Intrapatient emergence of OXA-247: a novel carbapenemase found in a patient previously infected with OXA-163-producing Klebsiella pneumoniae.

Two genetically related Klebsiella pneumoniae strains carrying OXA-type carbapenemases were isolated from a single patient 1 month apart. Kpn163 harboured OXA-163 and Kpn247 a new variant named OXA-247 that showed susceptibility to carbapenems and expanded-spectrum cephalosporins similar to OXA-48. Our epidemiological, biochemical and molecular results suggest the intrapatient emergence of blaOXA -247 from blaOXA -163.

[Molecular typification of Pseudomonas aeruginosa strains isolated from patients with cystic fibrosis]. / Tipificación molecular de aislamientos de Pseudomonas aeruginosa obtenidos de pacientes con fibrosis quística.

Cystic fibrosis is the most frequent lethal genetic disease that affects the caucasian population. The main cause of morbidity is the chronic lung infection, being the infection caused by Pseudomonas aeruginosa the most difficult to eradicate. This bacteria can be acquired in direct form, by person-to-person transfer, or indirectly, by hospital acquired infection. The Centro Provincial de Referencia de Fibrosis Quistica functioning in the Hospital de Niños "Sor María Ludovica", in La Plata, cares almost 220 patients aged two months to 45 years. The life expectancy depends of factors like the early diagnosis of the disease and the later acquisition of the chronic lung infection. The purpose of this work was the molecular typing of P. aeruginosa isolates obtained from cystic fibrosis patients to evaluate the genomic relationship among them. The study was carried out using RAPD-PCR. The analysis showed a great genetic heterogeneity among the isolates. The separation of the patients in groups in accordance with its bacteriology, that implies the attendance in different days and the implementation of isolation (or segregation) measures had demonstrated to be, in addition to other strategies, effective in the reduction of cross infections.

Tipificación molecular de aislamientos de Pseudomonas aeruginosa obtenidos de pacientes con fibrosis quística / Molecular typification of Pseudomonas aeruginosa strains isolated from patients with cystic fibrosis

La fibrosis quística es la enfermedad genética letal de mayor frecuencia en la población caucásica. La infección pulmonar crónica es la principal causa de morbilidad de la enfermedad, siendo la infección por Pseudomonas aeruginosa la más importante, ya que resulta de difícil erradicación. El Centro de Referencia Provincial de Fibrosis Quística que funciona en el Hospital de Niños "Sor María Ludovica" de La Plata asiste a alrededor de 220 pacientes con fibrosis quística cuyas edades oscilan entre los dos meses y los 45 años. La edad de sobrevida depende de una serie de factores entre los que se encuentran el diagnóstico temprano de la enfermedad y la adquisición de la infección pulmonar crónica por P. aeruginosa. La misma puede adquirirse en forma directa, por transmisión persona a persona o de forma indirecta a través del uso de elementos hospitalarios contaminados. El objetivo de este trabajo fue la tipificación molecular de aislamientos de P. aeruginosa obtenidos de pacientes con fibrosis quística, con el fin de evaluar la relación genómica entre los mismos. El estudio se llevó a cabo mediante RAPD-PCR. El análisis demostró que existe gran heterogeneidad genética entre los aislamientos. La separación en cohortes de pacientes de acuerdo con su bacteriología, que implica la asistencia en días diferentes y las hospitalizaciones en habitaciones aisladas ha demostrado, junto a otras estrategias, disminuir las infecciones cruzadas.

Cystic fibrosis is the most frequent lethal genetic disease that affects the caucasian population. The main cause of morbidity is the chronic lung infection, being the infection caused by Pseudomonas aeruginosa the most difficult to eradicate. This bacteria can be acquired in direct form, by person-to-person transfer, or indirectly, by hospital acquired infection. The Centro Provincial de Referencia de Fibrosis Quística functioning in the Hospital de Niños "Sor María Ludovica", in La Plata, cares almost 220 patients aged two months to 45 years. The life expectancy depends of factors like the early diagnosis of the disease and the later acquisition of the chronic lung infection. The purpose of this work was the molecular typing of P. aeruginosa isolates obtained from cystic fibrosis patients to evaluate the genomic relationship among them. The study was carried out using RAPD-PCR. The analysis showed a great genetic heterogeneity among the isolates. The separation of the patients in groups in accordance with its bacteriology, that implies the attendance in different days and the implementation of isolation (or segregation) measures had demonstrated to be, in addition to other strategies, effective in the reduction of cross infections.

Bordetella Bronchiseptica aislada en paciente con fibrosis quística / Isolation Bordetella bronchiseptica in a patients with cystic fibrosis

Presentamos el caso de una paciente de 15 años con Fibrosis Quística (FQ) en la cual, en dos oportunidades y con un intervalo de 2 años; se aisló Bordetella Bronchiseptica con idéntico perfil genético estudiado por electroforesis de campo pulsado. El mecanismo lesional de B. Bronchiseptica en el árbol bronquial de pacientes con FQ no esta claramente establecido, pero la habilidad de esta bacteria para inhibir la función de los leucocitos y su capacidad de adherirse a las células del epitelio bronquial explicaría su capacidad infectiva y su persistencia en el tracto respiratorio.

Bordetella Bronchiseptica aislada en paciente con fibrosis quística / Isolation Bordetella bronchiseptica in a patients with cystic fibrosis

Presentamos el caso de una paciente de 15 años con Fibrosis Quística (FQ) en la cual, en dos oportunidades y con un intervalo de 2 años; se aisló Bordetella Bronchiseptica con idéntico perfil genético estudiado por electroforesis de campo pulsado. El mecanismo lesional de B. Bronchiseptica en el árbol bronquial de pacientes con FQ no esta claramente establecido, pero la habilidad de esta bacteria para inhibir la función de los leucocitos y su capacidad de adherirse a las células del epitelio bronquial explicaría su capacidad infectiva y su persistencia en el tracto respiratorio.

Concerted escalation of dose and dosing duration in a phase I study of the oral camptothecin gimatecan (ST1481) in patients with advanced solid tumors.

BACKGROUND: Gimatecan is an orally bioavailable camptothecin analogue with preclinical findings of promising antitumor activity. A phase I design of concerted dose escalation and dosing duration was implemented to assess the potential schedule dependency of tolerability that emerged from animal studies. PATIENTS AND METHODS: Gimatecan was given daily for five consecutive days per week for 1, 2 or 3 weeks every 28 days. Plasma levels of total gimatecan were measured on the first and the last day of treatment in each schedule. RESULTS: Overall, 108 patients were treated with 0.8-7.2 mg/m(2) of gimatecan per cycle. The main toxicity was myelosuppression with dose-limiting thrombocytopenia. In the 1-, 2- and 3-week schedule, the maximum tolerated doses were 4.5, 5.6 and 6.4 mg/m(2). Diarrhea and asthenia were of low grade and of minor clinical relevance, while the higher incidence of nausea and vomiting in the 1-week schedule required the use of antiemetic prophylaxis. Due to the prolonged half-life (approximately 77 h), the plasma concentration of gimatecan increased from the first to the last day of dosing. Six partial responses were observed. CONCLUSIONS: Tolerability of gimatecan was schedule dependent. Further testing with schedules taking into account its long persistence in human plasma is worthwhile.

Differences of circulating Bordetella pertussis population in Argentina from the strain used in vaccine production.

In Argentina, as in other countries, the number of pertussis cases has been increasing, even in highly vaccinated zones. Many reports suggest that the decline of vaccine efficacy due to antigenic shifts in the circulating Bordetella pertussis might be among the factors that contribute to pertussis re-emergence in different parts of the world. To evaluate the incidence of this factor in Argentina, we decided to characterize the circulating bacteria of an important demographic area of this country in comparison with the strain used for vaccine production. From 1997 to 2003 we collected nasopharyngeal samples from pediatric patients with signs of Bordetella infection hospitalized in the metropolitan area of Buenos Aires and La Plata, Argentina. From these samples we identified 28 B. pertussis, which were characterized by biochemical techniques, PCR, DNA fingerprint, prn and ptx genes sequencing, and lipopolysaccharides (LPS) pattern. BOX-PCR from B. pertussis isolates yielded one cluster containing 13 isolates and some smaller ones, being all fingerprints different from the vaccine strain. Differences between Argentinean circulating bacteria and the vaccine strain were also observed for the Prn and Ptx variants as well as for the LPS pattern. Moreover, this last pattern seemed to change over the years. In addition, we identified two B. bronchiseptica. The presence of this Bordetella species together with the observed differences between circulating B. pertussis and the strain used in vaccine production should be considered for the development of an improved vaccine.

Phase II studies of BBR3464, a novel tri-nuclear platinum complex, in patients with gastric or gastro-oesophageal adenocarcinoma.

BBR3464, a novel tri-nuclear platinum complex, forms long-range DNA adducts and is highly potent when compared with cisplatin in vitro. Preclinical studies demonstrated activity in cisplatin-resistant tumours and tumours with mutated p53 status. Phase I & II clinical studies gave preliminary indications of activity in melanoma, pancreatic, lung and ovarian cancers. The aim of this study was to determine the efficacy and confirm the toxicity of BBR3464 when given either as first- or second-line treatment for advanced disease in patients with gastric and gastro-oesphageal adenocarcinoma. Two multicentre, open label, Gehan design studies were conducted; one study used BBR3464 as first-line and the other as second-line treatment for metastatic or locally advanced disease. Nineteen first-line and 26 second-line patients were enrolled receiving a total of 74 and 53 infusions, respectively. Initially, seven patients in the second-line study received BBR3464 using the planned schedule of 1.1 mg/m2 every 4 weeks; however, 5 of these patients experienced dose-limiting grade 3 or 4 febrile neutropenia; subsequent patients in both studies were treated using the modified schedule of 0.9 mg/m2, every 21 days. In 1 of 17 evaluable, previously untreated patients, regression of multiple skin lesions was noted with stabilisation of lung metastases and maxillary sinus mass, lasting 155 days. In the first-line study, the median time to progression was 85 days [95% Confidence Interval (CI): 42, 127] (2.8 months) and in the second-line study, the median time to progression was 71 days [95% CI: 42, 109] and 38 days [95% CI: 32, 73] in the 1.1 and 0.9 mg/m2 dose level groups, respectively. Toxicity data were available for 45 patients. Neutropenia was the main toxicity seen (G3: 40%, G4: 40%). Febrile neutropenia was observed in six patients (15%) treated with 0.9 mg/m2 compared with five patients (71%) treated with 1.1 mg/m2 BBR3464. Other drug-related toxicities (G3/4) included: anaemia, thrombocytopenia, nausea, vomiting, diarrhoea, mucositis and fatigue. Diarrhoea and nausea/ vomiting were adequately controlled by the use of loperamide and antiemetics, respectively. Recruitment to the second-line study was closed early due to the poor response rate (1/17 evaluable, 6%; 95% CI: 1%, 27%) and short time to progression noted in the first-line study. Further studies with BBR3464 in this tumour type are not recommended.

Higher frequency of early local side effects with aqueous versus depot immunotherapy for hymenoptera venom allergy.

Venom immunotherapy has proven a very effective method for the treatment of allergy to Hymenoptera venom. Aqueous instead of depot extracts are prevalently used for this immunotherapy. The advantage of using aqueous extracts has not been fully investigated. We made an open, non-controlled study on 45 subjects sensitized to either Apis mellifera or Vespula spp. Patients were assigned to either a depot (N=27) or an aqueous (N=18) immunotherapy regimen, and side effects were monitored during the induction and the 3-year maintenance phase. The effect of naturally occurring stings during the treatment and after its interruption was recorded as well. Side effects were less frequent with the depot extract both on a "per patient" (22.2% versus 50.0%) and on a "per dose" (2.9% versus 10,2%) basis (p=0.026 and p<0.000, respectively). Better tolerance was mainly due to the lower frequency of local side effects occurring at early times after vaccination. The efficacy of vaccination was comparable in the 2 cohorts, as expected. We conclude that depot immunotherapy to Hymenoptera venom should be preferred to aqueous immunotherapy for the lower occurrence of local side effects. This might influence a better compliance with this potentially life-saving treatment.

[Isolation of Haemophilus influenzae serotypes from deep sites in sick children]. / Aislamiento de distintos serotipos de Haemophilus influenzae en muestras profundas de pacientes pediátricos.

Haemophilus influenzae (Hi) is the causative agent of several human diseases such as sepsis, meningitis, celulitis, and osteoarthritis. We investigated the isolation of Hi serotypes from sterile sites in sick children. One hundred and seventy nine strains from 146 patients were studied, period 1996-2002, at the Microbiology Laboratory, Hospital de Niños Superiora Sor María Ludovica, Argentina. The serotype distribution was:1 a, 112 b,1 c,1 d, 4 e, 3 f y 24 no typable. Since the beginning of universal Hi b vaccination in 1998, we have observed the fast decrease of serotype b and a relative increase of other serotypes.

Aislamiento de distintos serotipos de Haemophilus influenzae en muestras profundas de pacientes pediátricos / Isolation of Haemophilus influenzae serotypes from sterile sites in sick children

Haemophilus influenzae (Hi) es responsable de diversas enfermedades humanas como sepsis, meningitis, celulitis y osteoartritis. En este trabajo se investigó la recuperación de distintos serotipos de Hi en muestras profundas de pacientes pediátricos. Se estudiaron 179 aislamientos de 146 niños durante el periodo 1996-2002 en el Laboratorio de Microbiología del Hospital de Niños Superiora Sor María Ludovica, Argentina. La distribución de los serotipos fue la siguiente: 1 a, 112 b, 1 c,1 d, 4 e, 3 f y 24 no tipificables. A partir del establecimiento de la estrategia de vacunación universal anti Hi b en 1998 se observa una disminución notable del serotipo b y un aumento relativo de otros y no tipificables.

Haemophilus influenzae (Hi) is the causative agent of several human diseases such as sepsis, meningitis, celulitis, and osteoarthritis. We investigated the isolation of Hi serotypes from sterile sites in sick children. One hundred and seventy nine strains from 146 patients were studied, period 1996-2002, at the Microbiology Laboratory, Hospital de Niños Superiora Sor María Ludovica, Argentina. The serotype distribution was:1 a, 112 b,1 c,1 d, 4 e, 3 f y 24 no typable. Since the beginning of universal Hi b vaccination in 1998, we have observed the fast decrease of serotype b and a relative increase of other serotypes.

Aislamiento de distintos serotipos de Haemophilus influenzae en muestras profundas de pacientes pediátricos. / [Isolation of Haemophilus influenzae serotypes from deep sites in sick children]

Haemophilus influenzae (Hi) is the causative agent of several human diseases such as sepsis, meningitis, celulitis, and osteoarthritis. We investigated the isolation of Hi serotypes from sterile sites in sick children. One hundred and seventy nine strains from 146 patients were studied, period 1996-2002, at the Microbiology Laboratory, Hospital de Niños Superiora Sor María Ludovica, Argentina. The serotype distribution was:1 a, 112 b,1 c,1 d, 4 e, 3 f y 24 no typable. Since the beginning of universal Hi b vaccination in 1998, we have observed the fast decrease of serotype b and a relative increase of other serotypes.

Allergic reactions to honey and royal jelly and their relationship with sensitization to compositae.

Honey and royal jelly are complex etherogeneous mixtures of flowers' nectar, sugars, proteins and bee's glandular secretions. The existence of a type I hypersensitivity to honey is still matter of debate, while an aetiological role of Compositae pollens in the clinical manifestations following honey ingestion has been envisaged. We describe two cases of severe systemic reactions (anaphylaxis and generalized urticaria/angioedema) due to honey and royal jelly ingestion in patients sensitized to compositae (mugwort). Both patients had a skin and RAST positivity to mugwort and a positive prick-by-prick to the offending foods. Moreover, in one of the two patients the RAST-inhibition assay showed the strong cross-reactivity between the proteins of honey and mugwort and the SDS-PAGE analysis showed that the major proteic bands from honey and mugwort extracts are largely superimposable. Both the clinical data and the laboratory analysis support the hypothesis of a strict link between sensitization to compositae and adverse reactions to honey and jelly.