Optimization and Characterization of Interspecific Hybrid Crude Palm Oil Unaué HIE OxG Nanoparticles with Vegetable By-Products as Encapsulants.

Interspecific hybrid crude palm oil (HCPO) HIE OxG derived from crossbred African oil palm (Elaeis guineensis) and American Caiaué (Elaeis oleifera) is prominent for its fatty acid and antioxidant compositions (carotenoids, tocopherols, and tocotrienols), lower production cost, and high pest resistance properties compared to crude palm oil. Biodegradable and sustainable encapsulants derived from vegetable byproducts were used to formulate HCPO nanoparticles. Nanoparticles with hybrid crude palm oil and jackfruit seed flour as a wall material (N-JSF) and with hybrid crude palm oil and jackfruit axis flour as a wall material (N-JAF) were optimized using a 22 experimental design. They exhibited nanoscale diameters (<250 nm) and were characterized based on their zeta potential, apparent viscosity, pH, color, and total carotenoid content. The nanoparticles demonstrated a monodisperse distribution, good uniformity, and stability (polydispersity index < 0.25; zeta potentials: N-JSF -19.50 ± 1.47 mV and N-JAF -12.50 ± 0.17 mV), as well as high encapsulation efficiency (%) (N-JSF 86.44 ± 0.01 and N-JAF 90.43 ± 1.34) and an optimal carotenoid retention (>85%). These nanoparticles show potential for use as sustainable and clean-label HCPO alternatives in the food industry.

Study of Structural and Optical Properties of Titanate Nanotubes with Erbium under Heat Treatment in Different Atmospheres.

Titanate nanotubes were synthesized and subjected to an ion exchange reaction with erbium salt aqueous solution to obtain titanate nanotubes exchanged with erbium (3+) ions. In order to evaluate the effects of the thermal treatment atmosphere on the structural and optical properties of erbium titanate nanotubes, we subjected them to heat treatment in air and argon atmospheres. For comparison, titanate nanotubes were also treated in the same conditions. A complete structural and optical characterizations of the samples was performed. The characterizations evidenced the preservation of the morphology with the presence of phases of erbium oxides decorating the surface of the nanotubes. Variations in the dimensions of the samples (diameter and interlamellar space) were promoted by the replacement of Na+ by Er3+ and the thermal treatment in different atmospheres. In addition, the optical properties were investigated by UV-Vis absorption spectroscopy and photoluminescence spectroscopy. The results revealed that the band gap of the samples depends on the variation of diameter and sodium content caused by ion exchange and thermal treatment. Furthermore, the luminescence strongly depended on vacancies, evidenced mainly by the calcined erbium titanate nanotubes in argon atmosphere. The presence of these vacancies was confirmed by the determination of Urbach energy. The results suggest the use of thermal treated erbium titanate nanotubes in argon atmosphere in optoelectronics and photonics applications, such as photoluminescent devices, displays, and lasers.

Na-TiNT Nanocrystals: Synthesis, Characterization, and Antibacterial Properties.

Titanium nanotubes have attractive morphological and physicochemical properties for several applications, such as high surface area, mesoporous structure, good stability, ion exchange capacity, and antibacterial property. Therefore, the field of nanotube applications is increasingly expanding, such as in solar cells sensitized by dye, photocatalysis, and antibacterial activity, among others. Therefore, a study of the antibacterial properties of sodium titanate nanotubes (Na-TiNTs) was carried out together with physicochemical characterizations, such as Raman spectroscopy which shows a peak characteristic of Na-O-Ti from nanotube-agglomerated regions. The XRD diffractogram confirmed the Raman spectra and evidenced the crystalline structure associated to Na-TiNT, which showed the characteristic peaks of the sodium trititanate crystal. SEM and TEM images showed the morphology of hollow nanotubes and forming semispherical particles. EDS shows the percentage values of each of the compounds in the Na-TiNT. The bacterial activity of the Na-TiNT was analyzed in Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa. Na-TiNT modified the activity of the gentamicin and norfloxacin antibiotics against multiresistant strains. Synergistic effects against Gram-positive S. aureus 10 and Gram-negative P. aeruginosa 15 bacteria were observed when the Na-TiNT was associated with gentamicin, reducing the concentration of this antibiotic that is required to inhibit bacterial growth. Another synergic effect was observed for S. aureus 10 with norfloxacin.

A Patent Data Analysis in Nanotechnology Applied to Essential Oils.

BACKGROUND: Essential oils (EOs) are natural substances that serve as sources of bioactive compounds with antioxidant and antimicrobial properties. OBJECTIVE: This objective is to understand intellectual property related to patent documents on EOs and nanotechnology. METHODS: The nanotechnology growth curve applied to EOs demonstrated that the period from 2015 to 2017 was the most prominent, with a peak in 2016. China is the dominant country, mainly through research developed in the academic area. RESULTS: The food industry area had the highest number of patents filed, highlighting the preservation line. Ginger essential oil, chitosan and Tween 80 were preferentially used as a core, wall material, and emulsifier, respectively. In the market, the use of EOs is more associated with the pharmaceutical/ cosmetics industry. In addition, the food industry market bets more on products based on hemp oil nanocapsules. CONCLUSION: EO nanotechnology is promising for the development of sustainable food systems. However, this nanotechnology in Brazil has not yet advanced enough in the food industry, although there are government incentives that may change this paradigm in the future. The profile of the patent documents and the products in the market differ between the application and the types of oils. In addition, there is a gap between the volume of patent documents investigated and the transfer of technology to the commercial sector, but this constitution could be better explored, given the properties of EOs.

Prospective Study on Microencapsulation of Oils and Its Application in Foodstuffs.

BACKGROUND: Edible oils have gained the interest of several industrial sectors for the different health benefits they offer, such as the supply of bioactive compounds and essential fatty acids. Microencapsulation is one of the techniques that has been adopted by industries to minimize the degradation of oils, facilitating their processing. OBJECTIVE: To evaluate the intellectual property related to patent documents referring to microencapsulated oils used in foods. METHODS: This prospective study investigated the dynamics of patents filed in the Espacenet and National Institute of Industrial Property (INPI) databases, and it mapped technological developments in microencapsulation in comparison with scientific literature. RESULTS: The years 2015 and 2018 showed the greatest growth in the number of patents filed in the Espacenet and INPI databases, respectively, with China leading the domains of origin, inventors, and owners of microencapsulation technology. The largest number of applications of microcapsules were observed in the food industry, and the foods containing microencapsulated oils were powdered seasonings, dairy products, rice flour, nutritional formulae, pasta, nutritional supplements, and bread. The increase in oxidative stabilities of oils was the most cited objective to microencapsulate oils. Spray drying was the most widely used microencapsulation technique, and maltodextrin, gum arabic, and modified starch were the most widely used wall materials. CONCLUSION: Microencapsulation of oils has been expanding over the years and increasing the possibilities of the use of microcapsules, but further investments and development of policies and incentive programs to boost this technology need to be made in less developed countries. For future perspectives, the microencapsulation technique is already a worldwide trend in the food industry, enabling the development of new products to facilitate their insertion in the consumer market.

Technological Prospection of Oil Nanoparticles: Primary Characteristics and Profiles.

The search for technological applications for oils has been growing largely due to their potential nutritional and economic applications. Encapsulation makes it possible to reduce the disadvantages of oils, such as physical instability or thermodynamics, or to improve their technological properties, enabling their use in various industrial areas. Nanoencapsulated oils have the potential to improve oil bioavailability and achieve controlled release and are able to target bioactive compounds with greater precision than microencapsulated oils. The present study aims to evaluate the primary characteristics and profiles of the technological prospection of oil nanoparticles. This technology foresight study investigates the patenting activity and the academic literature to map out the technological progress and difficulties in the area of nanoencapsulation. Exponential growth in patent filing was noted with a peak in 2017, with China filing the highest number of patents. Regarding the area of application, the food industry was most common followed by the pharmaceutical industry. The most commonly used terms in patent documents on the subject were nanoemulsion and nanoparticle. The most commonly used oil, technique, wall materials and emulsifiers were soybean oil, emulsification, chitosan and lecithin, and Span 80, Tween 80 and Tween 40, respectively. The obtained articles were typically patent documents. The main depositor was Jiangnan University, and most inventors filed the same number of patent documents. Nanoencapsulation of oils has many known advantages that have been widely published in the literature and used by industry. There is a trend in the growth of patent document deposits and related scientific publications, indicating that many innovations have been made, highlighting the importance of oil nanoencapsulation.

Control of pathogens in fresh pork sausage by inclusion of Lactobacillus sakei BAS0117.

A pork sausage was produced with low sodium content (1.64%) to which Lactobacillus sakei was added with the aim of developing a meat pork sausage for cooking and having technological, organoleptic, and hygienic advantages. The lactic acid bacteria (LAB) L. sakei, Lactococcus sp., and Pediococcus pentosaceus were submitted to extreme pH, temperature, and NaCl conditions. Lactobacillus sakei was used in pork sausage because of its resistance to different culture conditions and its antimicrobial potential. The food-borne pathogens Listeria monocytogenes Scott A, Enterococcus faecalis, and Staphylococcus aureus were used as indicator microorganisms to evaluate the antimicrobial activity of selected LAB strains. Salmonella enterica serotype Choleraesuis is a common pathogen of pigs. To the raw sausage product containing L. sakei and nonpathogenic endogenous microbiota, we added about >104 and <105 CFU/g of S. enterica serotype Choleraesuis to evaluate the inhibitory potential of L. sakei towards this pathogen. Salmonella Choleraesuis was inhibited in the presence of L. sakei over 7 days of storage of the meat product (about 3.0 log cycles reduction). Lactobacillus sakei significantly increased inhibition when compared with the nonfermented sausage. Thus, L. sakei BAS0117 played an important role as an additional hurdle in the fermented meat pork sausage during storage.

Herd-level prevalence and risk factors for bovine viral diarrhea virus infection in cattle in the State of Paraíba, Northeastern Brazil.

Serological surveys based on a planned sampling on bovine viral diarrhea virus (BVDV) infection in Brazilian cattle herds are scarce. A cross-sectional study was carried out to determine herd- and animal-level seroprevalences and to identify risk factors associated with herd-level seroprevalence for BVDV infection in the State of Paraíba, Northeastern Brazil, from September 2012 to January 2013. The state was divided into three sampling strata, and for each stratum, the prevalence of herds infected with BVDV and the prevalence of seropositive animals was estimated by a two-stage sampling survey. In total, 2443 animals were sampled from 478 herds. A virus-neutralization test was used for BVDV antibody detection. A herd was considered positive when at least one seropositive animal was detected. The herd- and animal-level prevalences in the State of Paraíba were 65.5% (95% confidence interval (CI) = 61.1-69.7%) and 39.1% (95% CI = 33.1-45.6%), respectively. The frequency of seropositive animals per herd ranged from 10 to 100% (median of 50%). The risk factors identified were as follows: more than six calves aged ≤12 months (odds ratio (OR) = 3.72; 95% CI = 2.08-6.66), animal purchasing (OR = 1.66; 95% CI = 1.08-2.55), pasture rental (OR = 2.15; 95% CI = 1.35-3.55), and presence of veterinary assistance (OR = 2.04; 95% CI = 1.10-3.79). Our findings suggest that the implementation of control and prevention measures among farmers, with the aim of preventing dissemination of the agent in the herds, is necessary. Special attention should be given to addressing the identified risk factors, such as sanitary control prior to animal purchasing and to discourage the pasture rental, as well as to encourage the vaccination in the herds.

Early manifestations of cystic fibrosis in a premature patient with complex meconium ileus at birth / Manifestações precoces da fibrose cística em paciente prematuro com íleo meconial complexo ao nascimento

OBJECTIVE: To report a case of a preterm infant with complex meconium ileus at birth and cystic fibrosis. CASE DESCRIPTION: A male infant was born by vaginal delivery at 33 weeks and 5 days of gestational age with respiratory distress and severe abdominal distension. The exploratory laparotomy in the first day of life identified meconium ileus and secondary peritonitis. Ileal resection and ileostomy were performed, followed by reconstruction of the bowel transit at 20 days of life. At 11 days of life, the first immunoreactive trypsinogen (IRT) was 154 ng/mL (reference value = 70), and oral pancreatic enzymes replacement therapy was started. After 23 days, the second IRT was 172ng/mL (reference value = 70). At 35 days of age he was discharged with referrals to primary care and to a special clinic for CF for the determination of sweat chloride. He was received in the outpatient clinic for neonatal screening for CF at 65 days of life presenting malnutrition and respiratory distress. The sweat chloride test was performed, with a positive result (126mEq/L). COMMENTS: This case illustrates the rapid evolution of CF in a premature patient with complex meconium ileus as the first clinical manifestation.

OBJETIVO: Relatar o caso de um recém-nascido prematuro com íleo meconial complexo e fibrose cística. DESCRIÇÃO DO CASO: Recém-nascido do sexo masculino nasceu de parto vaginal com 33 semanas e cinco dias de idade gestacional e apresentou desconforto respiratório e distensão abdominal grave. Foi submetido à laparotomia exploratória no primeiro dia de vida e identificado íleo meconial com peritonite secundária. Foram feitas ressecção ileal e ileostomia, com reconstrução do trânsito intestinal aos 20 dias de vida. Com 11 dias de idade, a primeira dosagem sérica de tripsina imunorreativa (TIR) foi 154ng/mL (valor de referência = 70) e optou-se pelo início da terapia de reposição oral de enzimas pancreáticas. Após 23 dias, a segunda TIR foi 172ng/mL (valor de referência = 70). Recebeu alta com 35 dias de vida com encaminhamentos à rede básica de saúde e ao serviço de referência para a detecção de fibrose cística. Foi atendido no ambulatório de triagem neonatal para fibrose cística aos 65 dias de vida e apresentava desnutrição e desconforto respiratório. O resultado do teste do cloro no suor foi positivo (126 mEq/L). COMENTÁRIOS: O caso ilustra a rápida evolução da fibrose cística em um paciente prematuro com íleo meconial complexo como primeira manifestação clínica.

[Early manifestations of cystic fibrosis in a premature patient with complex meconium ileus at birth]. / Manifestações precoces da fibrose cística em paciente prematuro com íleo meconial complexo ao nascimento.

OBJECTIVE: To report a case of a preterm infant with complex meconium ileus at birth and cystic fibrosis. CASE DESCRIPTION: A male infant was born by vaginal delivery at 33 weeks and 5 days of gestational age with respiratory distress and severe abdominal distension. The exploratory laparotomy in the first day of life identified meconium ileus and secondary peritonitis. Ileal resection and ileostomy were performed, followed by reconstruction of the bowel transit at 20 days of life. At 11 days of life, the first immunoreactive trypsinogen (IRT) was 154 ng/mL (reference value=70), and oral pancreatic enzymes replacement therapy was started. After 23 days, the second IRT was 172 ng/mL (reference value=70). At 35 days of age he was discharged with referrals to primary care and to a special clinic for CF for the determination of sweat chloride. He was received in the outpatient clinic for neonatal screening for CF at 65 days of life presenting malnutrition and respiratory distress. The sweat chloride test was performed, with a positive result (126mEq/L). COMMENTS: This case illustrates the rapid evolution of CF in a premature patient with complex Meconium ileus as the first clinical manifestation.

Avaliação de novas tecnologias para ampliar o acesso aos Centros de Testagem e Aconselhamento em Aids / Evaluation of new technologies to expand access to testing and counseling centers in AIDS

O projeto objetiva desenvolver, implantar e avaliar tecnologias para ampliar o acesso ao diagnóstico oportuno da infecção pelo HIV e outras DST e às ações de prevenção desenvolvidas nos Centros de Testagem e Aconselhamento (CTA). O desenvolvimento das tecnologias tomou por base os eixos organizativos dos serviços (porta de entrada, oferta de serviço e o aconselhamento) e busca reduzir barreiras de acesso para populações com maior prevalência do HIV, aumentar a resolubilidade do serviço e apoiar usuários para lidarem, de forma mais autônoma, com o resultado dos exames sorológicos e a prevenção das DST e aids. As tecnologias propostas compreendem as direcionadas para a: (1) identificação e mobilização de segmentos sociais na comunidade para o uso dos CTA; (2) organização do serviço a partir da demanda e do acolhimento do usuário desde a porta de entrada; (3) aprimoramento dos processos de trabalho e de gestão para a oferta oportuna do diagnóstico, insumos e ações de prevenção; e (4) aconselhamento continuado para o apoio aos indivíduos positivos e com práticas que aumentam o risco de infecção. A implantação e avaliação das tecnologias vêm ocorrendo em três serviços do País, que se diferenciam pela organização, estrutura, perfil dos usuários atendido e contexto epidemiológico da aids, sendo eles: CTA de Santo Amaro, vinculado à Secretaria Municipal de Saúde de São Paulo, CTA de Santarém, da Secretaria Municipal de Saúde de Santarém-PA e CTA de Olinda, pertencente à Secretaria Municipal de Olinda-PE. O desenvolvimento do projeto está previsto em quatro etapas. Na primeira foram delineadas as tecnologias propostas, o processo de implantação das mesmas e as estratégias e instrumentos de avaliação. Essa etapa foi desenvolvida a partir da revisão do diagnóstico situacional da Rede Nacional de CTA, das normas estabelecidas pelo Ministério da Saúde e das teorias sobre o acesso e uso de serviços de saúde em geral e os específicos em aids. Na segunda etapa foram conduzidos estudos qualitativos e quantitativos para realizar o diagnóstico situacional dos CTA incluídos no projeto, constituir a linha de base para a avaliação e adequar as novas tecnologias à realidade local. A terceira etapa compreende a implantação das inovações, com a capacitação dos gestores e profissionais e a adequação dos processos de trabalho pertinentes; A quarta etapa consiste na avaliação da efetividade, factibilidade e pertinência das tecnologias implantadas. Para a análise da efetividade foram estabelecidos indicadores para mensurar eventuais alterações na demanda dos serviços, na oferta oportuna do diagnóstico, na inclusão de populações de maior prevalência, na resolubilidade da oferta de serviço e no aumento da autonomia dos indivíduos frente ao diagnóstico do HIV e às situações de risco. Para a mensuração dos indicadores serão analisados os sistemas de informação existentes e o padrão de uso dos serviços e realizados inquéritos com usuários no momento de início e após o uso do serviço. A análise da factibilidade visa estudar as possibilidades e limites de uso das tecnologias nos CTA analisados e na rede de serviços e será desenvolvida, fundamentalmente, por meio dos estudos qualitativos. As dimensões a serem analisadas envolvem a adequação das inovações propostas em relação à complexidade dos CTA, a aceitação dos gestores e profissionais de saúde e reprodutibilidade em outros CTA. A análise da pertinência está direcionada para o usuário, enfocando a motivação para o uso do serviço, a avaliação da resolubilidade segunda suas demandas e a satisfação na utilização do CTA. Para tanto serão utilizados os estudos qualitativos e o inquérito com usuários. Estas análises serão realizadas por meio da comparação entre proporções ou médias observadas durante a linha de base e após a implantação das tecnologias e serão aplicadas técnicas de análise multivariada para compreender os aspectos associados à variação dos indicadores e eventos de interesse pré-estabelecidos. No componente qualitativo será utilizada a análise temática.

Avaliação de novas tecnologias para ampliar o acesso aos Centros de Testagem e Aconselhamento em Aids / Evaluation of new technologies to expand access to testing and counseling centers in AIDS

O projeto objetiva desenvolver, implantar e avaliar tecnologias para ampliar o acesso ao diagnóstico oportuno da infecção pelo HIV e outras DST e às ações de prevenção desenvolvidas nos Centros de Testagem e Aconselhamento (CTA). O desenvolvimento das tecnologias tomou por base os eixos organizativos dos serviços (porta de entrada, oferta de serviço e o aconselhamento) e busca reduzir barreiras de acesso para populações com maior prevalência do HIV, aumentar a resolubilidade do serviço e apoiar usuários para lidarem, de forma mais autônoma, com o resultado dos exames sorológicos e a prevenção das DST e aids. As tecnologias propostas compreendem as direcionadas para a: (1) identificação e mobilização de segmentos sociais na comunidade para o uso dos CTA; (2) organização do serviço a partir da demanda e do acolhimento do usuário desde a porta de entrada; (3) aprimoramento dos processos de trabalho e de gestão para a oferta oportuna do diagnóstico, insumos e ações de prevenção; e (4) aconselhamento continuado para o apoio aos indivíduos positivos e com práticas que aumentam o risco de infecção. A implantação e avaliação das tecnologias vêm ocorrendo em três serviços do País, que se diferenciam pela organização, estrutura, perfil dos usuários atendido e contexto epidemiológico da aids, sendo eles: CTA de Santo Amaro, vinculado à Secretaria Municipal de Saúde de São Paulo, CTA de Santarém, da Secretaria Municipal de Saúde de Santarém-PA e CTA de Olinda, pertencente à Secretaria Municipal de Olinda-PE. O desenvolvimento do projeto está previsto em quatro etapas. Na primeira foram delineadas as tecnologias propostas, o processo de implantação das mesmas e as estratégias e instrumentos de avaliação. Essa etapa foi desenvolvida a partir da revisão do diagnóstico situacional da Rede Nacional de CTA, das normas estabelecidas pelo Ministério da Saúde e das teorias sobre o acesso e uso de serviços de saúde em geral e os específicos em aids. Na segunda etapa foram conduzidos estudos qualitativos e quantitativos para realizar o diagnóstico situacional dos CTA incluídos no projeto, constituir a linha de base para a avaliação e adequar as novas tecnologias à realidade local. A terceira etapa compreende a implantação das inovações, com a capacitação dos gestores e profissionais e a adequação dos processos de trabalho pertinentes; A quarta etapa consiste na avaliação da efetividade, factibilidade e pertinência das tecnologias implantadas. Para a análise da efetividade foram estabelecidos indicadores para mensurar eventuais alterações na demanda dos serviços, na oferta oportuna do diagnóstico, na inclusão de populações de maior prevalência, na resolubilidade da oferta de serviço e no aumento da autonomia dos indivíduos frente ao diagnóstico do HIV e às situações de risco. Para a mensuração dos indicadores serão analisados os sistemas de informação existentes e o padrão de uso dos serviços e realizados inquéritos com usuários no momento de início e após o uso do serviço. A análise da factibilidade visa estudar as possibilidades e limites de uso das tecnologias nos CTA analisados e na rede de serviços e será desenvolvida, fundamentalmente, por meio dos estudos qualitativos. As dimensões a serem analisadas envolvem a adequação das inovações propostas em relação à complexidade dos CTA, a aceitação dos gestores e profissionais de saúde e reprodutibilidade em outros CTA. A análise da pertinência está direcionada para o usuário, enfocando a motivação para o uso do serviço, a avaliação da resolubilidade segunda suas demandas e a satisfação na utilização do CTA. Para tanto serão utilizados os estudos qualitativos e o inquérito com usuários. Estas análises serão realizadas por meio da comparação entre proporções ou médias observadas durante a linha de base e após a implantação das tecnologias e serão aplicadas técnicas de análise multivariada para compreender os aspectos associados à variação dos indicadores e eventos de interesse pré-estabelecidos. No componente qualitativo será utilizada a análise temática.

Accuracy of real-time PCR, Gram stain and culture for Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae meningitis diagnosis.

BACKGROUND: Although cerebrospinal fluid (CSF) culture is the diagnostic reference standard for bacterial meningitis, its sensitivity is limited, particularly when antibiotics were previously administered. CSF Gram staining and real-time PCR are theoretically less affected by antibiotics; however, it is difficult to evaluate these tests with an imperfect reference standard. METHODS AND FINDINGS: CSF from patients with suspected meningitis from Salvador, Brazil were tested with culture, Gram stain, and real-time PCR using S. pneumoniae, N. meningitidis, and H. influenzae specific primers and probes. An antibiotic detection disk bioassay was used to test for the presence of antibiotic activity in CSF. The diagnostic accuracy of tests were evaluated using multiple methods, including direct evaluation of Gram stain and real-time PCR against CSF culture, evaluation of real-time PCR against a composite reference standard, and latent class analysis modeling to evaluate all three tests simultaneously. RESULTS: Among 451 CSF specimens, 80 (17.7%) had culture isolation of one of the three pathogens (40 S. pneumoniae, 36 N. meningitidis, and 4 H. influenzae), and 113 (25.1%) were real-time PCR positive (51 S. pneumoniae, 57 N. meningitidis, and 5 H. influenzae). Compared to culture, real-time PCR sensitivity and specificity were 95.0% and 90.0%, respectively. In a latent class analysis model, the sensitivity and specificity estimates were: culture, 81.3% and 99.7%; Gram stain, 98.2% and 98.7%; and real-time PCR, 95.7% and 94.3%, respectively. Gram stain and real-time PCR sensitivity did not change significantly when there was antibiotic activity in the CSF. CONCLUSION: Real-time PCR and Gram stain were highly accurate in diagnosing meningitis caused by S. pneumoniae, N. meningitidis, and H. influenzae, though there were few cases of H. influenzae. Furthermore, real-time PCR and Gram staining were less affected by antibiotic presence and might be useful when antibiotics were previously administered. Gram staining, which is inexpensive and commonly available, should be encouraged in all clinical settings.

Burden of group A streptococcal meningitis in Salvador, Brazil: report of 11 years of population-based surveillance.

BACKGROUND: Over recent decades, a resurgence of invasive group A streptococcal (GAS) infections has been observed; GAS remains a rare cause of pyogenic meningitis. We report herein population-based findings of long-term surveillance for GAS meningitis in Salvador, Brazil, and estimate the overall burden of invasive GAS infections. METHODS: From February 1996 to February 2007 we conducted active surveillance for GAS meningitis in the state reference hospital for infectious diseases in Salvador, Brazil. Data on clinical presentation, laboratory records, and outcome were collected through interviews and chart review. GAS isolates were evaluated for antimicrobial susceptibility and emm type. RESULTS: We identified 20 cases of GAS meningitis, which accounted for 0.9% of all culture-proven bacterial meningitis in the study period. The mean annual incidence of GAS meningitis was 0.03 cases per 100,000 population in metropolitan Salvador and peaked in children <1 year of age (0.67 cases per 100,000 population). Among 17 cases with clinical information available, 41% required intensive care unit support and 25% died. Tested isolates were susceptible to penicillin and exhibited large emm type diversity. Based on the incidence of GAS meningitis, we estimate that the annual incidence of GAS infection is 3 cases per 100,000 population in metropolitan Salvador. CONCLUSIONS: Although rare, GAS is a life-threatening cause of bacterial meningitis. Knowledge of the incidence and emm type variability of the disease is necessary for planning immunization strategies.