in different patterns of environmental variables (depth, water temperature and dissolved oxygen), affected habitat use by the different species. Variances in faunal community were detected between seasons, stimulated by salinity fluctuations from freshwater input during the rainy season. These differences suggest an important cycling of habitats and an increase in connectivity between adjacent habitats (estuary and coastal waters). Moreover, the results showed that this intertidal sandy beach also provides an alternative nursery and protected shallow-water area for the initial development phase of many marine and estuarine species. In addition, this intertidal habitat plays an important role in the maintenance of the ecological functioning of the estuarine-coastal ecosystem continuum.

Trophic niche and habitat shifts of sympatric Gerreidae.

The diet and mouth growth rates of three Gerreidae species (Eugerres brasilianus, Eucinostomus melanopterus and Diapterus rhombeus) were assessed at different ontogenetic phases (juveniles, sub-adults and adults) in order to detect allometric growth, and whether they are related to habitat and seasonal changes in the Goiana Estuary, north-east Brazil. The importance of each prey for each ontogenetic phase was described using the index of relative importance. The three species showed seasonal ontogenetic shifts in diet and allometric growth of mouth morphology. They also had an exclusively zoobenthic diet, comprising mainly Polychaeta, Copepoda, Ostracoda, Gastropoda and Bivalvia. Mouth development showed a possible influence on diet changes for E. melanopterus. Significant interactions (P < 0·01) were detected among seasons, areas and ontogenetic phases for the most important prey for E. brasilianus and E. melanopterus. Diet overlaps are evidence of intra and interspecific competition among gerreids for specific prey. A conceptual model of the competition and seasonal diet shifts among ontogenetic phases of gerreids is given. The sediment ingested due to the feeding mechanisms of Gerreidae species could also partially explain the ingestion of synthetic items observed for all ontogenetic phases, which indicates one of a myriad effects of human activities (e.g. artisanal fishery) in this estuary.

Early development of marine catfishes (Ariidae): from mouth brooding to the release of juveniles in nursery habitats.

The development and allometric growth patterns of the ariid catfishes Cathorops spixii and Cathorops agassizii were studied from neurula embryos to juveniles. The ontogenetic sequence revealed that prior to hatching, embryos of both species are well developed, and their axial and appendicular skeletons are well ossified. Embryos of both species grow slowly longitudinally, but positively allometric growth (growth coefficient, ß1 > 1) was observed in head width and eye diameter. It is hypothesized that these growth patterns might be related to functional priorities for the development of sensory organs, such as the inner ears (otoliths), the Weberian apparatus, eyes and nostrils, during the embryonic period. The first appearance of vertebrae and otoliths, as well as the ossification of otoliths and the Weberian apparatus, occur earlier in embryos of C. agassizii than in embryos of C. spixii. After hatching, mouth-brooded free embryos of both species grow isometrically. Negatively allometric growth was observed in head width and eye diameter during the yolk-sac period, which is expected given that the sensory organs are already formed. Free embryos of C. agassizii are distinguishable from those of C. spixii by their larger eyes, longer snouts, longer heads and heavier yolk sacs. The end of the yolk-sac period is characterized by a direct change from free embryo to juvenile, without a true larval period. The juveniles of the two species can also be distinguished from each other by the larger eyes of C. agassizii compared with C. spixii, as in adult fishes.

Influence of moon phase on fish assemblages in estuarine mangrove tidal creeks.

Significant differences in the composition of fish assemblages during different moon phases were detected in mangrove tidal creeks of the Goiana Estuary. The numbers of Zabaleta anchovy Anchovia clupeoides, Tarpon snook Centropomus pectinatus and Guavina Guavina guavina as well as at least 15 other species showed significant changes according to moon phase and were higher in terms of individuals (32%) and mass (34%) during the new moon.

Movement patterns of catfishes (Ariidae) in a tropical semi-arid estuary.

From December 2005 to November 2006, 216 samples were taken from the main channel of the Goiana Estuary, representing a total sampled area of 23 ha. Ariidae species were the most abundant in density (1600 individuals ha(-1), 53%) and biomass (18,813 g ha(-1), 63%). Cathorops spixii was the most abundant in density (1340 individuals ha(-1)) and biomass (14,203 g ha(-1)). The variables: number of species, total density and biomass, showed significant interactions between the factors of areas and seasons (P < 0.01). The highest total density (7394 individuals ha(-1)) and biomass (70,292 g ha(-1)) occurred in the middle and upper estuaries, respectively, during the early-rainy season. The density of C. spixii differed significantly between areas and seasons (P < 0.01), while Cathorops agassizii differed significantly only between seasons (P < 0.01). The biomass differed significantly for the species C. spixii, C. agassizii and Sciades herzbergii between seasons, and C. spixii and C. agassizii between areas. Also, the density and biomass of C. spixii and C. agassizii showed interaction between areas and seasons. Only the biomass of S. herzbergii showed interaction between areas and seasons (P < 0.01). This indicates that seasonal variations influenced the distribution of Ariidae species in the different areas of the Goiana Estuary. Moreover, canonical correspondence analysis highlighted a strongly significant correlation (P < 0.01) between the seasonal variations of the environmental gradients (salinity and water temperature) and distribution of catfishes. The management and conservation of estuaries should take into account the life cycle of these species in different estuarine areas and hydrological seasons.

The effects of Chlorella vulgaris in the protection of mice infected with Listeria monocytogenes. Role of natural killer cells.

In this work we have demonstrated the effects of oral administration of Chlorella vulgaris (CV) on Natural Killer cells (NK) activity of mice infected with a sublethal dose of viable Listeria monocytogenes. The treatment with C. vulgaris produced a significant increase on NK cells activity in normal (non-infected) animals compared to the animals that received only vehicle (water) (p < 0.0001). Similarly, the infection alone produced a significant increase on NK cells activity, which was observed at 48 and 72 hours after the inoculation of L. monocytogenes. Moreover, when CV was administered in infected animals, there was an additional increase in NK cells activity which was significantly higher than that found in the infected groups (p < 0.0001). CV treatment (50 and 500mg/Kg) of mice infected with a dose of 3 x 10(5) bacteria/animal, which was lethal for all the non-treated controls, produced a dose-response protection which led to a 20% and 55% survival, respectively (p < 0.0001).

Effects of Chlorella vulgaris on bone marrow progenitor cells of mice infected with Listeria monocytogenes.

In this study we investigated the effects of the treatment with Chlorella vulgaris extract (CVE) on the hematopoietic response of granulocyte-macrophage colony-forming unit (CFU-GM) of mice infected with a sublethal dose of Listeria monocytogenes (1 x 10(4) organisms/animal). CVE was given orally as 50 mg/kg/day for 5 days. In the CVE treated/infected groups L. monocytogenes was administered at the end of CVE treatment. The colony stimulating activity of the serum (CSA) was also studied in all groups. Although no effects on CFU-GM, as compared to controls, were observed in the groups receiving CVE alone, the extract produced an increase in CSA levels as compared to controls. On the other hand, the presence of the infection led to a significant reduction in the numbers of CFU-GM as observed at 48 and 72 h after the infection, in spite of the significant increase in serum CSA activity. CVE treatment of infected animals restored the numbers of CFU-GM to control levels. In the treated/ infected group the increased serum CSA was significantly higher than that observed in the only infected group. The CVE treatment (50 and 500 mg/kg) of mice infected with a dose of 3 x 10(5) bacteria/animal, which was lethal for all the non-treated controls, produced a dose-response protection which led to a 20 and 52% survival, respectively. These results demonstrated that CVE produces a significant increase in the resistance of the animals infected with L. monocytogenes, and that this protection is due, at least in part, to increased CFU-GM in the bone marrow of infected animals.

B lymphocytes in mercury-exposed workers.

We have investigated the number of B lymphocytes in mercury-exposed workers. The study group consisted of 33 workers from a mercury-producing plant, mean age 27 years and a mean exposure period 19 months. At the time of testing and for the three previous months, the exposed persons had urinary mercury levels below the currently accepted limit of 50 micrograms g creatinine. A significant reduction in the number of B lymphocytes was observed in the mercury-exposed individuals. We found no correlation between B lymphocytes changes and urinary mercury concentrations, length of exposure or age of the workers.

Immunoglobulin E and autoantibodies in mercury-exposed workers.

In this work we have studied the serum immunoglobulin E (IgE) levels and the concentration of anti-DNA and anti-nucleus antibodies in mercury-exposed workers. The study group consisted of 36 workers from a mercury producing plant, with a mean age of 27 years and a mean exposure period to mercury of 19 months. At the time of testing, and for the three previous months, the exposed population had urinary mercury levels below the currently accept limit of 50 ug/g creatinine. Significantly increased IgE levels was found in the mercury-exposed individuals. Moreover, a moderate negative correlation (r = -0.43 P < 0.05) between the length of exposure to mercury and IgE levels was observed. Anti-DNA and anti-nucleus antibodies were not detected in these workers. These results suggest that the humoral immune response is an indicator of cellular changes in workers chronically exposed to mercury, even in those with urinary mercury concentrations within levels considered safe in the occupational area.

T lymphocytes in mercury-exposed workers.

In this work we have investigated the changes in T-helper and T-suppressor cells and T-cell proliferative response to phytohemagglutinin (PHA) in mercury-exposed workers. The study group consisted of 33 workers from a mercury-producing plant with a mean age of 29 years and a mean exposure period of 19 months. At the time of testing, and for the three previous months, the exposed population had urinary mercury levels below the currently accepted limit of 50 micrograms/g creatinine. A reverse CD4+/CD8+ ratio was observed in the mercury-exposed individuals which was characterized by a reduction in the number of CD4+ lymphocytes. No changes were observed in the proliferative response of lymphocytes from exposed individuals to PHA. Similarly, no proliferative response was observed when lymphocytes from normal individuals were cultivated in the presence of serum from the exposed workers. We found no correlations between lymphocytes changes and urinary mercury concentrations, time of exposure or the age of the workers.

Engulfment and killing capabilities of neutrophils and phagocytic splenic function in persons occupationally exposed to lead.

Phagocytosis and intracellular killing of Candida albicans and Candida pseudotropicalis by neutrophils as well as phagocytic splenic function from lead-exposed workers were studied. Two species of Candida were used since in individuals with myeloperoxidase deficiency neutrophils are unable to kill C. albicans, whereas C. pseudotropicalis can be effectively lysed. Phagocytosis with both antigens and phagocytic splenic function were normal in all the workers studied. However, lytic activity towards C. albicans, but not C. pseudotropicalis was impaired. This defect was observed in lead-exposed workers with blood lead levels and urinary delta-aminolevulinic acid (ALA-U) concentrations in the "safe" (below 60 micrograms/dl and 6 mg/l, respectively) and toxic ranges. An impaired ability to kill C. albicans suggests that lead exposure may lead to a myeloperoxidase deficiency. With the exception of blood lead levels and ALA-U concentrations, there was no correlation between any of the other parameters examined.

Immunoglobulin levels in workers exposed to inorganic mercury.

The serum immunoglobulin (IgG, IgM and IgA) concentrations of 44 mercury-exposed workers were examined and compared with those of non-exposed, age- and sex-matched individuals. At the time of testing, the exposed population had a mean (+/- S.D.) mercury urinary concentration of 24.7 +/- 19.1 and in 40 of them urinary mercury levels were below the currently accepted limit of 50 micrograms/g creatinine. Increased IgG, IgA and IgM levels were found in the mercury-exposed individuals and in 16, a second evaluation was performed six months later. During the intervening six months, the level of hygiene was improved throughout the plant, and urinary mercury concentrations were determined monthly in each worker. Despite a significant reduction in mercury urinary concentrations, serum immunoglobulin levels did not return to the normal range. There was no correlation between the length or level of exposure and the immunoglobulin levels. Liver protein synthesis, as studied by factor V, prothrombin time, prealbumin and transaminase activity, was normal and liver injury, as evaluated by serum aspartate and alanine aminotransferase activities (AST and ALT, respectively), was not observed. No haematological abnormalities were noted. These results indicate that "safe" levels of mercury exposure may lead to humoral immunological stimulation.

Immunoglobulin levels and cellular immune function in lead exposed workers.

The immunological status of lead acid battery workers with blood lead levels and urinary delta-aminolevulinic acid (ALA-U) concentrations ranging from safe to toxic levels has been examined and compared with those of non-exposed, age and sex matched controls. No differences in the serum concentrations of IgG, IgA and IgM between the populations were observed and there existed no correlation between blood lead level or ALA-U concentrations and serum immunoglobulin levels. In addition assessment was made of the capacity of peripheral blood mononuclear cells to respond to the mitogen phytohaemagglutinin (PHA), a correlate of T cell function. As before, there was no difference between exposed and control populations and no correlation between reactivity and blood lead concentration. Our data suggest that chronic exposure to lead fail to compromise lymphocyte function in man.