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2.
PLoS Med ; 16(4): e1002781, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30990820

RESUMO

BACKGROUND: A nonsputum blood test capable of predicting progression of healthy individuals to active tuberculosis (TB) before clinical symptoms manifest would allow targeted treatment to curb transmission. We aimed to develop a proteomic biomarker of risk of TB progression for ultimate translation into a point-of-care diagnostic. METHODS AND FINDINGS: Proteomic TB risk signatures were discovered in a longitudinal cohort of 6,363 Mycobacterium tuberculosis-infected, HIV-negative South African adolescents aged 12-18 years (68% female) who participated in the Adolescent Cohort Study (ACS) between July 6, 2005 and April 23, 2007, through either active (every 6 months) or passive follow-up over 2 years. Forty-six individuals developed microbiologically confirmed TB disease within 2 years of follow-up and were selected as progressors; 106 nonprogressors, who remained healthy, were matched to progressors. Over 3,000 human proteins were quantified in plasma with a highly multiplexed proteomic assay (SOMAscan). Three hundred sixty-one proteins of differential abundance between progressors and nonprogressors were identified. A 5-protein signature, TB Risk Model 5 (TRM5), was discovered in the ACS training set and verified by blind prediction in the ACS test set. Poor performance on samples 13-24 months before TB diagnosis motivated discovery of a second 3-protein signature, 3-protein pair-ratio (3PR) developed using an orthogonal strategy on the full ACS subcohort. Prognostic performance of both signatures was validated in an independent cohort of 1,948 HIV-negative household TB contacts from The Gambia (aged 15-60 years, 66% female), longitudinally followed up for 2 years between March 5, 2007 and October 21, 2010, sampled at baseline, month 6, and month 18. Amongst these contacts, 34 individuals progressed to microbiologically confirmed TB disease and were included as progressors, and 115 nonprogressors were included as controls. Prognostic performance of the TRM5 signature in the ACS training set was excellent within 6 months of TB diagnosis (area under the receiver operating characteristic curve [AUC] 0.96 [95% confidence interval, 0.93-0.99]) and 6-12 months (AUC 0.76 [0.65-0.87]) before TB diagnosis. TRM5 validated with an AUC of 0.66 (0.56-0.75) within 1 year of TB diagnosis in the Gambian validation cohort. The 3PR signature yielded an AUC of 0.89 (0.84-0.95) within 6 months of TB diagnosis and 0.72 (0.64-0.81) 7-12 months before TB diagnosis in the entire South African discovery cohort and validated with an AUC of 0.65 (0.55-0.75) within 1 year of TB diagnosis in the Gambian validation cohort. Signature validation may have been limited by a systematic shift in signal magnitudes generated by differences between the validation assay when compared to the discovery assay. Further validation, especially in cohorts from non-African countries, is necessary to determine how generalizable signature performance is. CONCLUSIONS: Both proteomic TB risk signatures predicted progression to incident TB within a year of diagnosis. To our knowledge, these are the first validated prognostic proteomic signatures. Neither meet the minimum criteria as defined in the WHO Target Product Profile for a progression test. More work is required to develop such a test for practical identification of individuals for investigation of incipient, subclinical, or active TB disease for appropriate treatment and care.


Assuntos
Biomarcadores/sangue , Proteoma/análise , Tuberculose/diagnóstico , Adolescente , Biomarcadores/análise , Biomarcadores/metabolismo , Criança , Estudos de Coortes , Testes Diagnósticos de Rotina/métodos , Progressão da Doença , Feminino , Humanos , Estudos Longitudinais , Masculino , Testes Imediatos , Prognóstico , Estudos Prospectivos , Proteoma/metabolismo , Proteômica , Tuberculose/sangue , Tuberculose/patologia
3.
Int J Infect Dis ; 84: 30-38, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31009738

RESUMO

BACKGROUND: Diagnosis of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is challenging and new tools are needed for early diagnosis as well as to understand the biochemical events that underlie the pathology in TB-IRIS. METHODS: Plasma samples were obtained from participants from a randomized HIV/TB treatment strategy study (AIDS Clinical Trials Group [ACTG] A5221) with (n = 26) and without TB-IRIS (n = 22) for an untargeted metabolomics pilot study by liquid-chromatography mass spectrometry. The metabolic profile of these participants was compared at the study entry and as close to the diagnosis of TB-IRIS as possible (TB-IRIS window). Molecular features with p < 0.05 and log2 fold change ≥0.58 were submitted for pathway analysis through MetaboAnalyst. We also elucidated potential metabolic signatures for TB-IRIS using a LASSO regression model. RESULTS: At the study entry, we showed that the arachidonic acid and glycerophospholipid metabolism were altered in the TB-IRIS group. Sphingolipid and linoleic acid metabolism were the most affected pathways during the TB-IRIS window. LASSO modeling selected a set of 8 and 7 molecular features with the potential to predict TB-IRIS at study entry and during the TB-IRIS window, respectively. CONCLUSION: This study suggests that the use of plasma metabolites may distinguish HIV-TB patients with and without TB-IRIS.


Assuntos
Síndrome Inflamatória da Reconstituição Imune/sangue , Metabolômica , Adulto , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Cromatografia Líquida , Feminino , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , Humanos , Síndrome Inflamatória da Reconstituição Imune/imunologia , Masculino , Projetos Piloto , Espectrometria de Massas em Tandem , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/diagnóstico
4.
PLoS Pathog ; 13(11): e1006687, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29145483

RESUMO

Our understanding of mechanisms underlying progression from Mycobacterium tuberculosis infection to pulmonary tuberculosis disease in humans remains limited. To define such mechanisms, we followed M. tuberculosis-infected adolescents longitudinally. Blood samples from forty-four adolescents who ultimately developed tuberculosis disease ("progressors") were compared with those from 106 matched controls, who remained healthy during two years of follow up. We performed longitudinal whole blood transcriptomic analyses by RNA sequencing and plasma proteome analyses using multiplexed slow off-rate modified DNA aptamers. Tuberculosis progression was associated with sequential modulation of immunological processes. Type I/II interferon signalling and complement cascade were elevated 18 months before tuberculosis disease diagnosis, while changes in myeloid inflammation, lymphoid, monocyte and neutrophil gene modules occurred more proximally to tuberculosis disease. Analysis of gene expression in purified T cells also revealed early suppression of Th17 responses in progressors, relative to M. tuberculosis-infected controls. This was confirmed in an independent adult cohort who received BCG re-vaccination; transcript expression of interferon response genes in blood prior to BCG administration was associated with suppression of IL-17 expression by BCG-specific CD4 T cells 3 weeks post-vaccination. Our findings provide a timeline to the different immunological stages of disease progression which comprise sequential inflammatory dynamics and immune alterations that precede disease manifestations and diagnosis of tuberculosis disease. These findings have important implications for developing diagnostics, vaccination and host-directed therapies for tuberculosis. TRIAL REGISTRATION: Clincialtrials.gov, NCT01119521.


Assuntos
Mycobacterium tuberculosis , Linfócitos T/imunologia , Tuberculose/microbiologia , Tuberculose/terapia , Adolescente , Criança , Progressão da Doença , Humanos , Inflamação/complicações , Inflamação/imunologia , Inflamação/terapia , Vacinas/uso terapêutico
6.
J Clin Microbiol ; 55(2): 391-402, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27852671

RESUMO

The tests for diagnosing latent tuberculosis infection (LTBI) are limited by a poor predictive value for identifying people at the highest risk for progressing to active tuberculosis (TB) and have various sensitivities and specificities in different populations. Identifying a more robust signature for LTBI is important for TB prevention and elimination. A pilot study was conducted with samples from immigrants to the United States that were screened for LTBI by the three commercially approved tests, namely, the tuberculin skin test (TST), the Quantiferon-TB Gold in-tube (QFT-GIT), and the T-SPOT.TB (T-SPOT). QFT-GIT supernatants from 13 people with concordant positive results and 26 people with concordant negative results were analyzed via the highly multiplexed SOMAscan proteomic assay. The proteins in the stimulated supernatants that distinguished LTBI from controls included interleukin-2 (IL-2), monocyte chemotactic protein 2 (MCP-2), interferon gamma inducible protein-10 (IP-10), interferon gamma (IFN-γ), tumor necrosis factor superfamily member 14 (TNFSF14, also known as LIGHT), monokine induced by gamma interferon (MIG), and granzyme B (P <0.00001). In addition, antigen stimulation increased the expression of heparin-binding EGF-like growth factor (HB-EGF) and activin AB in LTBI samples. In nil tubes, LIGHT was the most significant marker (P <0.0001) and was elevated in LTBI subjects. Other prominent markers in nonstimulated QFT-GIT supernatants were the complement-3 components C3b, iC3b, and C3d, which were upregulated in LTBI and markedly decreased upon stimulation. We found known and novel proteins that warrant further studies for developing improved tests for LTBI, for predicting progression to active disease, and for discriminating LTBI from active TB.


Assuntos
Biomarcadores/análise , Fatores Imunológicos/análise , Tuberculose Latente/diagnóstico , Proteoma/análise , Proteômica/métodos , Adolescente , Adulto , Emigrantes e Imigrantes , ELISPOT/métodos , Feminino , Humanos , Testes de Liberação de Interferon-gama/métodos , Masculino , Pessoa de Meia-Idade , Teste Tuberculínico/métodos , Estados Unidos , Adulto Jovem
7.
Chest ; 149(6): e191-4, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27287596

RESUMO

A 65-year-old man with treated latent tuberculous infection presented with 1 week of fevers (up to 39.6°C), chills, headache, lightheadedness, and malaise. He reported a chronic, nonproductive cough without hemoptysis but denied other localizing symptoms, sick contacts, or recent travel. He lived in an urban area in eastern Colorado and owned one healthy dog but otherwise denied known animal exposures. He was a retired oil driller who had worked in southern Arizona, New Mexico, and northern Mexico (Sonora region). Other travel included 3 years in the early 1970s working as a military aircraft mechanic in Vietnam, Laos, and Thailand. Six weeks prior to admission, he began work as a groundskeeper on a golf course that had experienced recent flooding, using a riding mower and exposing himself to airborne dust and organic debris. He smoked a pipe daily for 30 years but quit 2 months prior to presentation, although he continued to smoke marijuana weekly. He denied intravenous drug use.


Assuntos
Ciprofloxacina/administração & dosagem , Francisella tularensis , Linfadenopatia , Nódulos Pulmonares Múltiplos/diagnóstico , Tórax/diagnóstico por imagem , Tularemia , Idoso , Antibacterianos/administração & dosagem , Diagnóstico Diferencial , Francisella tularensis/imunologia , Francisella tularensis/isolamento & purificação , Humanos , Linfadenopatia/diagnóstico , Linfadenopatia/etiologia , Masculino , Testes Sorológicos/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Tularemia/complicações , Tularemia/diagnóstico , Tularemia/tratamento farmacológico , Tularemia/fisiopatologia
8.
J Med Microbiol ; 65(1): 1-8, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26515915

RESUMO

Non-tuberculous mycobacteria (NTM) infections are increasingly being reported worldwide. They are a major concern for healthcare professionals for multiple reasons, ranging from the intrinsic resistance of NTM to most conventionally utilized antimicrobials to inharmonious diagnostic criteria utilized for evaluation of NTM-infected patients, leading to high morbidity. In this review, we highlight the paucity of drugs having potent anti-NTM activity amongst the new antimicrobials currently under various stages of development for anti-tubercular activity and issue a call for the establishment of a concerted dedicated drug discovery pipeline targeting NTM.


Assuntos
Antibacterianos/farmacologia , Descoberta de Drogas , Micobactérias não Tuberculosas/efeitos dos fármacos , Adamantano/análogos & derivados , Adamantano/farmacologia , Aminopiridinas/farmacologia , Azepinas/farmacologia , Benzamidas/farmacologia , Ensaios Clínicos como Assunto , Diarilquinolinas/farmacologia , Etilenodiaminas/farmacologia , Fluoroquinolonas/farmacologia , Humanos , Minociclina/análogos & derivados , Minociclina/farmacologia , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Nitroimidazóis/farmacologia , Oxazóis/farmacologia , Piperazinas/farmacologia , Compostos de Espiro/farmacologia , Tiazinas/farmacologia , Tigeciclina , Uridina/análogos & derivados , Uridina/farmacologia
9.
Clin Chest Med ; 36(1): 67-78, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25676520

RESUMO

Rapidly growing mycobacteria (RGM) include a diverse group of species. We address the treatment of the most commonly isolated RGM-M abscessus complex, M fortuitum, and M chelonae. The M abscessus complex is composed of 3 closely related species: M abscessus senso stricto (hereafter M abscessus), M massiliense, and M bolletii. Most studies address treatment of M abscessus complex, which accounts for 80% of lung disease caused by RGM and is the second most common RGM to cause extrapulmonary disease (after M fortuitum). The M abscessus complex represent the most drug-resistant nontuberculous mycobacteria and are the most difficult to treat.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Pneumopatias/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Micobactérias não Tuberculosas/efeitos dos fármacos , Antibacterianos/administração & dosagem , Avaliação Pré-Clínica de Medicamentos , Humanos , Pneumopatias/microbiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Micobactérias não Tuberculosas/patogenicidade
10.
Am J Infect Control ; 42(8): 932-4, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25087149

RESUMO

After several accounts across the globe of mycobacteria outbreaks associated with medical procedures and aldehyde disinfectants resistance, we undertook an analysis of mycobacteria isolated from patients seen in a hospital in the United States between 1994 and 2008 to determine prevalence of resistance to aldehyde-based disinfectants. Out of the 117 clinical isolates screened, 6 isolates belonging to the emerging Mycobacterium abscessus group were found to display significant levels of resistance to glutaraldehyde and ortho-phthalaldehyde.


Assuntos
Desinfetantes/farmacologia , Farmacorresistência Bacteriana , Glutaral/farmacologia , Micobactérias não Tuberculosas/efeitos dos fármacos , o-Ftalaldeído/farmacologia , Humanos , Infecções por Mycobacterium não Tuberculosas/microbiologia , Micobactérias não Tuberculosas/isolamento & purificação , Estados Unidos
11.
Emerg Infect Dis ; 20(3): 364-71, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24565502

RESUMO

Three recently sequenced strains isolated from patients during an outbreak of Mycobacterium abscessus subsp. massiliense infections at a cystic fibrosis center in the United States were compared with 6 strains from an outbreak at a cystic fibrosis center in the United Kingdom and worldwide strains. Strains from the 2 cystic fibrosis outbreaks showed high-level relatedness with each other and major-level relatedness with strains that caused soft tissue infections during an epidemic in Brazil. We identified unique single-nucleotide polymorphisms in cystic fibrosis and soft tissue outbreak strains, separate single-nucleotide polymorphisms only in cystic fibrosis outbreak strains, and unique genomic traits for each subset of isolates. Our findings highlight the necessity of identifying M. abscessus to the subspecies level and screening all cystic fibrosis isolates for relatedness to these outbreak strains. We propose 2 diagnostic strategies that use partial sequencing of rpoB and secA1 genes and a multilocus sequence typing protocol.


Assuntos
Surtos de Doenças , Infecções por Mycobacterium/epidemiologia , Mycobacterium/isolamento & purificação , Brasil , Fibrose Cística/complicações , Genoma Bacteriano , Humanos , Tipagem de Sequências Multilocus , Mycobacterium/classificação , Mycobacterium/genética , Infecções por Mycobacterium/complicações , Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/microbiologia , Filogenia , Polimorfismo de Nucleotídeo Único , Reino Unido , Estados Unidos
12.
J Antimicrob Chemother ; 69(4): 1057-64, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24222613

RESUMO

OBJECTIVES: Of the non-tuberculous mycobacteria, Mycobacterium abscessus is particularly refractory to antimicrobial therapy and new agents with activity against these pathogens are urgently needed. The screening of candidate antimicrobial agents against M. abscessus requires a relevant and reproducible animal model of chronic infection. Granulocyte-macrophage colony-stimulating factor knockout (GM-CSF KO) mice were used to develop a new animal model of chronic pulmonary M. abscessus infection that can be used for preclinical efficacy testing of antimicrobial drugs. METHODS: GM-CSF KO mice were infected with a clinical isolate of M. abscessus via intrapulmonary aerosol delivery using a microsprayer device. The clinical condition, histology and cfu of M. abscessus-infected GM-CSF KO mice were evaluated over a period of 4 months. Mice were treated with azithromycin (100 mg/kg) by oral gavage and the clinical condition, histology and bacterial burden was determined after 2 weeks of treatment. RESULTS: We show that pulmonary infection of GM-CSF KO mice with M. abscessus results in a chronic pulmonary infection that lends itself to preclinical testing of new antimicrobial drugs against this bacterium. Azithromycin treatment of M. abscessus-infected GM-CSF KO mice resulted in a lower bacterial burden in the lungs and spleen, weight gain and significant improvement in lung pathology. CONCLUSIONS: Intrapulmonary aerosol infection of GM-CSF KO mice with M. abscessus is a useful animal model for studying pathogenesis as well as pre-clinical testing of new compounds against M. abscessus in acute or chronic phases of infection.


Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Fator Estimulador de Colônias de Granulócitos e Macrófagos/deficiência , Infecções por Mycobacterium/tratamento farmacológico , Mycobacterium/efeitos dos fármacos , Pneumonia Bacteriana/tratamento farmacológico , Animais , Carga Bacteriana , Doença Crônica , Modelos Animais de Doenças , Avaliação Pré-Clínica de Medicamentos/métodos , Histocitoquímica , Pulmão/microbiologia , Pulmão/patologia , Camundongos , Camundongos Knockout , Infecções por Mycobacterium/microbiologia , Infecções por Mycobacterium/patologia , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/patologia , Baço/microbiologia
13.
Proc Natl Acad Sci U S A ; 104(51): 20529-33, 2007 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-18077362

RESUMO

Culture of bronchoalveolar lavage fluid (BALF) is the gold standard for detection of pathogens in the lower airways in cystic fibrosis (CF). However, current culture results do not explain all clinical observations in CF, including negative culture results during pulmonary exacerbation and inflammation in the absence of pathogens. We hypothesize that organisms not routinely identified by culture occur in the CF airway and may contribute to disease. To test this hypothesis we used a culture-independent molecular approach, based on use of rRNA sequence analysis, to assess the bacterial composition of BALF from children with CF and disease controls (DC). Specimens from 42 subjects (28 CF) were examined, and approximately 6,600 total clones were screened to identify 121 species of bacteria. In general, a single rRNA type dominated clone libraries from CF specimens, but not DC. Thirteen CF subjects contained bacteria that are not routinely assessed by culture. In four CF subjects, candidate pathogens were identified and include the anaerobe Prevotella denticola, a Lysobacter sp., and members of the Rickettsiales. The presumptive pathogens Tropheryma whipplei and Granulicatella elegans were identified in cases from the DC group. The presence of unexpected bacteria in CF may explain inflammation without documented pathogens and consequent failure to respond to standard treatment. These results show that molecular techniques provide a broader perspective on airway bacteria than do routine clinical cultures and thus can identify targets for further clinical evaluation.


Assuntos
Bactérias/classificação , Líquido da Lavagem Broncoalveolar/microbiologia , Fibrose Cística/microbiologia , DNA Bacteriano/análise , Pneumopatias/microbiologia , Adolescente , Adulto , Bactérias/genética , Bactérias/isolamento & purificação , Criança , Pré-Escolar , Feminino , Genes Bacterianos , Genes de RNAr , Humanos , Lactente , Masculino , Dados de Sequência Molecular
14.
Appl Environ Microbiol ; 72(12): 7602-6, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17056679

RESUMO

High numbers of mycobacteria, including known pathogenic species such as Mycobacterium avium, Mycobacterium intracellulare, and Mycobacterium chelonae, were recovered from aerosols produced by pouring commercial potting soil products and potting soil samples provided by patients with pulmonary mycobacterial infections. The dominant mycobacteria in the soil samples corresponded to the dominant species implicated clinically. Profiles of large restriction fragments obtained by pulsed-field gel electrophoresis demonstrated a closely related pair of M. avium isolates recovered from a patient and from that patient's own potting soil. Thus, potting soils are potential sources of infection by environmental mycobacteria. Use of dust-excluding masks should be considered during potting or other activities that generate aerosol with soil.


Assuntos
Jardinagem , Pneumopatias/microbiologia , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/microbiologia , Microbiologia do Solo , Aerossóis , Eletroforese em Gel de Campo Pulsado , Humanos , Complexo Mycobacterium avium/classificação , Complexo Mycobacterium avium/genética
15.
J Clin Microbiol ; 43(10): 5369-71, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16208021

RESUMO

Mycobacterium tuberculosis infections are a major global health problem. Fast and accurate detection of M. tuberculosis is clearly needed at both the clinical level and the research level. We report a rapid and reliable in situ hybridization technique using rRNA oligonucleotide probes for the identification of M. tuberculosis in tissues and cultures.


Assuntos
Hibridização in Situ Fluorescente/métodos , Mycobacterium tuberculosis/isolamento & purificação , Sondas de Oligonucleotídeos/genética , RNA Ribossômico/genética , Animais , Bovinos , Meios de Cultura , Cobaias , Humanos , Pulmão/microbiologia , Camundongos , Mycobacterium tuberculosis/genética , Sensibilidade e Especificidade , Especificidade da Espécie , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/microbiologia
16.
J Clin Microbiol ; 43(4): 1505-14, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15814959

RESUMO

Members of the Mycobacterium avium complex (MAC) are important environmental pathogens that are implicated in several chronic, idiopathic diseases. Diagnosis of MAC-based diseases is compromised by the need to cultivate these fastidious and slowly growing organisms in order to identify which mycobacterial species are present. Detection is particularly difficult when MAC is intracellular or embedded within mammalian tissues. We report on the development of culture-independent, in situ hybridization (ISH) assays for the detection of MAC in culture, sputum, and tissue. This assay includes a highly reliable technique for the permeabilization of mycobacterial cells within culture and tissues. We describe a set of rRNA-based oligonucleotide probes that specifically detect either M. intracellulare, the two M. avium subspecies associated with human disease, or all members of MAC. The results call into question the validity of ISH results derived by the use of other gene loci, such as IS900.


Assuntos
Hibridização In Situ/métodos , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Sondas de Oligonucleotídeos/genética , RNA Ribossômico/genética , Animais , Técnicas de Tipagem Bacteriana , Bovinos , Elementos de DNA Transponíveis/genética , Humanos , Complexo Mycobacterium avium/classificação , Complexo Mycobacterium avium/genética , Infecção por Mycobacterium avium-intracellulare/microbiologia , Especificidade de Órgãos , RNA Ribossômico 16S/genética , RNA Ribossômico 23S/genética
17.
Pediatr Infect Dis J ; 24(3): 278-80, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15750472

RESUMO

Probiotic agents are increasingly used for the treatment and prevention of a variety of infectious and inflammatory conditions. They are generally safe, but complications of probiotic use can occur. In this report, we describe bacteremia after ingestion of a Lactobacillus rhamnosus GG probiotic tablet in a child with short gut syndrome. We used sequencing of the ribosomal operon region and strain typing with pulsed field electrophoresis of the isolates to show identity between the tablet and bloodstream isolates.


Assuntos
Bacteriemia/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Lactobacillus/classificação , Probióticos/administração & dosagem , Síndrome do Intestino Curto/terapia , Antibacterianos , Bacteriemia/complicações , Bacteriemia/diagnóstico , Sequência de Bases , Cateterismo/efeitos adversos , Cateterismo/métodos , Terapia Combinada , DNA Bacteriano/análise , Quimioterapia Combinada/uso terapêutico , Seguimentos , Gastrostomia/efeitos adversos , Gastrostomia/métodos , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/diagnóstico , Humanos , Lactente , Masculino , Dados de Sequência Molecular , Reação em Cadeia da Polimerase/métodos , Medição de Risco , Índice de Gravidade de Doença , Síndrome do Intestino Curto/complicações , Síndrome do Intestino Curto/diagnóstico , Resultado do Tratamento
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