Antimicrobial susceptibility of Rhodococcus equi strains isolated from foals in Chile.

Rhodococcus equi is responsible for foal pneumonia worldwide, with a significant economic impact on the production and breeding of horses. In Chile, the first case was reported in 2000, and since then, its incidence has been increasing. Distinctive characteristics of R. equi as an intracellular pathogen in macrophages, emergence of virulence plasmids encoding surface lipoprotein antigens, and appearance of antibiotic resistance against macrolides and rifampicin have significantly complicated the treatment of R. equi pneumonia in foals. Therefore, in vitro susceptibility studies of first-line and newer antibiotics against R. equi are the first step to establishing effective treatments and optimizing new therapeutic options. The aim of the present study is to determine the susceptibility profile of fourteen strains of R. equi isolated from foals in Chile to several antibiotics of the macrolide group including azithromycin, amikacin, tildipirosin and gamithromycin as well as others such as rifampicin, doxycycline and ceftiofur. Identification of R. equi in collected isolates from foals in Chile has been performed by CAMP test and PCR based on detecting of the gene encoding the 16 S rRNA. The presence of genes encoding virulence plasmids was also determined using PCR. Results obtained have demonstrated presence of virulent R. equi strains in Chile. In vitro susceptibility pattern to different antibiotics has shown better results for doxycycline and rifampicin similar to previous studies performed. Current macrolides have been evaluated in order to consider alternative treatment options in a context of emerging resistance to classic macrolides and rifampicin, obtaining better results with gamithromycin (MIC range of 0.125 to 128 mg/ml) than with tildipirosin (MIC range of 16 to 128 mg/ml). An adequate diagnosis of bacterial susceptibility based on antibiograms is necessary to treat the Rhodococcus equi infection in foals.

Immune response of adult horses, pregnant mares and foals to an experimental vaccine with recombinant EMA-2 protein of Theileria equi.

Equine theileriosis, caused by the Theileria equi protozoan, is a disease of worldwide importance. T. equi expresses surface proteins, of which the EMA-2 protein is a promising antigen for vaccine use. The aim of this study was to evaluate the immune response of adult horses, pregnant mares, and foals to an experimental EMA-2 protein of recombinant T. equi vaccine. A total of 46 horses were used in this study for vaccine trials and challenges. Twelve geldings, 14 pregnant mares, and 14 foals were divided into vaccinated and control groups. Total serum specific anti-rEMA-2 IgG, IgG subclasses, and transcription of cytokines related to the immune response were evaluated. For the vaccine challenge, six six-month-old foals were divided into vaccinated and control groups. For the challenge, blood from a horse with theileriosis was transfused to the foals. Geldings and pregnant mares maintained anti-rEMA-2 IgG levels at 130 and 140 days after vaccination, respectively. The most-detected IgG subclasses in vaccinated were IgG3/5, IgG4/7, and IgG1. IL2, IL10, IL12, IL17, IFN-γ, and TNF-α were the most-transcribed cytokines in PBMCs of vaccinated horses stimulated with rEMA-2. Challenge with T. equi demonstrated that vaccinated foals had an increase of 33% in total IgG four days after blood transfusion, while control foals had no significant response, suggesting that vaccine antibodies may have recognized EMA-2 protein of the native T. equi antigen. T. equi recombinant EMA-2 was shown to be a promising vaccine antigen by inducing humoral and cellular immunity similar to that observed in natural parasite infections.

Rhodococcus equi, primer reporte de un caso de enfermedad diseminada en el Perú / Rhodococcus equi, first case report of disseminated disease in Peru

Resumen Presentamos el caso de un paciente con infección por virus de inmunodeficiencia humana (VIH) con recuento de LTCD4+ 49 céls/mm3, que consultó por un cuadro de siete meses de baja de peso, dolor abdominal, diarrea crónica y lesiones cutáneas gomosas. El mielocultivo y hemocultivos fueron positivos para Rhodococcus equi. Además, se observaron lesiones histológicas en piel e intestino compatibles con este agente como malacoplaquia, reacción granulomatosa y cuerpos de Michaelis-Gutmann. Se descartó compromiso pulmonar mediante tomografía de tórax. Recibió terapia antibacteriana combinada con claritromicina, imipenem y vancomicina. A pesar del tratamiento, el paciente evolucionó desfavorablemente y falleció.

Abstract We present the case of a patient with human immunodeficiency virus (HIV) with a LTCD4 + 49 cells/mm3, who was admitted due to a seven-month period of weight loss, abdominal pain, chronic diarrhea and rubbery skin lesions. Myeloculture and blood cultures were positive for Rhodococcus equi. In addition, histological lesions in the skin and intestine compatible with this agent were observed, such as malacoplachy, granulomatous reaction and Michaelis-Gutmann bodies. Pulmonary involvement was ruled out by chest tomography. The patient received antibacterial therapy combined with clarithromycin, imipenem, and vancomycin. Despite the treatment, the patient evolved unfavorably and died.

Petroleum-Tolerant Rhizospheric Bacteria: Isolation, Characterization and Bioremediation Potential.

Petroleum is an important energy source. Due to its intensive exploration, accidents resulting in oil spills on soil are frequent, which creates consequences to ecosystems and human health. Rhizodegradation is an efficient technique that promotes the decontamination of polluted environments through the selection and use of rhizosphere microorganisms from phytoremediation plants. The aim of this study was to isolate, identify and characterize bacteria capable of degrading petroleum from the rhizosphere of Panicum aquaticum Poir., a plant that grows in petroleum contaminated soils. Three bacteria were isolated and characterized at the morphological (Gram staining), molecular (16S rRNA gene sequence analysis) and biochemical level. These bacteria were identified as new strains of Bacillus thurigiensis, Bacillus pumilus and Rhodococcus hoagii, which have been reported as potential bioremediators in the literature. All three bacteria were able to use petroleum hydrocarbons as the sole carbon source during in vitro degradation assays. Gas chromatography analysis of these assays indicated reductions of petroleum hydrocarbons between 23% and 96% within 48 h. Among the isolated bacteria, Rhodococcus hoagii presented the highest efficiency of petroleum consumption, reaching 87% of degradation after only 24 h of cultivation, which corresponds to a higher and faster degradation than previously reported, confirming the potential use of Rhodococcus hoagii for petroleum biodegradation.

GAPDH, rhbC, and vapA gene expression in Rhodococcus equi cultured under different iron concentrations.

The ability of Rhodococcus equi to survive in macrophages and cause pneumonia in foals depends on vapA and rhbC genes, which produce the virulence-associated protein A (VapA) and the rhequichelin siderophore, respectively. Virulent R. equi acquires Fe from transferrin by unknown mechanisms. Our objectives were to determine the role of GAPDH in Fe homeostasis, to further characterize GAPDH, rhbC, and vapA expression under iron homeostasis, and to document the occurrence of rhbC gene in R. equi isolates. Therefore, vapA + R. equi was cultured under excessive, physiologic, and restricted iron concentrations, and quantitative culture and gene expression were performed. The relative expression of GAPDH, rhbC, and vapA after 48 h of culture were analyzed by qPCR. To determine the rhbC occurrence, total DNA was extracted from R. equi isolated from foals with clinical rhodococcosis (n = 22), healthy horses (feces, n = 16; nasal swab, n = 9), soil (n = 6), and 2 ATCC reference strains. Conventional PCR was performed to identify genus/species, vapA, and rhbC genes. Iron restriction proportionally decreased R. equi growth rates, and induced high expression of both GAPDH and vapA. The putative role of GAPDH in R. equi iron homeostasis should be further investigated. rhbC was significantly up-regulated under both Fe excess and critical starvation. The rhbC gene was identified in all clinical isolates and soil, but it was absent in 2 isolates from healthy horses, suggesting that rhequichelin is not required for R. equi nasal and intestinal colonization.

[Rhodococcus equi, first case report of disseminated disease in Peru]. / Rhodococcus equi, primer reporte de un caso de enfermedad diseminada en el Perú.

We present the case of a patient with human immunodeficiency virus (HIV) with a LTCD4 + 49 cells/mm3, who was admitted due to a seven-month period of weight loss, abdominal pain, chronic diarrhea and rubbery skin lesions. Myeloculture and blood cultures were positive for Rhodococcus equi. In addition, histological lesions in the skin and intestine compatible with this agent were observed, such as malacoplachy, granulomatous reaction and Michaelis-Gutmann bodies. Pulmonary involvement was ruled out by chest tomography. The patient received antibacterial therapy combined with clarithromycin, imipenem, and vancomycin. Despite the treatment, the patient evolved unfavorably and died.

Clinical and pathological findings of Rhodococcus equi infection in foals / Achados clínicos e patológicos da infecção por Rhodococcus equi em potros

Infection by Rhodococcus equi is considered one of the major health concerns for foals worldwide. In order to better understand the disease's clinical and pathological features, we studied twenty cases of natural infection by R. equi in foals. These cases are characterized according to their clinical and pathological findings and immunohistochemical aspects. Necropsy, histologic examination, bacterial culture, R. equi and Pneumocystis spp. immunohistochemistry were performed. The foals had a mean age of 60 days and presented respiratory signs (11/20), hyperthermia (10/20), articular swelling (6/20), prostration (4/20), locomotor impairment (3/20) and diarrhea (3/20), among others. The main lesions were of pyogranulomatous pneumonia, seen in 19 foals, accompanied or not by pyogranulomatous lymphadenitis (10/20) and pyogranulomatous and ulcerative enterocolitis (5/20). Pyogranulomatous osteomyelitis was seen in 3 foals, one of which did not have pulmonary involvement. There was lymphoplasmacytic (4/20), lymphoplasmacytic and neutrophilic (1/20) or pyogranulomatous arthritis (1/20), affecting multiple or singular joints. Immunohistochemistry revealed to be a valuable tool for the detection of R. equi, confirming the diagnosis in all cases. Furthermore, pulmonary immunostaining for Pneumocystis spp. demonstrates that a coinfection with R. equi and this fungal agent is a common event in foals, seen in 13 cases.(AU)

Infecção por Rhodococcus equi é considerado um dos maiores problemas sanitários para potros em todo o mundo. Para melhor compreender a apresentação clínica e patológica da enfermidade, foram avaliados vinte casos de infecção natural por R. equi em potros. Os casos são caracterizados de acordo com seus achados clínicos e patológicos e aspectos imuno-histoquímicos. Foram realizados exames de necropsia, histologia, bacteriologia e imuno-histoquímica para R. equi e Pneumocystis spp. Os potros tinham idade media de 60 dias e apresentaram sinais respiratórios (11/20), hipertermia (10/20), aumento de volume articular (6/20), prostração (4/20), distúrbios locomotores (3/20) e diarreia (3/20), entre outros. As lesões mais importantes eram pneumonia piogranulomatosa, vista em 19 potros, acompanhada ou não por linfadenite piogranulomatosa (10/20) e enterocolite ulcerativa (5/20). Osteomielite piogranulomatosa foi constatada em três potros, um dos quais não apresentava envolvimento pulmonar. Artrites afetando uma ou múltiplas articulações eram caracterizadas por infiltrado linfoplasmocítico (4/20), linfoplasmocítico e neutrofílico (1/20) e piogranulomatoso (1/20). A imuno-histoquímica demonstrou ser uma ferramenta valiosa na detecção de R. equi, permitindo confirmar o diagnóstico em todos os casos avaliados. Além disso, a imuno-histoquímica para Pneumocystis spp. demonstra que a coinfecção por R. equi e o agente fúngico é um evento frequente em potros, constatado em 13 casos.(AU)

Enteropatógenos de potencial zoonótico identificados em aves silvestres / Enteric pathogens with zoonotic potential identified in wild birds / Patógenos entéricos de potencial zoonótico identificados en aves silvestres

Os enteropatógenos podem ser considerados um dos principais grupos de micro-organismos patogênicos para humanos e animais. Podem estabelecer infecção nos suscetíveis devido a contaminação de água, alimentos ou pelo contato estreito com animais, incluindo as aves silvestres ou com o ambiente de criação. O acesso das aves da fauna silvestre ao ambiente próximo aos domicílios favorece a contaminação peridomiciliar pelas fezes dos passeriformes e psitaciformes. Locais como parques e praças podem se tornar propícios para veiculação destes patógenos devido a deficiente higienização e livre acesso destas aves silvestres. Neste artigo foram revisados alguns enteropatógenos de origem bacteriana e viral que podem ser considerados de alto risco para infecção humana levando-se em consideração a relevância das aves silvestres neste contexto.(AU)

Entheric pathogens can be considered one of the main pathogenic groups of microorganisms in humans and animals. It can stablish infection in susceptible due to contamination of water, food, or by close contact with animals, including wild birds or the breeding environment. The access of wild birds to the environment close to residences predispose peridomestic contamination by feces of passeriforms and psittaciformes. Places like parks and squares can become propitious for propagation of these pathogens due to poor hygiene and free access of wild birds. In this article some enteric pathogens of bacterial and viral origin was revised, which can be considered of high risk for human infection considering the relevance of wild birds in this context.(AU)

Los patógenos entéricos pueden ser considerados como uno de los grupos principales de microorganismos patogénicos para el ser humano y los animales. Pueden establecer la infección en susceptibles debido a la contaminación del agua, los alimentos o por el contacto cercano con los animales, incluyendo los pájaros salvajes o con el ambiente de la creación. El acceso a las aves de vida silvestre para el medio ambiente cerca de los hogares peridomésticos favorece la contaminación por heces de aves paseriformes y psitaciformes. Los lugares como parques y plazas pueden llegar a ser propicio para la propagación de estos patógenos debido a la falta de higiene y el libre acceso de las aves silvestres. En este artículo algunos patógenos entéricos del origen bacteriano y viral fueron revisados que pueden ser considerados de alto riesgo de contaminación humana, teniendo en cuenta la relevancia de las aves silvestres en este contexto.(AU)

Clinical and pathological findings of Rhodococcus equi infection in foals / Achados clínicos e patológicos da infecção por Rhodococcus equi em potros

Infection by Rhodococcus equi is considered one of the major health concerns for foals worldwide. In order to better understand the disease's clinical and pathological features, we studied twenty cases of natural infection by R. equi in foals. These cases are characterized according to their clinical and pathological findings and immunohistochemical aspects. Necropsy, histologic examination, bacterial culture, R. equi and Pneumocystis spp. immunohistochemistry were performed. The foals had a mean age of 60 days and presented respiratory signs (11/20), hyperthermia (10/20), articular swelling (6/20), prostration (4/20), locomotor impairment (3/20) and diarrhea (3/20), among others. The main lesions were of pyogranulomatous pneumonia, seen in 19 foals, accompanied or not by pyogranulomatous lymphadenitis (10/20) and pyogranulomatous and ulcerative enterocolitis (5/20). Pyogranulomatous osteomyelitis was seen in 3 foals, one of which did not have pulmonary involvement. There was lymphoplasmacytic (4/20), lymphoplasmacytic and neutrophilic (1/20) or pyogranulomatous arthritis (1/20), affecting multiple or singular joints. Immunohistochemistry revealed to be a valuable tool for the detection of R. equi, confirming the diagnosis in all cases. Furthermore, pulmonary immunostaining for Pneumocystis spp. demonstrates that a coinfection with R. equi and this fungal agent is a common event in foals, seen in 13 cases.(AU)

Infecção por Rhodococcus equi é considerado um dos maiores problemas sanitários para potros em todo o mundo. Para melhor compreender a apresentação clínica e patológica da enfermidade, foram avaliados vinte casos de infecção natural por R. equi em potros. Os casos são caracterizados de acordo com seus achados clínicos e patológicos e aspectos imuno-histoquímicos. Foram realizados exames de necropsia, histologia, bacteriologia e imuno-histoquímica para R. equi e Pneumocystis spp. Os potros tinham idade media de 60 dias e apresentaram sinais respiratórios (11/20), hipertermia (10/20), aumento de volume articular (6/20), prostração (4/20), distúrbios locomotores (3/20) e diarreia (3/20), entre outros. As lesões mais importantes eram pneumonia piogranulomatosa, vista em 19 potros, acompanhada ou não por linfadenite piogranulomatosa (10/20) e enterocolite ulcerativa (5/20). Osteomielite piogranulomatosa foi constatada em três potros, um dos quais não apresentava envolvimento pulmonar. Artrites afetando uma ou múltiplas articulações eram caracterizadas por infiltrado linfoplasmocítico (4/20), linfoplasmocítico e neutrofílico (1/20) e piogranulomatoso (1/20). A imuno-histoquímica demonstrou ser uma ferramenta valiosa na detecção de R. equi, permitindo confirmar o diagnóstico em todos os casos avaliados. Além disso, a imuno-histoquímica para Pneumocystis spp. demonstra que a coinfecção por R. equi e o agente fúngico é um evento frequente em potros, constatado em 13 casos.(AU)

First Microbiological and Molecular Identification of Rhodococcus equi in Feces of Nondiarrheic Cats.

Rhodococcus equi is responsible for infections in multiple-host animals. In humans, the prevalence of rhodococcus has increased worldwide and represents an emergent risk. R. equi is a soil-borne opportunistic bacterium isolated from feces of a wide variety of domestic species, except cats; thus, there is no known potential risk of its transmission from humans. Here, the mono- and cooccurrence of Rhodococcus equi and other bacteria and selected virulence markers were investigated in feces of nondiarrheic cats from urban (n=100) and rural (n=100) areas. Seven (7/200=3.5%) R. equi isolates were recovered in ceftazidime, novobiocin, and cycloheximide (CAZ-NB) selective media, exclusively of cats from three distinct farms (p=0.01), and these cats had a history of contact with horses and their environment (p=0.0002). None of the R. equi isolates harbored hosted-adapted plasmid types associated with virulence (pVAPA, pVAPB, and pVAPN). One hundred seventy-five E. coli isolates were identified, and 23 atypical enteropathogenic E. coli (aEPEC), 1 STEC (Shiga-toxin producing E. coli), and 1 EAEC (enteroaggregative E. coli) were detected. Eighty-six C. perfringens type A isolates were identified, and beta-2 and enterotoxin were detected in 21 and 1 isolates, respectively. Five C. difficile isolates were identified, one of which was toxigenic and ribotype 106. The main cooccurring isolates in cats from urban areas were E. coli and C. perfringens A (26/100=26%), E. coli and C. perfringens type A cpb2+ (8/100=8%), and aEPEC (eae+/escN+) and C. perfringens type A (5/100=5%). In cats from farms, the main cooccurring isolates were E. coli and C. perfringens type A (21/100=21%), E. coli and C. perfringens type A cpb 2 + 8/100=8%), and E. coli and R. equi (4/100=4%). We identified, for the first time, R. equi in nondiarrheic cats, a finding that represents a public health issue because rhodococcus has been reported in both immunosuppressed and immunocompetent humans, particularly people living with HIV/AIDS.

Rhodococcus equi como causa de neumonía en el síndrome de inmunodeficiencia adquirida / Rhodococcus equi as a cause of pneumonia in the acquired immunodeficiency syndrome

RESUMEN Rhodococcus equi es un microorganismo emergente asociado a infecciones oportunistas en individuos inmunocomprometidos, especialmente en pacientes con infección por virus de inmunodeficiencia humana. Se desarrolló una búsqueda en la Biblioteca Virtual de Infomed, fueron revisados 215 trabajos científicos sin limitación de año y país, seleccionándose 55. El rhodococcus es un patógeno intracelular capaz de crecer y persistir dentro de los macrófagos que expresan en su superficie el receptor Mac-1 (CD11b/CC18), y posteriormente destruirlos. La manifestación clínica más frecuente es la neumonía de comienzo insidioso y en su evolución natural tiende a la cavitación. El diagnóstico se realiza mediante su identificación en cultivo de muestras de tejido afectado. Los hemocultivos son positivos en el 50% de los inmunodeprimidos En el diagnóstico radiográfico, los hallazgos más comunes referidos en la literatura científica son el compromiso lobar y la cavitación. La particular evolución que experimentan los pacientes con síndrome de inmunodeficiencia adquirida y neumonía por R. equi, obliga a implementar esquemas terapéuticos basados en antimicrobianos con actividad bactericida intracelular, administrados inicialmente por vía intravenosa y durante un tiempo prolongado e incluso la cirugía. La infección por R. equi es una complicación infrecuente en pacientes con síndrome de inmunodeficiencia adquirida, pero con una elevada tasa de letalidad, por lo que debe ser sospechado en pacientes que presenten una infección respiratoria de curso inhabitual. El diagnóstico precoz, el tratamiento antimicrobiano combinado y prolongado y el inicio de la Terapia Antiretroviral de Gran Actividad en forma temprana pueden mejorar la evolución y el pronóstico de estos pacientes (AU).

ABSTRACT Rhodococcus equi is an emergent microorganism associated to opportunistic infections in immune-compromised individuals, especially in patients infected with the human immunodeficiency virus. A search was carried out in the Virtual Library of Infomed; 215 scientific works were reviewed without limits of publication years and countries. From them, 55 were chosen. Rhodococcus equi is an intracellular pathogen that is able to grow and live inside the macrophages expressing the Mac-1 (CD11b/CC18) receptor in the surface and destroying them later. The most common clinical manifestation is insidious beginning pneumonia, tending to cavitation in its natural evolution. The diagnosis is made through identification in culture of affected tissues samples. Blood cultures are positive in 50 % of the immune-depressed people. At the radiographic diagnosis, the most common findings referred to in the scientific literature are lobar compromise and cavitation. The particular evolution of the patients with acquired immune-deficiency syndrome and pneumonia due to Rhodococcus equi forces the implementation of therapeutic schemes based on antimicrobials with intracellular bactericide activity, administered firstly intravenously and during a long time, and even to perform the surgery. Rhodococcus equi infection is an infrequent complication in patients with acquired immunodeficiency syndrome, but having a high lethality rate, therefore it should be suspected in patients presenting a respiratory infection of unusual curse. The precocious diagnosis, combined and prolonged antimicrobial treatment and early beginning of the highly active antiretroviral therapy could improve the evolution and prognosis of these patients (AU).

Rhodococcus equi como causa de neumonía en el síndrome de inmunodeficiencia adquirida / Rhodococcus equi as a cause of pneumonia in the acquired immunodeficiency syndrome

RESUMEN Rhodococcus equi es un microorganismo emergente asociado a infecciones oportunistas en individuos inmunocomprometidos, especialmente en pacientes con infección por virus de inmunodeficiencia humana. Se desarrolló una búsqueda en la Biblioteca Virtual de Infomed, fueron revisados 215 trabajos científicos sin limitación de año y país, seleccionándose 55. El rhodococcus es un patógeno intracelular capaz de crecer y persistir dentro de los macrófagos que expresan en su superficie el receptor Mac-1 (CD11b/CC18), y posteriormente destruirlos. La manifestación clínica más frecuente es la neumonía de comienzo insidioso y en su evolución natural tiende a la cavitación. El diagnóstico se realiza mediante su identificación en cultivo de muestras de tejido afectado. Los hemocultivos son positivos en el 50% de los inmunodeprimidos En el diagnóstico radiográfico, los hallazgos más comunes referidos en la literatura científica son el compromiso lobar y la cavitación. La particular evolución que experimentan los pacientes con síndrome de inmunodeficiencia adquirida y neumonía por R. equi, obliga a implementar esquemas terapéuticos basados en antimicrobianos con actividad bactericida intracelular, administrados inicialmente por vía intravenosa y durante un tiempo prolongado e incluso la cirugía. La infección por R. equi es una complicación infrecuente en pacientes con síndrome de inmunodeficiencia adquirida, pero con una elevada tasa de letalidad, por lo que debe ser sospechado en pacientes que presenten una infección respiratoria de curso inhabitual. El diagnóstico precoz, el tratamiento antimicrobiano combinado y prolongado y el inicio de la Terapia Antiretroviral de Gran Actividad en forma temprana pueden mejorar la evolución y el pronóstico de estos pacientes.

ABSTRACT Rhodococcus equi is an emergent microorganism associated to opportunistic infections in immune-compromised individuals, especially in patients infected with the human immunodeficiency virus. A search was carried out in the Virtual Library of Infomed; 215 scientific works were reviewed without limits of publication years and countries. From them, 55 were chosen. Rhodococcus equi is an intracellular pathogen that is able to grow and live inside the macrophages expressing the Mac-1 (CD11b/CC18) receptor in the surface and destroying them later. The most common clinical manifestation is insidious beginning pneumonia, tending to cavitation in its natural evolution. The diagnosis is made through identification in culture of affected tissues samples. Blood cultures are positive in 50 % of the immune-depressed people. At the radiographic diagnosis, the most common findings referred to in the scientific literature are lobar compromise and cavitation. The particular evolution of the patients with acquired immune-deficiency syndrome and pneumonia due to Rhodococcus equi forces the implementation of therapeutic schemes based on antimicrobials with intracellular bactericide activity, administered firstly intravenously and during a long time, and even to perform the surgery. Rhodococcus equi infection is an infrequent complication in patients with acquired immunodeficiency syndrome, but having a high lethality rate, therefore it should be suspected in patients presenting a respiratory infection of unusual curse. The precocious diagnosis, combined and prolonged antimicrobial treatment and early beginning of the highly active antiretroviral therapy could improve the evolution and prognosis of these patients.

Enteropatógenos de potencial zoonótico identificados em aves silvestres / Enteric pathogens with zoonotic potential identified in wild birds / Patógenos entéricos de potencial zoonótico identificados en aves silvestres

Os enteropatógenos podem ser considerados um dos principais grupos de micro-organismos patogênicos para humanos e animais. Podem estabelecer infecção nos suscetíveis devido a contaminação de água, alimentos ou pelo contato estreito com animais, incluindo as aves silvestres ou com o ambiente de criação. O acesso das aves da fauna silvestre ao ambiente próximo aos domicílios favorece a contaminação peridomiciliar pelas fezes dos passeriformes e psitaciformes. Locais como parques e praças podem se tornar propícios para veiculação destes patógenos devido a deficiente higienização e livre acesso destas aves silvestres. Neste artigo foram revisados alguns enteropatógenos de origem bacteriana e viral que podem ser considerados de alto risco para infecção humana levando-se em consideração a relevância das aves silvestres neste contexto.

Entheric pathogens can be considered one of the main pathogenic groups of microorganisms in humans and animals. It can stablish infection in susceptible due to contamination of water, food, or by close contact with animals, including wild birds or the breeding environment. The access of wild birds to the environment close to residences predispose peridomestic contamination by feces of passeriforms and psittaciformes. Places like parks and squares can become propitious for propagation of these pathogens due to poor hygiene and free access of wild birds. In this article some enteric pathogens of bacterial and viral origin was revised, which can be considered of high risk for human infection considering the relevance of wild birds in this context.

Los patógenos entéricos pueden ser considerados como uno de los grupos principales de microorganismos patogénicos para el ser humano y los animales. Pueden establecer la infección en susceptibles debido a la contaminación del agua, los alimentos o por el contacto cercano con los animales, incluyendo los pájaros salvajes o con el ambiente de la creación. El acceso a las aves de vida silvestre para el medio ambiente cerca de los hogares peridomésticos favorece la contaminación por heces de aves paseriformes y psitaciformes. Los lugares como parques y plazas pueden llegar a ser propicio para la propagación de estos patógenos debido a la falta de higiene y el libre acceso de las aves silvestres. En este artículo algunos patógenos entéricos del origen bacteriano y viral fueron revisados que pueden ser considerados de alto riesgo de contaminación humana, teniendo en cuenta la relevancia de las aves silvestres en este contexto.

Correção cirúrgica de empiema de bolsa gutural causado por Rhodococcus equi: relato de caso / Surgical correction of gutural bag empire caused by Rhodococcus equi: case report / Correo quirúrgico de empiema de bolsa gutural causado por Rhodococcus equi: relato de caso

As bolsas guturais são divertículos da tuba auditiva, divididas em compartimentos medial e lateral, possuindo uma capacidade média de aproximadamente 300 ml em um equino adulto e assume funções de termorregulação. Suas afecções mais frequentes são empiema, micose e timpanismo. O empiema é o que ocorre com maior frequência, e tem como principal agente causador o Streptococcus equi. Os sinais clínicos mais evidentes são secreção nasal, linfadenite e quando crônico, torna-se denso e agrupado em massas ovoides denominadas condroides. Objetiva-se com este trabalho relatar a utilização do acesso cirúrgico através da bolsa gutural pelo triângulo de Viborg para a retirada de condroides secundários ao empiema crônico causado por Rhodococcus equi em uma égua adulta.

Guttural sacs are diverticula of the auditory tube, divided into medial and lateral compartments, having an average capacity of approximately 300 ml in an adult equine and assuming thermoregulation functions. Its most frequent affections are empyema, mycosis and tympanism. The empyema is the one that occurs most frequently, and its main causative agent is Streptococcus equi. The most obvious clinical signs are nasal secretion, lymphadenitis and when chronic, it becomes dense and grouped into ovoid masses called chondroids. The objective of this work is to report the use of surgical access through the guttural pocket through the Viborg triangle for the removal of chondroids secondary tochronic empyema caused by Rhodococcus equi in an adult mare.

Las bolsas guturales son divertículos de la tuba auditiva, divididas en compartimientos medial y lateral, con una capacidad media de aproximadamente 300 ml en un equino adulto y asume funciones de termorregulación. Sus afecciones más frecuentes son empiema, micosis y timpanismo. El empiema es el que ocurre con mayor frecuencia, y tiene como principal agente causante el Streptococcus equi. Los signos clínicos más evidentes son secreción nasal, linfadenitis y cuando crónico, se vuelve denso y agrupado en masas ovoides denominadas condroides. Se pretende con este trabajo relatar la utilización del acceso quirúrgico a través de la bolsa gutural por el triángulo de Viborg para la retirada de condroides secundarios al empiema crónico causado por Rhodococcus equi en una yegua adulta.

Absceso glúteo por Rhodococcus Equi: presentación atípica de enfermedad emergente / Gluteus abscess due to RhodococcusEqui: atypical presentation of emerging disease

Resumen Rhodococcusequi, bacteria aislada principalmente en potros, se considera en la actualidad un patógeno zoonótico emergente en seres humanos, la mayoría inmunocomprometidos, coincidiendo con la epidemia de VIH y los avances en la medicina de trasplantes y la quimioterapia del cáncer, lo que justifica la revisión sobre su patogenia, características clínicas, diagnóstico y tratamiento. Más frecuente en hombres que en mujeres, el inicio de las infecciones es generalmente insidioso y los síntomas que presentan varían según el sitio de la infección, la enfermedad respiratoria, caracterizada por neumonía necrosante es la manifestación más común, y tiende a seguir un curso subagudo, mientras las personas inmunocompetentes son afectadas con baja frecuencia y suelen presentarse con enfermedad localizada. Las infecciones de la piel o partes blandas, incluyendo abscesos, son poco frecuentes incluso en huéspedes inmunocomprometidos y están usualmente relacionadas con contaminación ambiental. El laboratorio de microbiología juega un papel clave en la identificación del organismo, ya que este puede confundirse con flora normal de la piel. El caso que se presenta corresponde a una paciente adulta inmunocompetente, con infección de herida quirúrgica por R equiluego de una cirugía estética, requirió tratamiento antibiótico, múltiples lavados quirúrgicos y debridamientos, más drenaje de absceso, con mejoría del proceso infeccioso. Este caso sugiere la importancia clínica de la identificación precisa de patógenos inusuales, capaces de entorpecer la evolución normal de un proceso quirúrgico y de producir un alto costo de atención de salud y el alcance medidas preventivas relacionadas con la vigilancia de la salud.

Abstract Rhodococcusequi, a bacterium isolated mainly in foals, is currently considered an emerging zoonotic pathogen in humans, most of them immunocompromised, coinciding with the HIV epidemic and advances in transplant medicine and cancer chemotherapy, which justifies the review on its pathogenesis, clinical characteristics, diagnosis and treatment. More frequent in men than in women, the onset of infections is usually insidious and the symptoms they present vary according to the site of infection, the respiratory disease, characterized by necrotizing pneumonia is the most common manifestation, and tends to follow a subacute course , while immunocompetent people are affected with low frequency and usually have localized disease. Infections of the skin or soft tissues, including abscesses, are rare even in immunocompromised hosts and are usually related to environmental contamination. The microbiology laboratory plays a key role in the identification of the organism, since it can be confused with normal flora of the skin. The case presented corresponds to an adult immunocompetent patient, with surgical wound infection by R equiafter cosmetic surgery, required antibiotic treatment, multiple surgical washes and debridements, and abscess drainage, with improvement of the infectious process. This case suggests the clinical importance of the precise identification of unusual pathogens, capable of obstructing the normal evolution of a surgical process and of producing a high cost of health care and the scope of preventive measures related to health surveillance.

Correção cirúrgica de empiema de bolsa gutural causado por Rhodococcus equi: relato de caso / Surgical correction of gutural bag empire caused by Rhodococcus equi: case report / Correo quirúrgico de empiema de bolsa gutural causado por Rhodococcus equi: relato de caso

As bolsas guturais são divertículos da tuba auditiva, divididas em compartimentos medial e lateral, possuindo uma capacidade média de aproximadamente 300 ml em um equino adulto e assume funções de termorregulação. Suas afecções mais frequentes são empiema, micose e timpanismo. O empiema é o que ocorre com maior frequência, e tem como principal agente causador o Streptococcus equi. Os sinais clínicos mais evidentes são secreção nasal, linfadenite e quando crônico, torna-se denso e agrupado em massas ovoides denominadas condroides. Objetiva-se com este trabalho relatar a utilização do acesso cirúrgico através da bolsa gutural pelo triângulo de Viborg para a retirada de condroides secundários ao empiema crônico causado por Rhodococcus equi em uma égua adulta.(AU)

Guttural sacs are diverticula of the auditory tube, divided into medial and lateral compartments, having an average capacity of approximately 300 ml in an adult equine and assuming thermoregulation functions. Its most frequent affections are empyema, mycosis and tympanism. The empyema is the one that occurs most frequently, and its main causative agent is Streptococcus equi. The most obvious clinical signs are nasal secretion, lymphadenitis and when chronic, it becomes dense and grouped into ovoid masses called chondroids. The objective of this work is to report the use of surgical access through the guttural pocket through the Viborg triangle for the removal of chondroids secondary tochronic empyema caused by Rhodococcus equi in an adult mare.(AU)

Las bolsas guturales son divertículos de la tuba auditiva, divididas en compartimientos medial y lateral, con una capacidad media de aproximadamente 300 ml en un equino adulto y asume funciones de termorregulación. Sus afecciones más frecuentes son empiema, micosis y timpanismo. El empiema es el que ocurre con mayor frecuencia, y tiene como principal agente causante el Streptococcus equi. Los signos clínicos más evidentes son secreción nasal, linfadenitis y cuando crónico, se vuelve denso y agrupado en masas ovoides denominadas condroides. Se pretende con este trabajo relatar la utilización del acceso quirúrgico a través de la bolsa gutural por el triángulo de Viborg para la retirada de condroides secundarios al empiema crónico causado por Rhodococcus equi en una yegua adulta.(AU)

Chronic cavitary pneumonia by Rhodococcus equi in a highly prevalent tuberculosis country: a diagnosis challenge.

Rhodococcus equi is a facultative aerobic, intracellular, non-motile, non-spore-forming, Gram-positive, weakly acid-fast coccobacillus belonging to the group of nocardioform actinomycetes. R. equi infections are rare opportunistic illnesses in patients with Acquired Immunodeficiency Syndrome (AIDS), associated with a high mortality rate. The most common clinical presentation of R. equi infections is a chronic cavitary pneumonia. Due to its acid-fastness, R. equi can be mistaken for others acid-fast organisms, as Mycobacterium tuberculosis. In turn, R. equi is also a gram-positive pleomorphic bacteria and can be mistaken for diphtheroids or Micrococcus organisms, being accidentally disregarded as oral contaminants in sputum cultures. Therefore, in Brazil, a highly prevalent tuberculosis (TB) country, pulmonary infections caused by R. equi may mimic pulmonary TB and represent a diagnostic challenge. Here, we report on a case of chronic cavitary pneumonia by R. equi in a Human Immunodeficiency Virus (HIV)-infected patient, focusing on diagnostic aspects.

Identification of Mycobacterium species and Rhodococcus equi in peccary lymph nodes.

Mycobacterium species and the virulence-associated proteins (vapA, vapB, and vapN genes) of Rhodococcus equi isolated from 330 lymph nodes of collared peccaries (Tayassu tajacu) and white-lipped peccaries (Tayassu pecari) intended for human consumption were investigated. Thirty-six (10.9%) R. equi strains were isolated; 3.3% (n = 11/330) were from white-lipped peccary lymph nodes, and 7.6% (25/330) were from collared peccary lymph nodes. Among the 11 isolates of R. equi from the white-lipped peccaries, 90.9% (n = 10/11) were obtained from the mesenteric lymph nodes, and only 9.1% (n = 1/10) were obtained from the mediastinal lymph nodes. In the 25 isolates of R. equi obtained from the collared peccaries, 40.0% (n = 10/25) were recovered from the mesenteric lymph nodes, 36% (n = 9/25) from the submandibular lymph nodes, and 24.0% (n = 6/25) from the mediastinal lymph nodes. No vapA, vapB, or vapN genes (plasmidless) or three host-associated types (pVAPA, pVAPB, and pVAPN) were identified among the R. equi isolates. Mycobacterium species were isolated in 3.03% (n = 10/330) of all the lymph nodes analyzed. Among the 10 mycobacterial isolates, 60% (n = 6/10) were from the white-lipped peccary lymph nodes, and 40% (n = 4/10) were from the collared peccary lymph nodes. Ten Mycobacterium species were detected by PCR-PRA with a predominance of M. avium type 1. Sequencing of the hsp65 and rpob genes revealed mycobacteria that were saprophytic (M. sinense and M. kumamotonense) and potentially pathogenic (M. colombiense and M. intracellulare) to humans and animals. To our knowledge, this is the first description of R. equi and/or mycobacterial species identified in the lymph nodes of peccary specimens. R. equi (plasmidless) and the mycobacterial species described here have been reported as causes of pulmonary and extrapulmonary infections in both immunocompetent and immunocompromised humans.

Prevalence of Rhodococcus equi from the nasal cavity of 1010 apparently healthy horses.

BACKGROUND: Rhodococcus equi is an important cause of foal pneumonia. While its isolation from different sources has been widely evaluated, there is a need to better understand the R. equi epidemiology from samples of the nasal cavity of healthy horses. OBJECTIVES: To determine the prevalence of R. equi from the nasal cavity of healthy horses, along with its virulence profile, antimicrobial susceptibility and environmental variables associated. STUDY DESIGN: Cross-sectional study. METHODS: Swabs from the nasal cavity of 1010 apparently healthy horses from 341 farms were submitted for bacteriological analyses. The identity and virulence profile of the R. equi isolates were assessed by multiplex PCR; antimicrobial susceptibility was determined by the disk-diffusion method. The occurrence of R. equi was calculated at the level of both animal and farm. The association of seven specific environmental factors with R. equi isolation was assessed using logistic regression and by a spatial scan statistical method to determine the presence of local clusters. RESULTS: Antimicrobial-sensitive R. equi was isolated from 10 (1%) of 1010 horses ranging between 3 and 29 years old. Ten farms (3%) had at least one positive horse. Only one R. equi isolate (10%) was classified as virulent. Red-Yellow Argisol (PVA/PV) soils were significantly associated with R. equi isolation (odds ratio (OR) 8.02; CI95% , 1.98-32.50, P = 0.01), and areas with well-drained soil were less likely to be test positive (OR 0.85; CI95% , 0.76-0.96, P = 0.03). MAIN LIMITATIONS: The use of culture-based method instead of PCR-based assay and the lack of soil sampling. CONCLUSIONS: Antimicrobial-sensitive R. equi may be considered a minor part of the normal bacterial flora in the nasal cavity of healthy and immunologically functional horses breeding on pasture. Further studies are warranted to determine if soils rich in iron and well-drained are, in fact, associated with the occurrence of R. equi.

Novel bovine-associated pVAPN plasmid type in Rhodococcus equi identified from lymph nodes of slaughtered cattle and lungs of people living with HIV/AIDS.

Rhodococcus equi is a well-recognized Gram-positive intracellular facultative bacterium that is opportunistic in nature, which causes pyogranulomatous infections in humans and multiple host animals. The pathogenicity of the microorganism has been attributed to the presence of plasmid-encoded virulence-associated proteins (Vap). To date, three host-associated virulence plasmid types of R. equi have been identified as follows: the circular pVAPA and pVAPB, related, respectively, to equine and porcine isolates, and a recently described linear pVAPN plasmid associated with bovine strains, although these three types are found in human isolates. Recent phylogenomic studies support the evidence that human R. equi infection is zoonotically acquired. Nevertheless, data regarding distribution and prevalence of the host-adapted virulence plasmid types of R. equi isolated from meat animals are scarce or unnoticed. Here, the three host-associated virulence plasmid types (pVAPA, pVAPB, and pVAPN) were investigated in 154 R. equi isolates recovered from lymph nodes of cattle with lymphadenitis (n = 31), faeces of cattle without enteric signs (n = 49), as well as different clinical specimens from human patients (n = 74). The analysis of virulence profile of 74 R. equi from humans revealed six (8.1%) isolates pVAPB (type 8), two (2.7%) pVAPN, and one (1.3%) pVAPB (type 11), all of which were from lung samples from people living with HIV/AIDS. From the lymph node samples of cattle, 41.9% (13 of 31) isolates revealed pVAPN type, whereas all isolates from faecal samples were negative for three host-associated types. Here, recently described bovine-associated pVAPN type was detected in R. equi isolates recovered from the lungs of people living with HIV/AIDS and lymph nodes from slaughtered cattle intended for human consumption; a finding that represents a public health concern, mainly in countries where undercooked or raw meat are traditionally consumed.