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2.
J Hosp Infect ; 113: 145-154, 2021 Jul.
Article in English | MEDLINE | ID: mdl-33852950

ABSTRACT

BACKGROUND: SARS-CoV-2 predisposes patients to secondary infections; however, a better understanding of the impact of coinfections on the outcome of hospitalized COVID-19 patients is still necessary. AIM: To analyse death risk due to coinfections in COVID-19 patients. METHODS: The odds of death of 212 severely ill COVID-19 patients were evaluated, with detailed focus on the risks for each pathogen, site of infection, comorbidities and length of hospitalization. FINDINGS: The mortality rate was 50.47%. Fungal and/or bacterial isolation occurred in 89 patients, of whom 83.14% died. Coinfected patients stayed hospitalized longer and had an increased odds of dying (odds ratio (OR): 13.45; R2 = 0.31). The risk of death was increased by bacterial (OR: 11.28) and fungal (OR: 5.97) coinfections, with increased levels of creatinine, leucocytes, urea and C-reactive protein. Coinfections increased the risk of death if patients suffered from cardiovascular disease (OR: 11.53), diabetes (OR: 6.00) or obesity (OR: 5.60) in comparison with patients with these comorbidities but without pathogen isolation. The increased risk of death was detected for coagulase-negative Staphylococcus (OR: 25.39), Candida non-albicans (OR: 11.12), S. aureus (OR: 10.72), Acinetobacter spp. (OR: 6.88), Pseudomonas spp. (OR: 4.77), and C. albicans (OR: 3.97). The high-risk sites of infection were blood, tracheal aspirate, and urine. Patients with coinfection undergoing invasive mechanical ventilation were 3.8 times more likely to die than those without positive cultures. CONCLUSION: Severe COVID-19 patients with secondary coinfections required longer hospitalization and had higher risk of death. The early diagnosis of coinfections is essential to identify high-risk patients and to determine the right interventions to reduce mortality.


Subject(s)
Bacterial Infections/mortality , COVID-19/mortality , Coinfection/mortality , Mycoses/mortality , Adult , Aged , Bacterial Infections/complications , COVID-19/complications , Female , Humans , Length of Stay , Male , Middle Aged , Mycoses/complications , Respiration, Artificial
3.
Lett Appl Microbiol ; 71(5): 490-497, 2020 Nov.
Article in English | MEDLINE | ID: mdl-32777092

ABSTRACT

The aim of this study was to synthesize and investigate the in vitro antifungal properties of 23 cinnamyl Schiff bases. In addition, cytotoxic effects of such cinnamyl Schiff bases against human lung, kidney or red blood cells were also checked. The compounds were synthesized in a single-step, 2 min of reaction under microwave irradiation produced up to 97% yield. Six of the 23 cinnamyl Schiff bases possessed antifungal activities against strains of Candida, Aspergillus, Fonsecaea and, particularly, Cryptococcus species. Indeed, cinnamyl Schiff bases 1 and 23 exhibited minimum inhibitory concentration (MIC) values more than twofold lower than fluconazole (FCZ) against all the Cryptococcus neoformans strains (MIC = 1·33, 1·4 and 5·2 µg ml-1 , respectively) and Cryptococcus gattii strains (MIC = 5·3, 2·8 and 9·2 µg ml-1 , respectively) (12 strains of each species) while cinnamyl Schiff base 11 was as potent as FCZ against all strains from both Cryptococcus species. No significant cytotoxic effects were observed for Schiff bases against human lung, kidney or red blood cells, all presenting selective indexes higher than 10. In conclusion, this study revealed cinnamyl Schiff bases, especially 1 and 23, as new lead anticryptococcal agents for the discovery of novel antifungal drugs. SIGNIFICANCE AND IMPACT OF THE STUDY: The occurrence and severity of fungal infections have increased in recent decades due to resistance to available antifungal drugs and the appearance of new emerging pathogens. Thus, the search for new antifungal agents is mandatory. From a series of 23 cinnamyl Schiff bases, two compounds (1 and 23) were interrogated as new anticryptococcal agents without significant cytotoxicity against human lung, kidney or red blood cells. In turns, these new Schiff bases are lead compounds for the discovery of novel antifungal drugs.


Subject(s)
Antifungal Agents/pharmacology , Mycoses/drug therapy , Schiff Bases/pharmacology , Antifungal Agents/chemical synthesis , Antineoplastic Agents/pharmacology , Aspergillus/drug effects , Candida/drug effects , Cryptococcus gattii/drug effects , Cryptococcus neoformans/drug effects , Fluconazole/pharmacology , Fonsecaea/drug effects , Humans , Microbial Sensitivity Tests , Schiff Bases/chemical synthesis
4.
New Microbes New Infect ; 29: 100496, 2019 May.
Article in English | MEDLINE | ID: mdl-30949344

ABSTRACT

Many factors that lead to host immunosuppression are clearly known to predispose the host to fungal diseases, significantly influencing the occurrence of mycoses. However, little or nothing has been discussed regarding social or economic factors that can influence the occurrence of diseases caused by fungi. In this minireview, we discuss several factors that may affect the occurrence of mycoses in Brazil, a continentally extended country that is marked by large climatic variations and severe socioeconomic distortions that may limit access to health services for the population.

5.
Science ; 361(6405): 894-899, 2018 08 31.
Article in English | MEDLINE | ID: mdl-30139911

ABSTRACT

The yellow fever virus (YFV) epidemic in Brazil is the largest in decades. The recent discovery of YFV in Brazilian Aedes species mosquitos highlights a need to monitor the risk of reestablishment of urban YFV transmission in the Americas. We use a suite of epidemiological, spatial, and genomic approaches to characterize YFV transmission. We show that the age and sex distribution of human cases is characteristic of sylvatic transmission. Analysis of YFV cases combined with genomes generated locally reveals an early phase of sylvatic YFV transmission and spatial expansion toward previously YFV-free areas, followed by a rise in viral spillover to humans in late 2016. Our results establish a framework for monitoring YFV transmission in real time that will contribute to a global strategy to eliminate future YFV epidemics.


Subject(s)
Disease Outbreaks/prevention & control , Epidemiological Monitoring , Genomics/methods , Yellow Fever/prevention & control , Yellow Fever/transmission , Yellow fever virus/isolation & purification , Aedes/virology , Age Factors , Animals , Brazil/epidemiology , Disease Outbreaks/statistics & numerical data , Evolution, Molecular , Humans , Phylogeny , Polymerase Chain Reaction , Risk , Sex Factors , Spatio-Temporal Analysis , Yellow Fever/epidemiology , Yellow Fever/virology , Yellow fever virus/classification , Yellow fever virus/genetics
6.
Eur J Clin Nutr ; 70(12): 1408-1413, 2016 12.
Article in English | MEDLINE | ID: mdl-27406159

ABSTRACT

BACKGROUND: Resistance training (RT) has selective effects on body composition that may counteract the deleterious effects of aging. Changes in phase angle (PhA) may serve to monitor the influence of RT in older people. OBJECTIVES: To describe the effect of RT in training, detraining and retraining on body composition, including PhA in older women. SUBJECTS/METHODS: Thirty-three older women (⩾60 years old) participated. The RT program was carried out over 12 weeks for each stage (training, detraining and retraining). Whole-body fat-free mass and fat mass (FM) and appendicular lean soft tissue (ALST) measurements were carried out using a dual energy X-ray absorptiometry. Bioimpedance spectroscopy was used to estimate total body water (TBW), intra (ICF) and extracellular (ECF) fluids, whole-body resistance (R) and reactance (Xc) and PhA. Upper and lower body muscle strength were also assessed. RESULTS: From baseline to after training muscle strength, ALST and PhA significantly (P<0.05) increased. In detraining, significant (P<0.05) reductions in muscle strength, TBW, ECF, ICF and PhA along with significant (P<0.05) increases in R were observed, with the greatest magnitude observed for PhA (Δ=-7.6%). From detraining to retraining a significant reduction in FM along with increases in Xc, PhA and muscle strength were observed. Although an increase was observed from detraining to retraining in PhA, the values were still lower than baseline PhA. CONCLUSIONS: In untrained older women, a RT is associated with increases in PhA, whereas detraining results in a marked decrease in PhA, and more time may be required in retraining to counteract the negative influence of absence of exercise stimulus.


Subject(s)
Aging/physiology , Body Composition/physiology , Electric Impedance , Exercise/physiology , Resistance Training/methods , Aged , Dielectric Spectroscopy , Female , Humans , Middle Aged , Muscle Strength , Muscle, Skeletal/physiology
7.
J Appl Microbiol ; 120(1): 41-8, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26442997

ABSTRACT

AIM: The aim of this study was to investigate the in vitro and in vivo activities of pure curcumin, as well as its combination with fluconazole, against Cryptococcus gattii. METHODS AND RESULTS: The minimal inhibitory concentrations (MIC) of curcumin and its interactions with fluconazole against C. gattii were assessed in vitro using standard methods. This same combination was used to treat C. gattii-induced cryptococcosis in mice. The behavioural and functional assessment of the mice during treatment was also performed. The average MIC for curcumin was 19·8 µg ml(-1) . Its combination with fluconazole resulted in FICΣ (fractional inhibitory concentration index) values between 0·79 and 2·29. Curcumin (alone or combined with fluconazole) significantly reduced pulmonary damage and fungal burden in the brain. No colonies were found in the brain following combination treatment, which was also confirmed by the improved behaviour of mice. CONCLUSIONS: The combination therapy with curcumin and fluconazole was the most effective among the treatments tested, as in addition to reducing the fungal burden and damage on lung tissues, it was able to eliminate the fungal burden in the brain, enhancing the survival of mice. SIGNIFICANCE AND IMPACT OF THE STUDY: This study points to the possibility of using curcumin in combination with fluconazole as a clinical treatment of cryptococcosis.


Subject(s)
Antifungal Agents/administration & dosage , Cryptococcosis/drug therapy , Cryptococcus gattii/drug effects , Curcumin/administration & dosage , Fluconazole/administration & dosage , Animals , Cryptococcosis/microbiology , Cryptococcus gattii/growth & development , Drug Synergism , Drug Therapy, Combination , Female , Humans , Mice , Mice, Inbred C57BL
8.
Pediatr Obes ; 11(4): 272-8, 2016 08.
Article in English | MEDLINE | ID: mdl-26199046

ABSTRACT

BACKGROUND: Central fatness might be a more sensitive predictor of atherosclerotic changes in children than are total body fat measures. However, it is unclear whether a total body fat measure coupled with an estimate of a more central pattern of fat accumulation predicts increased carotid intima-media-thickness (cIMT) better than either measure alone. OBJECTIVE: The objective of the study is to identify the ability of a combination of simple anthropometric screening tools or a combination of objective measures of body composition to predict cIMT. METHODS: cIMT was assessed on the common carotid artery in 349 children aged 11-12 years old (183 girls). Body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) were dichotomized according to established criteria and indices of total body (TBFI) and abdominal (ABFMI) fat were assessed by dual-energy X-ray absorptiometry and categorized (increased risk ≥85%). Single and combined associations among anthropometric and laboratorial measures with the risk of having increased cIMT (≥85%) and discriminatory performance were tested with logistic regression analysis and Receiver Operator Curve analysis. RESULTS: Children with higher total fatness (BMI and TBFI) or higher central pattern of fat accumulation (WC, WHtR and BFMI) were in higher risk for increased cIMT [odds ratio (OR): 2.08-3.24). The risk for increased cIMT was not higher among children who coupled high total and high central fatness (OR: 2.27-3.10). CONCLUSIONS: Combination of total and central measures of fat does not improve the prediction of increased cIMT in children. Simple surrogate measures of fatness can be used to predict increased cIMT urging special attention to those children who exhibit increased abdominal fat.


Subject(s)
Anthropometry/methods , Body Composition , Carotid Intima-Media Thickness , Pediatric Obesity/physiopathology , Absorptiometry, Photon/methods , Adolescent , Carotid Artery, Common/diagnostic imaging , Child , Female , Hemodynamics/physiology , Humans , Male , Phenotype , ROC Curve , Risk Factors
9.
Int J Sports Med ; 36(8): 624-30, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25875317

ABSTRACT

The aim of this cross-sectional study was to examine the influence of muscular strength on carotid intima-media thickness (cIMT) in children, controlling for the effect of cardiorespiratory fitness (CRF) and central adiposity and to examine if differences among muscular strength tertiles translate to physiological differences. We assessed cIMT of the common carotid artery in 366 children between 11-12 years of age (191 girls). Measures included cIMT assessed with high-resolution ultrasonography, a maximal handgrip strength test, body fat mass and lean mass from DXA and CRF determined using a maximal cycle ergometer test. Association between muscular strength and cIMT adjusted for CRF and central adiposity, as measured by trunk fat, was tested with multiple linear regression analysis. Differences in risk factors among muscular strength groups were tested with ANOVA. The Muscular Strength Index (MSI) was inversely associated with cIMT independently of CRF and central adiposity (p<0.05). The low MSI group had the highest values of cIMT, waist circumference and systolic blood pressure and the lowest CRF (p<0.05). There was an inverse and independent association between muscular strength and cIMT. Low muscular strength was associated with higher levels of cardiovascular disease risk factors in children.


Subject(s)
Cardiovascular Diseases/etiology , Carotid Intima-Media Thickness , Hand Strength/physiology , Adiposity , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/physiopathology , Child , Cross-Sectional Studies , Exercise Test , Female , Humans , Linear Models , Male , Overweight/physiopathology , Pediatric Obesity/physiopathology , Physical Fitness , Risk Factors , Waist Circumference
11.
Eur J Clin Nutr ; 69(1): 20-7, 2015 Jan.
Article in English | MEDLINE | ID: mdl-24690589

ABSTRACT

BACKGROUND/OBJECTIVES: A combined heart rate (HR) and motion sensor (Actiheart) has been proposed as an accurate method for assessing total energy expenditure (TEE) and physical activity energy expenditure (PAEE). However, the extent to which factors such as caffeine may affect the accuracy by which the estimated HR-related PAEE contribution will affect TEE and PAEE estimates is unknown. Therefore, we examined the validity of Actiheart in estimating TEE and PAEE in free-living adults under a caffeine trial compared with doubly labeled water (DLW) as reference criterion. SUBJECTS/METHODS: Using a double-blind crossover trial (Clinicaltrials.gov ID: #NCT01477294) with two conditions (4-day each with a 3-day-washout period), randomly ordered as caffeine (5 mg/kg per day) and placebo (malt-dextrine) intake, TEE was measured by DLW in 17 physically active men (20-38 years) who were non-caffeine users. In each condition, resting energy expenditure (REE) was assessed by indirect calorimetry and PAEE was calculated as (TEE-(REE+0.1 TEE)). Simultaneously, PAEE and TEE were estimated by Actiheart using an individual calibration (ACC+HRstep). RESULTS: Under caffeine, ACC+HRstep explained 76 and 64% of TEE and PAEE from DLW, respectively; corresponding results for the placebo condition were 82 and 66%. No mean bias was found between ACC+HRstep and DLW for TEE (caffeine:-468 kJ per day; placebo:-407 kJ per day), although PAEE was slightly underestimated (caffeine:-856 kJ per day; placebo:-1147 kJ per day). Similar limits of agreement were observed in both conditions ranging from -2066 to 3002 and from -3488 to 1776 kJ per day for TEE and PAEE, respectively. CONCLUSIONS: Regardless of caffeine intake, the combined HR and motion sensor is valid for estimating free-living energy expenditure in a group of healthy men but is less accurate for an individual assessment.


Subject(s)
Caffeine/administration & dosage , Energy Metabolism/physiology , Heart Rate/physiology , Movement/physiology , Adult , Body Composition , Calorimetry, Indirect , Cross-Over Studies , Deuterium Oxide , Double-Blind Method , Humans , Male , Oxygen Isotopes , Placebos , Young Adult
12.
Int J Sports Med ; 35(13): 1101-5, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25009970

ABSTRACT

Changes in body components occur over a season, but their impact on performance is still unclear. We aimed to analyze the relationship between changes in leg strength and jump performance with body composition over a season in highly trained athletes. Measures from the beginning to the main competitive periods of a season were obtained in 40 male and 23 female basketball, handball and volleyball players (20±5 years) for fat (FM) and fat-free mass (FFM) estimated by DXA. Total body water (TBW) and extracellular water (ECW) were assessed by deuterium and bromide dilution, respectively, and intracellular water (ICW) was calculated as TBW minus ECW. Maximal strength was determined by the leg press, while jumping height was assessed with squat (SJ) and countermovement (CMJ) jumps. Significant improvements in strength (12.5±20.8%) and jumping height (SJ:8.3±13.9%; CMJ:6.3±8.5%) were found. FFM, TBW and ECW significantly increased (3.0±2.7%; 1.7±5.5%; 3.0±8.6%, respectively), while %FM decreased (-4.5±9.1%) and no changes were observed in ICW (1.2±9.7%). Among body composition changes only ICW was associated with performance even adjusted for gender, age, season length and sport (strength: ß=71.209, p=0.012; SJ: ß=0.311, p=0.049; CMJ: ß=0.366, p=0.018). Body composition, strength and jumping height improved over a season and ICW was the main predictor of performance in national level players.


Subject(s)
Athletic Performance/physiology , Body Water/physiology , Intracellular Fluid/physiology , Muscle Strength/physiology , Absorptiometry, Photon , Body Fat Distribution , Competitive Behavior/physiology , Extracellular Fluid/physiology , Female , Humans , Leg/physiology , Male , Plyometric Exercise , Seasons
13.
J Sports Med Phys Fitness ; 54(2): 162-73, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24509987

ABSTRACT

AIM: Body composition changes among elite athletes may influence competitive performance. This study aimed to characterize the body composition changes at the molecular, cellular, tissue, and whole-body level of analysis in elite junior basketball players during the course of a season. METHODS: Twelve males and 11 females (16 to 17 years) were evaluated. Dual-energy X-ray absorptiometry (DXA) was used to assess bone mineral (Mo) and lean-soft tissue (LST). Total-body water (TBW) and extracellular water (ECW) were assessed using isotope dilution techniques, and extracellular (ECF) and intracellular fluids (ICF) were calculated. Fat mass (FM) and fat-free mass (FFM) were assessed with a four-compartment model. Body cell mass was calculated (LST - (ECF + ECS)). Skeletal muscle (SM) was estimated using appendicular LST (ALST) as: (1.19 x ALST) - 1.65. At the whole-body level, weight, sum of 7 skinfolds, and muscle circumferences (Mc) were measured. The handgrip and the countermovement jump tests were used for performance assessment. RESULTS: Males increased FFM (4.4±2.3%), TBW (3.5±4.6%), SM (4.5±2.3%), and arm (3.4±2.7%) and thigh (3.8±3%) Mc. Females increased SM (5.9±4.6%) and arm (3.6±3.8%) and thigh (4±5.2%) Mc and decreased ICF (-9.7±13.6%). FFM components differed from the established values based on cadaver analysis. Both genders increased their performance and associations were found between changes in molecular and whole-body components with performance. CONCLUSION: In conclusion the season was associated with an improved body composition profile in males and few changes in females.


Subject(s)
Basketball/physiology , Body Composition/physiology , Physical Education and Training , Absorptiometry, Photon , Adolescent , Body Water/physiology , Female , Hand Strength/physiology , Humans , Longitudinal Studies , Male , Movement/physiology , Portugal
14.
Int J Sports Med ; 34(11): 991-6, 2013 Nov.
Article in English | MEDLINE | ID: mdl-23606341

ABSTRACT

This purpose of this study was to: 1) determine the intensity corresponding to anaerobic threshold (AT) during a discontinuous resistance exercise protocol in healthy young and elderly subjects by analyzing heart rate variability (HRV) and blood lactate (BL) and 2) investigate the effect of aging on these variables. A total of 28 individuals, 14 young and 14 elderly healthy men underwent one-repetition maximum (1RM) testing to determine maximum load on the leg press. Discontinuous resistance exercise testing was initiated at 10% of the 1RM with subsequent increases of 10%. The load corresponding to AT was approximately 30% 1RM in both groups. The determination of AT by HRV was associated with BL responses (p<0.01). While HRV indexes decreased with increasing of loads in both groups, the elderly had lower values at loads below AT (p<0.05). Additionally, BL increased sharply after the load corresponding to AT in both groups, although elderly subjects showed the lowest values (p<0.05). In conclusion, HRV is an effective tool for determining AT, which was approximately 30% 1RM under the testing procedures included in the present study. Furthermore, there was a marked change in autonomic function, with gradual vagal withdrawal followed by sympathetic activation. These responses were lower in elderly subjects.


Subject(s)
Anaerobic Threshold/physiology , Heart Rate/physiology , Lactic Acid/blood , Resistance Training/methods , Adult , Age Factors , Aged , Aged, 80 and over , Autonomic Nervous System/physiology , Exercise/physiology , Humans , Male , Middle Aged , Sympathetic Nervous System/physiology , Vagus Nerve/physiology , Young Adult
15.
J Clin Microbiol ; 51(2): 436-43, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23175254

ABSTRACT

MIC assays with Paracoccidioides brasiliensis, the etiological agent of paracoccidioidomycosis, had been conducted with variable protocols, employing both macrodilution and microdilution tests and including differences in inoculum preparation, media used, incubation periods, and temperatures. Twenty-one clinical and environmental isolates of Paracoccidioides were tested using amphotericin B, itraconazole, ketoconazole, fluconazole, sulfamethoxazole, sulfamethoxazole-trimethoprim, and terbinafine, according to the National Committee for Clinical Laboratory Standards (National Committee for Clinical Laboratory Standards, document M27-A2, 2002), with modifications such as three medium formulations (RPMI 1640 medium, McVeigh and Morton [MVM] medium, and modified Mueller-Hinton [MMH] medium), two incubation temperatures (room temperature [25 to 28 °C] and 37 °C), and three incubation periods (7, 10, and 15 days). The antifungal activities were also classified as fungicidal or fungistatic. The best results were obtained after 15 days of incubation, which was chosen as the standard incubation time. The MICs for most individual isolates grown for the same length of time at the same temperature varied with the different media used (P < 0.05). Of the isolates, 81% showed transition from the yeast to the mycelial form in RPMI 1640 medium at 37 °C, independent of the presence of antifungals. MMH medium appears to be a suitable medium for susceptibility testing of antifungal drugs with P. brasiliensis, except for sulfamethoxazole and the combination of sulfamethoxazole-trimethoprim, for which the MVM medium yielded better results. The incubation temperature influenced the MICs, with, in general, higher MICs at 25 °C (mycelial form) than at 37 °C (P < 0.05). Based on our results, we tentatively propose a microdilution assay protocol for susceptibility testing of antifungal drugs against Paracoccidioides.


Subject(s)
Antifungal Agents/pharmacology , Microbial Sensitivity Tests , Paracoccidioides/drug effects , Culture Media , Microbial Sensitivity Tests/standards , Paracoccidioides/cytology , Paracoccidioides/growth & development , Temperature , Time Factors
16.
Epidemiol Infect ; 140(5): 906-15, 2012 May.
Article in English | MEDLINE | ID: mdl-21875453

ABSTRACT

SUMMARYAn outbreak of meningococcal disease (MD) with severe morbidity and mortality was investigated in midwestern Brazil in order to identify control measures. A MD case was defined as isolation of Neisseria meningitidis, or detection of polysaccharide antigen in a sterile site, or presence of clinical purpura fulminans, or an epidemiological link with a laboratory-confirmed case-patient, between June and August 2008. In 8 out of 16 MD cases studied, serogroup C ST103 complex was identified. Five (31%) cases had neurological findings and five (31%) died. The attack rate was 12 cases/100 000 town residents and 60 cases/100 000 employees in a large local food-processing plant. We conducted a matched case-control study of eight primary laboratory-confirmed cases (1:4). Factors associated with illness in single variable analysis were work at the processing plant [matched odds ratio (mOR) 22, 95% confidence interval (CI) 2·3-207·7, P<0·01], and residing <1 year in Rio Verde (mOR 7, 95% CI 1·11-43·9, P<0·02). Mass vaccination (>10 000 plant employees) stopped propagation in the plant, but not in the larger community.


Subject(s)
Disease Outbreaks , Infection Control/methods , Meningococcal Infections/epidemiology , Meningococcal Infections/microbiology , Neisseria meningitidis, Serogroup C/isolation & purification , Occupational Exposure , Adolescent , Adult , Brazil/epidemiology , Case-Control Studies , Child , Child, Preschool , Community-Acquired Infections/epidemiology , Community-Acquired Infections/microbiology , Community-Acquired Infections/mortality , Community-Acquired Infections/prevention & control , Female , Food Handling , Humans , Infant , Male , Mass Vaccination/methods , Meningococcal Infections/mortality , Meningococcal Infections/prevention & control , Middle Aged , Pneumococcal Vaccines/administration & dosage , Survival Analysis , Young Adult
17.
Int J Infect Dis ; 14(10): e898-903, 2010 Oct.
Article in English | MEDLINE | ID: mdl-20843719

ABSTRACT

BACKGROUND: An epidemic of acute gastroenteritis occurred in Rio Branco City, Acre State, in Brazil's Amazon region in 2005. An investigation was conducted to confirm the etiology and identify possible risk factors for death. METHODS: Rio Branco municipality surveillance data for the period May to October 2005 were reviewed. In a case-control study, children who died following acute gastroenteritis were compared to age-matched controls with acute gastroenteritis who survived. Rotavirus A (RV-A) was investigated in 799 stool samples and genotyped by reverse transcription polymerase chain reaction (RT-PCR). RESULTS: The cumulative incidence of diarrhea in children aged <5 years was 21%. A fatal outcome was significantly associated with uncovered household water storage containers. RV-A was identified in 88% of samples and G9 was the prevalent genotype (71%). CONCLUSIONS: Oral rehydration solution and boiling or chlorinating drinking water likely limited mortality. This epidemic was caused by RV-A genotype G9. After the outbreak, a rotavirus vaccine was introduced into the official childhood immunization schedule in Brazil.


Subject(s)
Disease Outbreaks , Gastroenteritis/epidemiology , Rotavirus Infections/epidemiology , Rotavirus/isolation & purification , Acute Disease , Brazil/epidemiology , Case-Control Studies , Child, Preschool , Gastroenteritis/mortality , Gastroenteritis/virology , Genotype , Humans , Infant , Risk Factors , Rotavirus/genetics , Rotavirus Infections/mortality , Rotavirus Infections/virology
18.
Eur J Clin Microbiol Infect Dis ; 29(12): 1525-32, 2010 Dec.
Article in English | MEDLINE | ID: mdl-20803047

ABSTRACT

Forty Cryptococcus gattii strains were submitted to antifungal susceptibility testing with fluconazole, itraconazole, amphotericin B and terbinafine. The minimum inhibitory concentration (MIC) ranges were 0.5-64.0 for fluconazole, <0.015-0.25 for itraconazole, 0.015-0.5 for amphotericin B and 0.062-2.0 for terbinafine. A bioassay for the quantitation of fluconazole in murine brain tissue was developed. Swiss mice received daily injections of the antifungal, and their brains were withdrawn at different times over the 14-day study period. The drug concentrations varied from 12.98 to 44.60 µg/mL. This assay was used to evaluate the therapy with fluconazole in a model of infection caused by C. gattii. Swiss mice were infected intracranially and treated with fluconazole for 7, 10 or 14 days. The treatment reduced the fungal burden, but an increase in fungal growth was observed on day 14. The MIC for fluconazole against sequential isolates was 16 µg/mL, except for the isolates obtained from animals treated for 14 days (MIC = 64 µg/mL). The quantitation of cytokines revealed a predominance of IFN-γ and IL-12 in the non-treated group and elevation of IL-4 and IL-10 in the treated group. Our data revealed the possibility of acquired resistance during the antifungal drug therapy.


Subject(s)
Antifungal Agents/pharmacology , Brain/microbiology , Central Nervous System Fungal Infections/drug therapy , Cryptococcosis/drug therapy , Cryptococcus gattii/drug effects , Fluconazole/pharmacology , Animals , Antifungal Agents/therapeutic use , Central Nervous System Fungal Infections/microbiology , Cryptococcosis/microbiology , Disease Models, Animal , Drug Resistance, Fungal , Fluconazole/therapeutic use , Humans , Male , Mice , Microbial Sensitivity Tests , Treatment Outcome
19.
Mycoses ; 50(4): 286-9, 2007 Jul.
Article in English | MEDLINE | ID: mdl-17576321

ABSTRACT

Thirty-two clinical isolates of Trichophyton rubrum exhibiting resistance to fluconazole [minimum inhibitory concentrations (MICs) > or = 64 microg ml(-1)] were selected to test the antifungal activity of ketoconazole, itraconazole, griseofulvin and terbinafine. We followed the guidelines of the National Committee for Clinical Laboratory Standards for testing filamentous fungi. The strains Candida parapsilosis (ATCC 22019), Candida krusei (ATCC 6258), T. rubrum (ATCC 40051) and Trichophyton mentagrophytes (ATCC 40004) were included for quality control. The microdilution plates were incubated at 28 degrees C and were read visually after 7 days of incubation and endpoint determination readings were performed visually. The MIC ranges for the four antifungals were: 0.0625-2 microg ml(-1) for ketoconazole, 0.25-2.0 microg ml(-1) for griseofulvin, < or =0.031-1.0 microg ml(-1) for itraconazole and < or =0.031 microg ml(-1) for terbinafine (for all tested isolates). Terbinafine was the most potent drug against T. rubrum, in vitro, followed by itraconazole, ketoconazole and griseofulvin. Much work is still needed to correlate the MICs of these drugs with clinical outcomes to develop interpretative breakpoints for T. rubrum and other dermatophytes.


Subject(s)
Antifungal Agents/pharmacology , Drug Resistance, Fungal , Fluconazole/pharmacology , Trichophyton/drug effects , Microbial Sensitivity Tests , Quality Control , Reference Standards , Temperature , Time
20.
Nat Prod Res ; 21(1): 47-55, 2007 Jan.
Article in English | MEDLINE | ID: mdl-17365689

ABSTRACT

The methanol extract from the stems and fruits of Swinglea glutinosa (Rutaceae) afforded 11 known acridone alkaloids and three N-phenylethyl-benzamide derivatives, glycocitrine-IV, 1,3,5-trihydroxy-4-methoxy-10-methyl-2,8-bis(3-methylbut-2-enyl)acridin-9(10H)-one, 1,3,5- trihydroxy-2,8-bis(3-methylbut-2-enyl)-10-methyl-9-acridone, citbrasine, citrusinine-II, citrusinine-I, 5-dihydroxyacronycine, pyranofoline, 3,4-dihydro-3,5,8-trihydroxy-6-methoxy-2,2,7-trimethyl-2H-pyrano[2,3-a]acridin-12(7H)-one, 2,3-dihydro-4,9-dihydroxy-2-(2-hydroxy-propan-2-yl)-11-methoxy-10-methylfuro[3,2-b]acridin-5(10H)-one, bis-5-hydroxyacronycine, N-(2-{4-[(3,7-dimethylocta-2,6-dien-1-yl)oxy]phenyl}ethyl)benzamide, N-(2-{4-[(3,7-dimethyl-4-acethyl-octa-2,6-dien-1-yl)oxy]phenyl}ethyl)benzamide, and severine acetate. All compounds isolated were examined for their activity against three cancer cell lines: human lung carcinoma (COR-L23), human breast adenocarcinoma (MCF7), human melanoma (C32), and normal human fetal lung cell line, MRC-5. The acridones tested exhibited weak cytotoxicity but the amides showed moderate nonselective cytotoxic activity.


Subject(s)
Acridines/isolation & purification , Acridines/pharmacology , Antineoplastic Agents, Phytogenic/isolation & purification , Antineoplastic Agents, Phytogenic/pharmacology , Benzamides/isolation & purification , Benzamides/pharmacology , Rutaceae/chemistry , Acridines/chemistry , Antineoplastic Agents, Phytogenic/chemistry , Benzamides/chemistry , Cell Line, Tumor , Drug Screening Assays, Antitumor , Humans , Inhibitory Concentration 50 , Molecular Structure , Nuclear Magnetic Resonance, Biomolecular , Optical Rotation , Spectrometry, Gamma , Spectrophotometry, Ultraviolet
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