ABSTRACT
Although the highest burden of Streptococcus agalactiae infections has been reported in industrialized countries, studies on the characterization and epidemiology are still limited in developing countries and implementation of control strategies remains undefined. The aim of this retrospective study was to assess the epidemiological, clinical, and microbiological aspects of S. agalactiae infections in cancer patients treated at a Reference Brazilian National Cancer Institute - INCA, Rio de Janeiro, Brazil. We reviewed the clinical and laboratory records of all cancer patients identified as having invasive S. agalactiae disease during 2010-2014. The isolates were identified by biochemical analysis and tested for antimicrobial susceptibility. A total of 263 strains of S. agalactiae were isolated from cancer patients who had been clinically and microbiologically classified as infected. S. agalactiae infections were mostly detected among adults with solid tumors (94 %) and/or patients who have used indwelling medical devices (77.2 %) or submitted to surgical procedures (71.5 %). Mortality rates (in-hospital mortality during 30 days after the identification of S. agalactiae) related to invasive S. agalactiae infections (n = 28; 31.1 %) for the specific category of neoplasic diseases were: gastrointestinal (46 %), head and neck (25 %), lung (11 %), hematologic (11 %), gynecologic (4 %), and genitourinary (3 %). We also found an increase in S. agalactiae resistance to erythromycin and clindamycin and the emergence of penicillin-less susceptible isolates. A remarkable number of cases of invasive infections due to S. agalactiae strains was identified, mostly in adult patients. Our findings reinforce the need for S. agalactiae control measures in Brazil, including cancer patients.
Subject(s)
Neoplasms/complications , Neoplasms/epidemiology , Streptococcal Infections/epidemiology , Streptococcal Infections/etiology , Streptococcus agalactiae , Adult , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Brazil/epidemiology , Combined Modality Therapy , Drug Resistance, Bacterial , Female , Humans , Male , Microbial Sensitivity Tests , Mortality , Neoplasms/therapy , Population Surveillance , Retrospective Studies , Streptococcal Infections/drug therapy , Streptococcal Infections/mortality , Streptococcus agalactiae/classification , Streptococcus agalactiae/drug effects , Streptococcus agalactiae/geneticsABSTRACT
The arrangement of the elastic and collagen fibers in the upper human duodenum was examined. These fibers lie parallel to the muscle fibers in the tunica muscularis. In the submucosa they form a pantographic network arrangement, the cross-over angles of which increase in the oro-aboral direction. The collagen and elastic fibers show a polar orientation among the muscle fibers.
Subject(s)
Collagen/ultrastructure , Duodenum/chemistry , Elastic Tissue/ultrastructure , Adult , Duodenum/cytology , Humans , Microscopy, Electron , Middle AgedABSTRACT
The internal anatomy of the first part of the duodenum was studied in 39 anatomical specimens obtained from necropsies. Three mucosal folds were observed in the aboral part of this segment: two folds had a radial disposition and the third a circular one. The localization of these folds corresponded to the narrow zone observed externally in the first part of the duodenum. The functional significance of these results is discussed.
