ABSTRACT
Streptococcus pyogenes causes a variety of infections because of virulence factors such as capsular hyaluronic acid and M protein. The aim of this study was to determine emm types and capsule phenotype in 110 isolates of S. pyogenes from patients with invasive (sterile sites) and non-invasive (mainly pharyngitis) infections in Chile, and the relationship between both virulence factors. The most abundant types found were emm12, emm1, emm4 and emm28 and their distribution was similar to that seen in Latin America and developed countries, but very different from that in Asia and Pacific Island countries. Ten of 16 emm types identified in pharyngeal isolates were found in sterile-site isolates, and three of nine emm types of sterile-site isolates occurred in pharyngeal isolates; three emm subtypes were novel. The amount of hyaluronic acid was significantly higher in sterile-site isolates but did not differ substantially among emm types. Only three isolates were markedly capsulate and two of them had mutations in the csrR gene that codes for a repressor of capsule synthesis genes. We found a non-random association between emm types and csrR gene alleles suggesting that horizontal gene transfer is not freely occurring in the population.
Subject(s)
Antigens, Bacterial/genetics , Bacterial Capsules/metabolism , Bacterial Outer Membrane Proteins/genetics , Bacterial Proteins/genetics , Carrier Proteins/genetics , Hyaluronic Acid/metabolism , Repressor Proteins/genetics , Streptococcal Infections/microbiology , Streptococcus pyogenes/classification , Streptococcus pyogenes/isolation & purification , Alleles , Chile , Genotype , Humans , Phenotype , Statistics as Topic , Streptococcus pyogenes/genetics , Streptococcus pyogenes/metabolism , Virulence Factors/geneticsABSTRACT
A 13-year-old girl developed transverse myelitis 2 weeks after an uncomplicated, combined general and epidural anaesthetic for orthopaedic surgery. Since epidural anaesthesia had been used, a causal relationship might have been assumed. We review the aetiology and pathogenesis of acute transverse myelitis and the role of anaesthesia in this disorder. Although a causal relationship cannot be assumed and regional anaesthesia in children is considered safe, we would like to re-emphasise the management principles and practices that may improve the benefit-to-risk ratio of these techniques.
Subject(s)
Anesthesia, Epidural/adverse effects , Anesthesia, General/adverse effects , Myelitis, Transverse/etiology , Acute Disease , Adolescent , Female , Humans , Magnetic Resonance Imaging , Myelitis, Transverse/diagnosisABSTRACT
A 37-year-old female with systemic lupus erythematosus and chronic treatment with steroids developed spontaneous bilateral rupture of tendons of both quadriceps muscles below the patella. Surgical treatment was undertaken with good results. The histologic features and a review of the literature are included.
