Emergence of clonal complex 5 (CC5) methicillin-resistant Staphylococcus aureus (MRSA) isolates susceptible to trimethoprim-sulfamethoxazole in a Brazilian hospital

In this study, genotyping techniques including staphylococcal chromosomal cassette mec (SCCmec) typing, pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and restriction-modification tests were used to compare the molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) isolates recovered at two times within a 10-year interval (1998 and 2008) from a tertiary Brazilian hospital. In addition, the antimicrobial susceptibility profiles were analyzed. All 48 MRSA isolates from 1998 and 85.7% from 2008 (48/56 isolates) displayed multidrug-resistance phenotypes and SCCmec III. All but one of the 13 representative SCCmec III isolates belonged to CC8 and had PFGE patterns similar to that of the BMB9393 strain (Brazilian epidemic clone of MRSA; BEC). In 2008, we found an increased susceptibility to rifampicin and chloramphenicol among the SCCmec III isolates. In addition, we detected the entrance of diverse international MRSA lineages susceptible to trimethoprim-sulfamethoxazole (SXT), almost all belonging to CC5. These non-SCCmec III isolates were related to the USA 300 (ST8-SCCmec IV; PFGE-type B), USA 800 (ST5-SCCmec IV; subtype D1), USA 100 (ST5-SCCmec II; subtype D2), and EMRSA-3/Cordobes (ST5-SCCmec I, type C) clones. To the best of our knowledge, this is the first report of the emergence of isolates genetically related to the EMRSA-3/Cordobes clone in southeast Brazil. In this regard, these isolates were the most common non-SCCmec III MRSA in our institution, accounting for 8.9% of all isolates recovered in 2008. Thus, despite the supremacy of BEC isolates in our country, significant changes may occur in local MRSA epidemiology, with possible consequences for the rationality of MRSA empiric therapy.

Sistema intravítreo bioerudivel de liberación prolongada de microesferas de triamcinolona (RETAAC). Comunicación preliminar de su utilidad potencial para el tratamiento del edema macular diabético / Intravitreal bioerudivel sustained-release triamcinolone microspheres system (RETAAC). Preliminary report of its potential usefulnes for the treatment of diabetic macular edema

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Human Fascioliasis in The Metropolitan Area of Curitiba, Brazil Evaluation of The Foci of Infection and Report of Nine Cases Treated With Triclabendazole.

In Brazil, only 35 cases of human fascioliasis have been reported. Several drugs have been used to treat Fasciola hepatica in humans, including praziquantel, and, more recently, triclabendazole. After three patients were diagnosed as having human fascioliasis by routine stool parasitological examinations done at Hospital de Clínicas UFPR, a study was done to determine the frequency of the infection in people and cattle from the surrounding area. Stool samples from 185 people and from 20 bovines were examined. Nine bovines' exams were positive for Fasciola hepatica and six new diagnoses of human fascioliasis were made. After taking a medical history, physical examination, routine blood examinations and biliary imaging in the 9 patients, therapy was given with praziquantel 75mg/Kg daily for 5 days. After 30 and 60 days stool examinations were made to evaluate the therapy's efficacy. All patients were asymptomatic. Hematological examinations were normal, and only one patient had an abnormal biliary system on the image study (echography). In the nine patients, praziquantel did not eliminate the fasciola eggs. Triclabendazole (a benzimidazole licensed for veterinary use) was therefore tested, 10mg/Kg one oral dose. Triclabendazole was effective and well tolerated in all patients. We conclude that fascioliasis is more common in some regions of Brazil than previously reported, and that single dose triclabendazole is effective and well tolerated in treating human fascioliasis.