Aislamiento de Escherichia coli productor de toxina Shiga durante un brote de gastroenteritis en un Jardín Maternal de la Ciudad de Mar del Plata / Isolation of Shiga toxin-producing Escherichia coli strains during a gastrointestinal outbreak at a day care center in Mar del Plata City

Entre el 15 de octubre y el 8 de noviembre de 2003 ocurrió un brote de gastroenteritis en un Jardín Maternal de un Hospital de la ciudad de Mar del Plata. Catorce de un total de 80 niños (17,5%), edad promedio 23,6 ± 13,9 meses, presentaron diarrea, y un caso evolucionó a síndrome urémico hemolítico. La madre de uno de los afectados presentó diarrea simultáneamente. No se pudo establecer el origen del brote, pero probablemente la transmisión haya sido fundamentalmente persona a persona. Las prácticas habituales en el lactario del jardín maternal, y las condiciones inadecuadas de infraestructura y hábitos de higiene de la cocina del Hospital fueron señalados como factores de riesgo. En un caso se detectó Escherichia coli productor de toxina Shiga (STEC) O103:H2, y STEC O26:H11 en otro. En el niño infectado por STEC O26:H11, la excreción se extendió por un período de 37 días. La no detección de STEC en aquellos casos en los cuales el intervalo entre el inicio de los síntomas y la toma de muestra fue mayor a 6 días, enfatiza la necesidad de la recolección temprana de especímenes. Las principales conclusiones de este estudio fueron la necesidad de establecer normas óptimas de higiene, informar rápidamente la ocurrencia de casos de gastroenteritis y confirmar la negativización de la excreción del patógeno.

From October 15 to November 8, 2003, a gastrointestinal outbreak occurred at a day care center in a Hospital in Mar del Plata City. Fourteen out of 80 (17.5%) children, mean age 23.6 ± 13.9 months, and the mother of one of them had diarrhea. One case developed hemolytic uremic syndrome. No conclusive evidence of the origin of the outbreak was found, but the epidemic curve suggested person-to-person spread. The usual practices at the place where infant milk formula was prepared at the day care center, together with the inadequate infrastructure conditions and hygiene practices at the kitchen of the hospital, were considered risk factors. One case had Shiga toxin-producing Escherichia coli (STEC) O103:H2 infection and other STEC O26:H11.The duration of shedding for the child with O26:H11 infection was 37 days. In the other symptomatic children, the pathogen was not recovered from fecal samples collected 6 or more days after the onset of the illness. This emphasizes that the collection of early samples is necessary to recover STEC strains. In order to prevent and control enteric diseases in day care facilities the following measures are necessary: optimal hygiene standards, early case reporting, and exclusion of those who remain culture-positive.

[Isolation of Shiga-toxin-producing Escherichia coli strains during a gastrointestinal outbreak at a day care center in Mar del Plata City]. / Aislamiento de Escherichia coil productor de toxina Shiga durante un brote de gastroenteritis en un Jardín maternal de la Ciudad de Mar del Plata.

From October 15 to November 8, 2003, a gastrointestinal outbreak occurred at a day care center in a Hospital in Mar del Plata City. Fourteen out of 80 (17.5%) children, mean age 23.6 +/- 13.9 months, and the mother of one of them had diarrhea. One case developed hemolytic uremic syndrome. No conclusive evidence of the origin of the outbreak was found, but the epidemic curve suggested person-to-person spread. The usual practices at the place where infant milk formula was prepared at the day care center, together with the inadequate infrastructure conditions and hygiene practices at the kitchen of the hospital, were considered risk factors. One case had Shiga toxin-producing Escherichia coli (STEC) O103:H2 infection and other STEC O26:H11. The duration of shedding for the child with O26:H11 infection was 37 days. In the other symptomatic children, the pathogen was not recovered from fecal samples collected 6 or more days after the onset of the illness. This emphasizes that the collection of early samples is necessary to recover STEC strains. In order to prevent and control enteric diseases in day care facilities the following measures are necessary: optimal hygiene standards, early case reporting, and exclusion of those who remain culture-positive.

Aislamiento de Escherichia coil productor de toxina Shiga durante un brote de gastroenteritis en un Jardín maternal de la Ciudad de Mar del Plata. / [Isolation of Shiga-toxin-producing Escherichia coli strains during a gastrointestinal outbreak at a day care center in Mar del Plata City]

From October 15 to November 8, 2003, a gastrointestinal outbreak occurred at a day care center in a Hospital in Mar del Plata City. Fourteen out of 80 (17.5

) children, mean age 23.6 +/- 13.9 months, and the mother of one of them had diarrhea. One case developed hemolytic uremic syndrome. No conclusive evidence of the origin of the outbreak was found, but the epidemic curve suggested person-to-person spread. The usual practices at the place where infant milk formula was prepared at the day care center, together with the inadequate infrastructure conditions and hygiene practices at the kitchen of the hospital, were considered risk factors. One case had Shiga toxin-producing Escherichia coli (STEC) O103:H2 infection and other STEC O26:H11.The duration of shedding for the child with O26:H11 infection was 37 days. In the other symptomatic children, the pathogen was not recovered from fecal samples collected 6 or more days after the onset of the illness. This emphasizes that the collection of early samples is necessary to recover STEC strains. In order to prevent and control enteric diseases in day care facilities the following measures are necessary: optimal hygiene standards, early case reporting, and exclusion of those who remain culture-positive.

[Isolation and characterization of Shiga-toxin-producing Escherichia coli from frozen hamburgers and soft cheeses]. / Aislamiento y caracterización de Escherichia coli productor de toxina Shiga en hamburguesas supercongeladas y quesos de pasta blanda.

Shiga toxin producing-Escherichia coli (STEC), an important emerging foodborne pathogen, has been associated with bloody and non-bloody diarrhea, hemorrhagic colitis, hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura. The cattle have been shown to be a major reservoir of STEC and raw foods such as ground beef and milk are the most common vehicles of infection. In the present study, the prevalence of STEC in 95 samples of frozen hamburgers and in 114 samples of soft cheese was established in 8.4% and 0.9%, respectively. The genotypic and phenotypic characteristics of the strains were determined. The virulence genes stx1, stx2, eaeA and EHEC-hlyA were identified by PCR and by colony blot hybridization assays. Serotyping, antimicrobial susceptibility and production of Stx using specific cytotoxicity assays on Vero cells were also determined. All STEC strains were characterized as eaeA-/EHEC-hlyA+. The stx2 genotype was prevalent (77.8%), and four different O:H serotypes were found, comprising: O8:H19 (5 strains), O113:H21 (1), O8:H16 (1), and O39:H49 (1). One STEC strain was nontypable. Although soft cheese complimented the microbiological quality controls for the coliform counts, the detection of STEC in one sample raises doubts concerning the effectiveness of the current quality controls. These data contribute to the implementation of strategies for the prevention and control of HUS.

Aislamiento y caracterización de Escherichia coli productor de toxina Shiga en hamburguesas supercongeladas y quesos de pasta blanda. / [Isolation and characterization of Shiga-toxin-producing Escherichia coli from frozen hamburgers and soft cheeses]

Shiga toxin producing-Escherichia coli (STEC), an important emerging foodborne pathogen, has been associated with bloody and non-bloody diarrhea, hemorrhagic colitis, hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura. The cattle have been shown to be a major reservoir of STEC and raw foods such as ground beef and milk are the most common vehicles of infection. In the present study, the prevalence of STEC in 95 samples of frozen hamburgers and in 114 samples of soft cheese was established in 8.4

and 0.9

, respectively. The genotypic and phenotypic characteristics of the strains were determined. The virulence genes stx1, stx2, eaeA and EHEC-hlyA were identified by PCR and by colony blot hybridization assays. Serotyping, antimicrobial susceptibility and production of Stx using specific cytotoxicity assays on Vero cells were also determined. All STEC strains were characterized as eaeA-/EHEC-hlyA+. The stx2 genotype was prevalent (77.8

), and four different O:H serotypes were found, comprising: O8:H19 (5 strains), O113:H21 (1), O8:H16 (1), and O39:H49 (1). One STEC strain was nontypable. Although soft cheese complimented the microbiological quality controls for the coliform counts, the detection of STEC in one sample raises doubts concerning the effectiveness of the current quality controls. These data contribute to the implementation of strategies for the prevention and control of HUS.

[Isolation of Escherichia coli O157:H7 in storm drains in the city of Mar del Plata with bacterial contamination of fecal origin]. / Aislamiento de Escherichia coli O157:H7 en desagües pluviales de la ciudad de Mar del Plata con contaminación bacteriana de origen fecal.

The present study was focused on the isolation and characterization of Escherichia coli, particularly the serotype O157:H7, from five combined-sewer outflows waters, which drain into the beaches of Mar del Plata. Seventeen hemolytic uremic syndrome cases were reported in Mar del Plata during the sampling period (May 1995-April 1996) in children between 9 month- and 5 year-old, and 3 deaths were recorded. E. coli identification was carried out by biochemical tests. E. coli was detected in 75% of the samples and a total of 98 strains were selected, with 11 sorbol non-fermenting strains. The strains belonged to the O1, O6, O44, O86a, O119 and O168 serogroups. As none of the known virulence factors was detected, strains could not be grouped within any of the diarrheagenic E. coli categories. None of the E. coli strains belonged to the O157:H7 serotype, but E. coli isolation showed fecal contamination in the combined-sewer outflows. Since their waters drain into beaches for recreational use, it is necessary to emphasize the detection of E. coli that would cause severe human illness. Bacterial pollution in combined-sewer outflows draining into Mar del Plata coasts might represent a high risk for human health.

Aislamiento de Escherichia coli O157:H7 en desag³es pluviales de la ciudad de Mar del Plata con contaminación bacteriana de origen fecal. / [Isolation of Escherichia coli O157:H7 in storm drains in the city of Mar del Plata with bacterial contamination of fecal origin]

The present study was focused on the isolation and characterization of Escherichia coli, particularly the serotype O157:H7, from five combined-sewer outflows waters, which drain into the beaches of Mar del Plata. Seventeen hemolytic uremic syndrome cases were reported in Mar del Plata during the sampling period (May 1995-April 1996) in children between 9 month- and 5 year-old, and 3 deaths were recorded. E. coli identification was carried out by biochemical tests. E. coli was detected in 75

of the samples and a total of 98 strains were selected, with 11 sorbol non-fermenting strains. The strains belonged to the O1, O6, O44, O86a, O119 and O168 serogroups. As none of the known virulence factors was detected, strains could not be grouped within any of the diarrheagenic E. coli categories. None of the E. coli strains belonged to the O157:H7 serotype, but E. coli isolation showed fecal contamination in the combined-sewer outflows. Since their waters drain into beaches for recreational use, it is necessary to emphasize the detection of E. coli that would cause severe human illness. Bacterial pollution in combined-sewer outflows draining into Mar del Plata coasts might represent a high risk for human health.

Influenza virus epidemiological surveillance in Argentina, 1987-1993, with molecular characterization of 1990 and 1993 isolates.

This report describes findings from epidemiological surveillance of influenza virus in two cities in Argentina (Mar del Plata and Córdoba) from 1987 to 1993. It includes information on reporting and serologic characterization of isolated influenza viruses. In addition, determination was made of the nucleotide sequences of the HA1 subunits of five type A (subtype H3) viral strains isolated in the epidemics of 1990 and 1993. The incidence of illness, type of viruses isolated, and H gene sequences were similar to what has been reported from other parts of the world during the same period. The H3 strains isolated in the 1990 and 1993 seasons were somewhat removed in their molecular characteristics from the strains the World Health Organization recommended for vaccines for those years, and appeared closer to the strains recommended for vaccination in subsequent seasons.

Tuberculosis en Pediatría: Hospital Materno Infantil : revisión de 5 años / Tuberculosis in Pediatrics: Maternal-infantile Hospital : review over 5 years

Presentamos una revisión de 5 años sobre los casos de tuberculosis (TBC) infantil registrados en el Hospital Interzonal Especializado Materno Infantil "Victorio Tetamanti" de la ciudad de Mar del Plata, desde enero de 1990 hasta septiembre de 1995. Se analizó la tendencia de la enfermedad, encontrando un incremento superior a lo esperado que coincide con cifras del ámbito de la provincia de Buenos Aires y del país. Se observó que la población afectada presentó 60 por ciento de formas pulmonares moderadas y 40 por ciento de formas graves, correspondiendo un 25 por ciento a formas extrapulmonares. Se registra desde 1993 la asociación de TBC infantil con el VIH, casi todos menores de 12 meses de edad, alcanzando desde entonces y hasta 1995, 10 por ciento del total de casos. Se obtuvo confirmación bacteriológica en el 20,3 por ciento y por histopatología en el 7,6 por ciento, con un índice de certificación diagnóstica del 23,6 por ciento. El índice de abandono de tratamiento fue del 13,9 por ciento. La mayoría de recibía tratamiento en forma autoadministrada. La mortalidad fue del 7,6 por ciento (6 casos), correspondiendo la mitad a niños con SIDA

Tuberculosis en Pediatría: Hospital Materno Infantil : revisión de 5 años / Tuberculosis in Pediatrics: Maternal-infantile Hospital : review over 5 years

Presentamos una revisión de 5 años sobre los casos de tuberculosis (TBC) infantil registrados en el Hospital Interzonal Especializado Materno Infantil "Victorio Tetamanti" de la ciudad de Mar del Plata, desde enero de 1990 hasta septiembre de 1995. Se analizó la tendencia de la enfermedad, encontrando un incremento superior a lo esperado que coincide con cifras del ámbito de la provincia de Buenos Aires y del país. Se observó que la población afectada presentó 60 por ciento de formas pulmonares moderadas y 40 por ciento de formas graves, correspondiendo un 25 por ciento a formas extrapulmonares. Se registra desde 1993 la asociación de TBC infantil con el VIH, casi todos menores de 12 meses de edad, alcanzando desde entonces y hasta 1995, 10 por ciento del total de casos. Se obtuvo confirmación bacteriológica en el 20,3 por ciento y por histopatología en el 7,6 por ciento, con un índice de certificación diagnóstica del 23,6 por ciento. El índice de abandono de tratamiento fue del 13,9 por ciento. La mayoría de recibía tratamiento en forma autoadministrada. La mortalidad fue del 7,6 por ciento (6 casos), correspondiendo la mitad a niños con SIDA

Cólera: estudio de casos y controles del brote registrado en el departamento El Carmen, provincia de Jujuy / Colera: case studies and controls of the outbreak verified in the El Carmen department of province Jujuy

Ante la aparición de un foco en el Dto. El Carmen de la Pcia. de Jujuy a partir de Diciembre de 1992 el Instituto Nacional de Epidemiología, realizó un estudio de casos y controles a fin de proveer futuras situaciones epidémicas. Para ello se planteó como objetivo determinar la presencia de factores de riesgo vinculados con el agua, alimentos y el saneamiento y valorar su importancia en este brote. Se trabajó en conjunto con las autoridades del Hospital "Arturo Zabala" perteneciente al Area Programática III con cabecera en la Ciudad de Perico, que abarca las localidades de Puerto Viejo, Pampita, El Milagro, Aguas Calientes, Manantiales y Pampa Blanca. Se realizaron 73 encuestas y de las mismas al analizar los principales factores de riesgo surge : - Alta frecuencia de Ingesta de agua de acequia sin potabilizar (37,1 por ciento ), que está en relación a la falta de agua potable en el hogar (22,2 por ciento ) y en el lugar de trabajo (32,2 por ciento ). - Ingesta de frutas (47,9 por ciento ) y de verduras crudas (22,9 por ciento ) productos estos que pueden estar contaminados por el V. cholerae de acuerdo a su manipulación y riesgo. Del análisis estadístico de estos factores de riesgo surge como causa más significativa el consumo de agua de acequia sin potabilizar (O.R.=7,2:X=11,6:P<0,001). Analizando el riesgo atribuible poblacional para agua de acequia sin potabilizar nos indica que eliminando este factor, se podría disminuir la posibilidad de enfermar de cólera en un 70 por ciento aproximadamente, en el área estudiada. Esto reafirma que trabajando sobre los tres pilares fundamentales para el control y erradicación del cólera : calidad de agua, saneamineto del medio y educación para la salud, es posible el control de esta enfermedad

Cólera: estudio de casos y controles del brote registrado en el departamento El Carmen, provincia de Jujuy / Colera: case studies and controls of the outbreak verified in the El Carmen department of province Jujuy

Ante la aparición de un foco en el Dto. El Carmen de la Pcia. de Jujuy a partir de Diciembre de 1992 el Instituto Nacional de Epidemiología, realizó un estudio de casos y controles a fin de proveer futuras situaciones epidémicas. Para ello se planteó como objetivo determinar la presencia de factores de riesgo vinculados con el agua, alimentos y el saneamiento y valorar su importancia en este brote. Se trabajó en conjunto con las autoridades del Hospital "Arturo Zabala" perteneciente al Area Programática III con cabecera en la Ciudad de Perico, que abarca las localidades de Puerto Viejo, Pampita, El Milagro, Aguas Calientes, Manantiales y Pampa Blanca. Se realizaron 73 encuestas y de las mismas al analizar los principales factores de riesgo surge : - Alta frecuencia de Ingesta de agua de acequia sin potabilizar (37,1 por ciento ), que está en relación a la falta de agua potable en el hogar (22,2 por ciento ) y en el lugar de trabajo (32,2 por ciento ). - Ingesta de frutas (47,9 por ciento ) y de verduras crudas (22,9 por ciento ) productos estos que pueden estar contaminados por el V. cholerae de acuerdo a su manipulación y riesgo. Del análisis estadístico de estos factores de riesgo surge como causa más significativa el consumo de agua de acequia sin potabilizar (O.R.=7,2:X=11,6:P<0,001). Analizando el riesgo atribuible poblacional para agua de acequia sin potabilizar nos indica que eliminando este factor, se podría disminuir la posibilidad de enfermar de cólera en un 70 por ciento aproximadamente, en el área estudiada. Esto reafirma que trabajando sobre los tres pilares fundamentales para el control y erradicación del cólera : calidad de agua, saneamineto del medio y educación para la salud, es posible el control de esta enfermedad