High prevalence of t895 and t9364 spa types of methicillin-resistant Staphylococcus aureus in a tertiary-care hospital in Mexico: different lineages of clonal complex 5.

BACKGROUND: Staphylococcus aureus is a leading cause of broad-spectrum infections both in the community and within healthcare settings. Methicillin-resistant Staphylococcus aureus (MRSA) has become a global public health issue. The aim of this study was to examine the clinical and molecular characteristics of Staphylococcus aureus isolates and to define the population structure and distribution of major MRSA clones isolated in a tertiary-care hospital in Mexico. RESULTS: From April 2017 to April 2018, 191 Staphylococcus aureus isolates were collected. The frequency of MRSA was 26.7%; these strains exhibited resistance to clindamycin (84.3%), erythromycin (86.2%), levofloxacin (80.3%), and ciprofloxacin (86.3%). The majority of MRSA strains harbored the SCCmec type II (76.4%) and t895 (56.8%) and t9364 (11.7%) were the most common spa types in both hospital-associated MRSA and community-associated MRSA isolates. ST5-MRSA-II-t895 (New York /Japan clone) and ST1011-MRSA-II-t9364 (New York /Japan-Mexican Variant clone) were the most frequently identified clones. Furthermore, different lineages of Clonal Complexes 5 (85.4%) and 8 (8.3%) were predominantly identified in this study. CONCLUSION: Our study provides valuable information about the epidemiology of MRSA in a city of the central region of Mexico, and this is the first report on the association between t895 and t9364 spa types and ST5 and ST1011 lineages, respectively. These findings support the importance of permanent surveillance of MRSA aimed to detect the evolutionary changes of the endemic clones and the emergence of new strains.

Complete Genome Sequence of Human Coronavirus OC43 Isolated from Mexico.

We report the complete genome sequence of the first Mexican human coronavirus (HCoV) OC43, obtained by new-generation sequencing and a metagenomic approach, isolated from a child hospitalized with pneumonia. The genome is closely related to the other OC43 genome sequences available, ranging from 99.8% to 98.2% nucleotide sequence identity.

Placental immaturity and hyperinsulinaemia in full-term newborns.

BACKGROUND: Evidence from large studies suggests that low birthweight is a risk factor for cardiovascular disease and glucose metabolism disorders in adulthood, but the physiological mechanisms involved in intrauterine growth conditioning low birthweight are not completely understood. The objectives of this study were to determine whether placental immaturity (PI), defined as the lower quartile of placental maturity index (PMI), is associated to hyperinsulinaemia at birth and to identify the risk factors associated with PI. MATERIALS AND METHODS: Cross-sectional study conducted at medical research units of two Mexican general hospitals. A total of 272 full-term newborns with gestational age >/= 38 and < 41 weeks were allocated into the corresponding group according to the quartile distribution of PMI. Data from the lower (PMI < 13.3) and higher quartile (PMI >/= 24.3) were compared. The PMI was estimated by dividing the number of epithelial plates by the average thickness of the epithelial plate. Serum measures included cord glucose and insulin levels of the newborns at birth. RESULTS: A total of 74 (27.2%) children had hyperinsulinaemia at birth, of them 47 (63.5%) with PI. The adjusted multiple regression analysis showed a strong association between PI and hyperinsulinaemia at birth [odds ratio (OR) 2.6; CI 95% 1.3-4.3). Additional adjusted analysis showed that both mother's age

[Incidence of nosocomial bacteremia and pneumonia in pediatric unit]. / Incidencia de bacteriemia y neumonía nosocomial en una unidad de pediatría.

OBJECTIVE: To determine the incidence of catheter-related bacteremia and ventilator-associated pneumonia in children admitted to a secondary care hospital. MATERIAL AND METHODS: A prospective active surveillance system was conducted from January 1999 to June 2000, at the Hospital General of Instituto Mexicano del Seguro Social in Durango, Mexico. Daily visits to the pediatric ward were conducted to detect episodes of bacteremia and pneumonia, according to the Official Mexican Norm. Hospitalized patients under mechanical ventilation and/or with a central venous catheter, were followed from the first day of exposure, until a nosocomial infection was detected, or until the invasive device was removed. Blood and tracheal aspirate cultures were obtained from all exposed patients. Incidence rates with 95% confidence intervals were calculated for ventilator-associated pneumonia and bacteremia/sepsis per 1000 exposure days. Also, the monthly infection rate is presented for days of exposure, using statistical control graphs. RESULTS: A total of 47 episodes of bacteremia/sepsis and 44 of ventilator associated pneumonia were recorded. The incidence rate of pneumonia and bacteremia/sepsis was 28 and 26 cases respectively, per 1000 days of exposure to and invasive device. The gram-positive rods (61.11%) were more common than the gram negative rods (38.88%). CONCLUSIONS: The most striking finding of this study was the higher incidence of these two nosocomial infections in children, as compared to that reported elsewhere. These findings call for preventive strategies and guidelines for handling intravenous catheters and mechanical ventilation in Mexico.

Outbreak of nosocomial sepsis and pneumonia in a newborn intensive care unit by multiresistant extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: high impact on mortality.

We describe a case-control study of a small outbreak of nosocomial sepsis and pneumonia with high mortality due to clonal dissemination of a multiresistant Klebsiella pneumoniae in the neonatal intensive care unit of a Mexican institution. Our study helped to change nosocomial infection control policy in this hospital.

[HIV infection in Mexican children]. / Infección por VIH en niños mexicanos.

OBJECTIVE: To review the experience of the Immunodeficiency Clinic of the Department of Infectious Diseases at Hospital Infantile de México "Federico Gómez", in the management of children with HIV infection and AIDS. MATERIAL AND METHODS: the medical records of 130 patients with a clinical and laboratory diagnosis of HIV/AIDS seen between September 1985 and June 1994 were reviewed. Data was obtained regarding diagnosis, epidemiological risk factors, clinical features, types and numbers of bacterial and opportunistic infections, malignancies, hospitalizations, general and specific treatment and outcome. The diagnosis followed CDC guidelines and was established in all 130 patients serologically with ELISA and Western Blot. In infants < 18 months, diagnosis was made by detection of p24 and/or viral culture in two separate occasions. RESULTS: Data from 130 subjects was obtained; 74 were male and 56 female for a M:F ratio of 1.3:1. With regards to mode of transmission, 62.3% was vertical, 20.8% post transfusion, 8.5% hemophiliacs (the latter two males were cases before occurred 1987), 6.2% sexual and 2.2% unknown. With regards to additional risk factors, in 35 cases the parents were heterosexual, in 18 one parent had a history of transfusion, and in eight the father was bisexual. According to the CDC classification; 16 had indeterminate infection or PO; nine were asymptomatic or P1; and 105 were symptomatic or P2. Eighty two patients had nonspecific findings, 60 had neurologic manifestations, 18 had lymphocytic interstitial pneumonia and four had secondary malignancies. It was possible to document 296 episodes of secondary infections: 154 bacterial, 58 opportunistic, and 84 with other pathogens. CONCLUSIONS: in Mexico, as in other Western countries, vertical transmission has become the dominant form of acquiring HIV infection in children, reflecting a change in the epidemiology of infection in women of child bearing age. Moreover, since IV drug use is a very limited phenomenon in Mexico, heterosexual transmission is the major form of transmission in women.

[The split notochord syndrome. A report of 2 cases]. / Síndrome de notocorda hendida. Informe de dos casos.

Split notochord syndrome has been described in several previous case reports; however, we recently treated two patients with a previous undescribed variant of this syndrome. A 2,800 g male baby was admitted to the neonatal patients room with a non covered mass on the lumbo-sacral region, and a portion of intestine, with meconium being passed attached to it the legs were equine-varus and the anus was absent. Radiographs were consistent with a double spine defect (lumbar and sacral split notochord), and the patient was taken to the operating room for closure. A 2,600 g male baby was first seen in other hospital, and was admitted with a circular defect in the mid-line of the lumbosacral region. This defect was conformed by knee, leg, ankle and fingers. Radiographs showed bony structures consistent with incomplete lower extremity. During surgery, the skin overlying the mass was excised, showing a wide spine defect including stomach, duodenum, jejunum, ileum and colon, covered by a peritoneal membrane; there was not communication between this structure and the normal digestive tract.

[Overview of HIV infections in pediatric population]. / Panorama de la infección por el virus de la inmunodeficiencia humana en población pediátrica.

A general overview of HIV infection/AIDS in the pediatric population, in Mexico, is provided. The principal categories of transmission in our country are: 45.5% perinatal, 44.0% following transfusion for hemophilia or for other reasons, and less frequently sexual transmission. In the United States and Europe, similar patterns are seen with perinatal transmission being the most important route, at higher percentages than ours. The number of cases of HIV infection in children continues to grow worldwide, primarily reflecting the problem in the adult population.

[Neurologic manifestations in pediatric patients with AIDS]. / Manifestaciones neurológicas en pacientes pediátricos con síndrome de inmunodeficiencia adquirida.

Since the first cases of childhood AIDS were reported, the neurological involvement has been more frequently recognized. Several motor, intellectual and conductual changes as well as unexplained abnormalities have been described due to CNS infections. Findings have shown HIV to affect the CNS although it is unknown as to when the viral invasion actually occurs. This report describes the neurological manifestations found in pediatric patients with HIV infection at the Hospital Infantil de Mexico and their correlations with CT scans, EEGs, auditory evoked potentials, I.Q.s and postmortem findings. The medical records of 60 symptomatic HIV infected children, stages P0 to P2, are reviewed. Neurological abnormalities were found in 51 patients, 20 of which (39.2%) were due to perinatal infection with symptoms starting, on the average at 11 months 7 days (from the initial contact) taking into consideration in utero exposure. Nine cases (17.6%) were patients infected through transfusions with symptoms appearing on the average at 24 months 8 days; 2 cases (3.9%) were of unknown origin. The CT scans, EEGs and psychometric evaluations of the HIV infected patients correlated well with the clinical findings.

[Bacterial infections in children with AIDS]. / Infecciones bacterianas en niños con síndrome de inmunodeficiencia adquirida.

The importance of bacterial infections in children with AIDS was emphasized when they were included within the CDC classification system for children under 13 years of age infected with the HIV. The information available in Mexico on frequency, types of infections and causative agents is scarce. In this study, the frequency and microbiology of bacterial infections in children with AIDS seen at the Hospital Infantil de Mexico Federico Gomez is reported. From September 1985 to December 1991, we found 72 HIV infected children, 6 were classified P0, 6 as asymptomatic (P1) and 60 as symptomatic infections (P2). From this last group, 50 were secondarily infected with bacteria; there was a total of 129 episodes of bacterial infections, averaging 2.5 episodes per patient. Respiratory infections were the most frequent (74.41%), followed by septicemia (10.07%), skin and underlying tissue infections (6.96%) and urinary tract infections (6.17%). Infections of the CNS and deep abscesses were less frequent. Overall mortality rate was 76%, however only in 18 children (36%) was it directly attributed to the bacterial infections. Etiology was documented in 46 episodes (33.65%) of which 30 (65.31%) were gram-negative bacteria and 16 (34.78%) were gram-positive. The best possible methodology must be used for the etiologic diagnosis of bacterial infections in children with AIDS in order to select the most appropriate treatment for severe or recurrent bacterial infections.

[Oral manifestations in HIV positive children]. / Manifestaciones orales en niños positivos al virus de la inmunodeficiencia humana.

Oral manifestations of HIV infection in children include oral candidiasis, herpetic stomatitis, oral hairy leukoplakia, parotid gland swelling, and other bacterial, viral and mycotic infections. The frequency and natural history of those disorders are not fully defined. The purpose of this work is to inform the oral findings in 57 HIV infected children studied at the Hospital Infantil de Mexico. All 57 patients presented nonspecific gingivitis; however it was not feasible to associate it with the HIV infection; in 28 oral candidiasis was observed, and in 3 cases herpetic stomatitis was documented. Oral candidiasis was found regardless the patient's sex, age, clinical stage, treatment, and mode of transmission of the HIV infection. It has been considered that oral candidiasis is a good marker of immunodeficiency; however, in our patients this correlation was not observed. Also, other HIV-associated oral manifestations were not observed in these cases. The severity and rapid clinical course presented by our patients, may explain both, the lack of correlation between candidiasis and immunodeficiency as well as the absence of other lesions.

[Health care worker relationship with HIV infected patients or AIDS patients]. / El trabajador de la salud y su relación con personas infectadas con el virus de la inmunodeficiencia humana o enfermos con síndrome de inmunodeficiencia adquirida.

The roll of the health care worker (HCW) providing care to HIV-infected patients or living with AIDS has became an important issue in the course of the epidemic, and has impacted the evolution of these patients. Diverse studies have shown that the acceptance of the HCW to care for these patients is related to the degree of education in regards to the subject. There is a positive correlation between knowledge about universal precautions and mechanisms of transmission with the willingness to care for HIV-infected patients. This review shows several studies that have been developed in order to assess the attitudes among HCW's toward HIV-infected patients and the phenomen HIV/AIDS as public health problem. In addition, political issues are discussed in regards to measure protection to HCW as well as HIV-infected patients.

[Medical facilities for women and children infected with HIV]. / Infraestructura de atención y servicio para mujeres y niños infectados por el virus de la inmunodeficiencia humana.

The phenomena HIV infection and acquired immunodeficiency syndrome (AIDS) among women and children is an important concern for underdeveloped and developing countries and has became a Public Health problem. The medical facilities required for care of these patients are special and demand a comprehensive approach and multidisciplinary team-work. In this way, the patients would receive adequate care for their needs. This review includes the antecedents of the HIV infection among women and children. Mechanisms of transmission, and the current model of medical care that exists in some developed countries. Finally, a commentary is made in regards to the importance of continuing medical education of the health-term in order to confront the AIDS epidemic.