Faringoamigdalitis y estreptococo, ¿enemigo o colonizador? / Tonsillopharyngitis and streptococcus, enemy or colonizer?

Introducción: la principal etiología de la faringoamigdalitis aguda (FAA) es vírica, y entre la bacteriana, Streptococcus pyogenes constituye un colonizador no despreciable de la población pediátrica sana. El objetivo del estudio es conocer el modo de utilización del test de diagnóstico rápido estreptocócico (TDR) en los servicios de urgencias pediátricas para poder optimizar su uso, reducir el sobrediagnóstico de las FAA estreptocócicas (FAAE) y la prescripción de antibióticos. Material y métodos: se recoge la información retrospectiva del número de TDR realizados a los pacientes atendidos en el servicio de urgencias pediátricas de un hospital terciario, desde enero de 2022 a enero de 2023 (ambos inclusive). También se ha recogido información acerca de a cuántos se les había practicado más de un TDR y el tiempo transcurrido. Resultados: durante los 13 meses estudiados se realizaron un total de 1610 TDR (43% en <5 años). Se realizó más de un TDR a 89 pacientes (53% en <5 años) y el 40% de estos se llevaron a cabo en los primeros 40 días. Discusión: las pruebas microbiológicas para detectar Streptococcus pyogenes no son capaces de diferenciar entre infección activa y estado de portador sano. Según los resultados de nuestro estudio parece existir un uso inadecuado de los TDR; la mayoría de las pruebas se realizan en <5 años, donde la etiología estreptocócica es menos frecuente y el estado de portador sano predominante. Esto conlleva un sobrediagnóstico de la FAAE, sobretratamiento antibiótico, aparición de efectos adversos y resistencias bacterianas. (AU)

Introduction: the most frequent aetiology of acute pharyngitis (AP) is viral, and among the bacterial causes, Streptococcus pyogenes is a colonizer that cannot be overlooked in the healthy paediatric population. The aim of the study was to determine how the rapid streptococcal diagnostic test (RST) is used in paediatric emergency departments in order to optimize its use and reduce the overdiagnosis of acute streptococcal pharyngitis (SP) and antibiotic prescribing. Material and methods: we collected retrospective data on the number of RSTs performed on patients managed in the paediatric emergency department of a tertiary care hospital between January 2022 and January 2023 (both included). We also collected data on the number of patients who underwent more than one RST and the time elapsed between tests. Results: during the 13-month study period, a total of 1610 RSTs were performed (43% in children < 5 years). More than one RST was performed in 89 patients (53% in children < 5 years), and 40% of additional tests were performed within 40 days of the previous one. Discussion: microbiological tests for S. pyogenes cannot differentiate between active infection and healthy carriage. Based on the findings of our study, there seems to be an inadequate use of RDTs; most tests are performed in children aged less than 5 years, in whom a streptococcal aetiology is less frequent and healthy carrier status predominates. This leads to overdiagnosis of acute SP, antibiotic overuse, adverse events and bacterial resistance. (AU)

Pre-operative Colonization by Staphylococcus aureus and Cephalosporin Non-susceptible Bacteria in Patients with Proximal Femoral Fractures / Colonização pré-operatória por Staphylococcus aureus e as bactérias não suscetíveis à cefalosporina, em pacientes com fratura proximal do fêmur

Abstract Objective To estimate the frequency of Staphylococcus aureus and cephalosporin nonsusceptible bacteria colonization in patients with proximal femoral fracture during preoperative hospitalization. Methods Prevalence and incidence assessment in 63 hospitalized patients over 1 year. The median time of pretreatment hospitalization was 12 days. Samples were collected from the nostrils, groin skin and anal mucosa during the pretreatment hospitalization and were tested by the disc-diffusion technique. Results The hospital colonization incidence and the prevalence of positive results were 14.3 and 44.4% for S. aureus; 3.2 and 6.4% for meticillin-resistant S. aureus; 28.6 and 85.7% for meticillin-resistant coagulase-negative Staphylococcus; 28.6 and 61.9% for cefazolin nonsusceptible Enterobacteriaceae (KFNSE); and 20.6 and 28.6% for cefuroxime nonsusceptible Enterobacteriaceae (CXNSE). In addition, factors such as to the duration of the pretreatment hospitalization period, being non-walker before fracture, antimicrobial use, American Society of Anesthesiologists (ASA) 4 surgical risk, and previous hospitalization, were related to an increase in the incidence of hospital acquisition and prevalence of colonization by the evaluated strains. The prevalence of colonization by KFNSE was three times higher than by CXNSE on admission, and twice as high at the time of fracture treatment. Conclusion There was a high incidence of hospital colonization and prevalence of colonization by all strains studied, which may guide the indication of prophylactic measures for infection.

Resumo Objetivo Estimar a frequência da colonização por Staphylococcus aureus e as bactérias não suscetíveis à cefalosporina, em pacientes com fratura proximal do fêmur durante a internação pré-operatória. Métodos Avaliação da prevalência e incidência em 63 pacientes hospitalizados ao longo de um ano. O tempo médio de internação pré-tratamento foi de 12 dias. As amostras foram coletadas das narinas, pele da virilha e mucosa anal, durante a internação prévia ao tratamento e testadas pela técnica de disco-difusão. Resultados A incidência da colonização hospitalar e a prevalência de resultados positivos foram de 14,3% e 44,4% para Staphylococcus aureus; 3,2% e 6,4% para S. aureus resistente à meticilina; 28,6% e 85,7% para Staphylococcus coagulase-negativo resistente à meticilina; 28,6% e 61,9% para Enterobacteriaceae não suscetível à cefazolina (KFNSE); e 20,6% e 28,6% para Enterobacteriaceae não suscetível à cefuroxima (CXNSE). Além da duração do período de internação pré-tratamento, os pacientes não deambularam previamente à ocorrência da fratura e nem fizeram uso de antimicrobiano. Além disso, a duração do período de internação pré-tratamento cirúrgico, ser não-deambulador antes da fratura, uso de antimicrobianos, risco cirúrgico IV pela American Society of Anesthesiologists (ASA) e internação anterior, estiveram relacionados a um aumento na incidência de aquisição hospitalar e prevalência de colonização pelas cepas avaliadas. A prevalência de colonização pela KFNSE foi três vezes maior do que pela CXNSE na admissão e duas vezes maior no momento do tratamento da fratura. Conclusão Observou-se uma alta incidência da colonização hospitalar e prevalência da colonização por todas as cepas estudadas, o que pode orientar a indicação de medidas profiláticas contra a infecção.

Factores asociados a la colonización rectal por Enterobacteriaceae productoras de betalactamasas de espectro extendido en pacientes de consulta externa de un hospital al norte del Perú / Factors associated with rectal colonization by extended-spectrum beta-lactamase-producing Enterobacteriaceae in outpatients in a hospital in northern Peru

Introducción: Las Enterobacteriaceae productoras de betalactamasas de espectro extendido están presentes en las heces de los individuos de la comunidad. En Perú, la automedicación, el tipo de alimentación, condiciones sanitarias podrían asociarse a esta colonización. Objetivo: determinar la frecuencia de colonización rectal por EP-BLEE en pacientes de consulta externa del Hospital Regional Lambayeque, así como los factores asociados a la misma, durante los meses de julio 2018 a febrero 2019. Material y métodos: 331 pacientes participantes fueron entrevistados, de los cuales se obtuvieron tres muestras seriadas de heces recién emitidas. Las muestras fueron cultivadas en agar McConkey. Las EP-BLEE se confirmaron con la prueba de disco combinado (método americano). Resultados: el 85,8 % de los pacientes estuvieron colonizados por EP-BLEE, siendo Escherichia coli el aislamiento más frecuente (87,7 %). El análisis bivariado asoció el consumo de carne de cerdo (RP=1,15 IC 95%: 1,07 - 1,24), caprino (RP=1,18, IC 95%: 1,10 - 1,25) y el consumo de ensaladas frecuentemente (RP=1,15, IC 95 %: 1,05 - 1,28) con una mayor probabilidad de ser portador rectal de EP-BLEE. La automedicación presentó valores cercanos al límite de validez (p=0,051, RP 1,12, IC 95% 0,98 - 1,26). Conclusiones: Consumir carne de cerdo, caprino y ensaladas aumentan la probabilidad de ser portador de EP-BLEE, mientras que la automedicación podría estar asociada, por lo que es necesario seguir investigando, ya que se desconocen las razones de este hallazgo en pacientes de la comunidad.

Background:Extended-spectrumbeta-lactamase-producing Enterobacteriaceae(EP-BLEE) are present in the feces of individuals in the community. In Peru, self-medication, type of diet and sanitary conditions could be associated with this colonization. Objective:to determine the frequency of rectal colonization by EP-BLEE in outpatients of the "Hospital Regional Lambayeque", as well as the factors associated with it, during the months of July 2018 to February 2019. 331 participating patients Material and methods:were interviewed, and three serial samples of freshly emitted stool were obtained from them. The samples were cultured on McConkey agar. EP-BLEE were confirmed with the combined disc test (American method). 85.8% of patients were colonized by EP-BLEE, and Escherichia coliwas the most frequent isolate (87.7%). Bivariate Results:analysis associated the consumption of pork (RP=1.15, 95% CI: 1.07 - 1.24), goat (RP=1.18, 95% CI: 1.10 - 1.25) and frequent consumption of salads (RP=1.15, 95% CI: 1.05 - 1.28) with a higher probability of being a rectal carrier of EP-BLEE. Self-medication presented values close to the limit of validity (p=0.051, RP1.12, 95% CI 0.98 - 1.26). Consuming pork, goat meat and salads increase the probability Conclusions:of being a carrier of EP-BLEE, while self-medication could be associated, so further research is needed, since the reasons for this finding are unknown.

Resistencia a antibióticos del Staphylococcus aureus en estudiantes de una facultad de odontología / Antibiotic resistance of Staphylococcus aureus in students of a dental school

Introducción: el Staphylococcus aureus es un coco gram positivo que causa diferentes tipos de infecciones; circula no solo en la comunidad sino también en centros hospitalarios. El profesional de odontología está en contacto continuo y por largos periodos durante la atención clínica, lo que incrementa el riesgo de infección. Objetivo: evaluar la resistencia a algunos antibióticos del Staphylococcus aureus en estudiantes de una facultad de odontología. Material y métodos: estudio de corte transversal en estudiantes de 9° y 10° semestre de clínica odontológica de la ciudad de Medellín, Colombia (n=62) que cumplieran con los criterios de inclusión: estar realizando práctica clínica y no estar en tratamiento con antibiótico en los últimos tres meses, y como criterios de exclusión: no haber presentado fiebre, tos, dificultad para respirar, erupciones cutáneas, ni haber estado sometido a procedimientos quirúrgicos y hospitalizaciones en los últimos seis meses. Se recolectaron datos sociodemográficos y la presencia de S. aureus mediante la toma de muestras de fosas nasales. La identidad de la bacteria se verificó mediante la coloración de gram, pruebas de catalasa, coagulasa y crecimiento en manitol sal. A los aislamientos positivos se les realizó tamizaje con los siguientes antibióticos: cefoxitin, oxacilina, vancomicina, eritromicina y ciprofloxacina. Resultados: del total de muestras analizadas el 67,7 por ciento resultaron positivas para S. aureus y de estas el 28,5 por ciento resultaron resistentes a cefoxitina, 35,7 por ciento a oxacilina y el 7,14 por ciento a ciprofloxacina. Conclusiones: la presencia del S. aureus superó el 60 por ciento en la población de estudio y mostró mayor resistencia y su presencia estaba relacionada con haber tenido sintomatología respiratoria. En el presente estudio S. aureus resultó ser más resistente a la cefoxitina y a la oxacilina que a la ciprofloxacina(AU)

Introduction: Staphylococcus aureus is a gram-positive coccus that causes different types of infections. It spreads not only in the community but also in hospital centers. Dental professionals are in continuous contact with this bacterium for long periods of time during clinical care, which increases the risk of infection. Objective: To evaluate antibiotic resistance of Staphylococcus aureus in students of a dental school. Materials and methods: A cross-sectional study was conducted in ninth and tenth semester students of a dental clinic in Medellin, Colombia (n = 62) that met the inclusion criteria: carrying out clinical practice and not receiving antibiotic treatment during the last three months; they also met the following exclusion criteria: not having fever, cough, shortness of breath or skin rashes as well as not having undergone surgical procedures or been hospitalized during the last six months. Sociodemographic data were collected. The presence of S. aureus was detected by taking samples from the nostrils. The identity of bacteria was verified by gram staining, catalase and coagulase tests and growth on mannitol salt. Positive samples were screened using the following antibiotics: cefoxitin, oxacillin, vancomycin, erythromycin, and ciprofloxacin. Results: Of the total of samples analyzed, 67.7 percent were positive for S. aureus and of these, 28.5 percent were resistant to cefoxitin, 35.7 percent to oxacillin and 7.14 percent to ciprofloxacin. Conclusions: Staphylococcus aureus was present in 60 percent of the study population, showing great resistance and being associated with respiratory symptoms. In this study, S. aureus was found to be more resistant to cefoxitin and oxacillin than to ciprofloxacin(AU)

Manifestações bucais do vírus linfotrópico de células T humanas ­ HTLV / Oral manifestations of human T-lymphotropic virus ­ HTLV

O vírus linfotrópico de células T humano (HTLV) possui quatro tipos conhecidos. Os tipos 1 e 2 do HTLV caracteristicamente possuem baixa virulência e sabe-se que dentre os portadores do vírus a grande maioria permanecerá sem desenvolver doenças em decorrência. Em contrapartida o HTLV detém potencial elevado para contagiar pessoas sadias, que não conviviam com o vírus. O HTLV possui manifestações sistêmicas e bucais, merecendo ser investigado minuciosamente por intermédio de anamnese minuciosa e exame clínico. O objetivo do presente artigo foi verificar as principais manifestações bucais ocasionadas pelo HTLV. Realizou-se estudo de revisão bibliográfica, envolvendo estudos e artigos acerca das manifestações bucais oriundas do HTLV. Foram consultadas as bases de dados PubMED e Google Acadêmico. A única manifestação bucal oriunda do HTLV, restringe-se ao linfoma de células T do adulto. Indiretamente pacientes com paraparesia espástica tropical podem desenvolver a síndrome de Sjogren, advindo da infecção ocasionada pelo vírus do HTLV. O HTLV pode causar alterações neuropsicomotoras que interferem no manejo odontológico dos pacientes pelo cirurgião dentista. Os princípios da biossegurança devem ser respeitados rigorosamente pelo cirurgião dentista quando do atendimento aos pacientes portadores do HTLV, uma vez que o vírus pode contaminar o próprio profissional durante as condutas. As condutas odontológicas realizadas nos pacientes com HTLV podem auxiliar na melhora das condições e da qualidade de vida dos infectados sintomáticos, minimizando o desconforto ocasionado pela doença(AU)

Human T-cell lymphotropic virus (HTLV) has four known types. HTLV types 1 and 2 characteristically have low virulence and it is known that among the virus carriers the vast majority will remain without developing diseases as a result. In contrast HTLV has high potential to infect healthy people who did not live with the virus. The HTLV has systemic and oral manifestations, deserving to be investigated thoroughly by means of detailed anamnesis and clinical examination. The aim of the present article was to verify the main oral manifestations caused by HTLV. A literature review was carried out, involving studies and articles about oral manifestations from HTLV. The databases PubMED and Google Scholar were consulted. The only oral manifestation from HTLV is restricted to adult T-cell lymphoma. Indirectly patients with tropical spastic paraparesis may develop Sjogren's syndrome, coming from the infection caused by the HTLV virus. HTLV may cause neuropsychomotor changes that interfere with the dental management of patients by the dental surgeon. The principles of biosafety must be strictly adhered to by the dental surgeon when treating patients with HTLV, since the virus can contaminate the professional himself during the ducts. The dental conducts performed in patients with HTLV can help improve the conditions and quality of life of the symptomatic infected, minimizing the discomfort caused by the disease(AU)

O viajante como agente ativo na transmissibilidade do SARS-CoV-2: uma revisão sistemática / The traveler as an active agent of SARS-CoV-2 transmission: a systematic review

O objetivo deste trabalho foi evidenciar o papel dos viajantes na transmissão e na disseminação do novo coronavírus. A busca pelos artigos foi realizada nas bases de dados PubMed®, SciELO, MEDLINE®, Cochrane, Center for Disease Control and Prevention e UpToDate. Foram incluídos artigos relacionados à transmissibilidade, principalmente aqueles associados à disseminação realizada por viajantes, do novo coronavírus. Excluíram-se artigos relacionados a outros surtos de coronavírus. Todos os estudos foram lidos e analisados integralmente. Onze artigos foram selecionados e tabulados, dos quais se pôde desenvolver uma fundamentação teórica, que expõe o grande impacto dos viajantes perante o crescimento da pandemia relacionada ao SARS-CoV-2, levando em consideração as diversas formas com que esse vírus pode se propagar, sendo elas por contato com superfícies contaminadas ou pessoa a pessoa, visto que a infecção pode ser decorrente de gotículas, aerossóis, fômites e, possivelmente, contato sexual, estando os indivíduos sintomáticos ou não.

The objective of this study was to highlight the travelers role in the transmission and dissemination of new coronavirus. The search for the articles was carried out in PubMed®, SciELO, MEDLINE®, Cochrane, Centers for Disease Control and Prevention, and UpToDate databases. Articles related with transmissibility of the new coronavirus were included, mainly those linked with the dissemination from travelers. Articles related with other coronavirus outbreaks were excluded. All of the studies were read and analyzed in their entirety. Eleven articles were selected and tabulated, from which a theoretical framework was developed, which exposes the great impact of travelers in the face of the growth of the pandemic related to the SARS-CoV-2, considering the several ways in which this virus can spread, either through contact with contaminated surfaces or person-to-person, since the infection may occur through droplets, aerosols, fomites, and possibly sexual contact, whether individuals are symptomatic or not.

Genetic counseling to a DMD asymptomatic carrier: First case report in the Peruvian public healthcare system / Asesoramiento genético a una portadora asintomática de DMD: Primer caso reportado en el Sistema de Salud Pública del Perú

SUMMARY Duchenne muscular dystrophy (DMD) is a rapidly progressive dystrophinopathy with X-linked inheritance. This report describes a woman with a family history of male relatives affected by DMD, as she sought out genetic counseling about her concerns related to family planning and risks of eventually having children with the disease. We proposed her to get involved in a pilot program for carrier-status diagnosis and genetic counseling. This case illustrates the importance of a genetic counseling program for diagnosis of asymptomatic carriers in neurogenetic diseases, particularly in regions with low-resource settings. We discussed successes and misunderstandings faced throughout the process, supporting policies for present and future challenges from this and similar kinds of diagnoses.

RESUMEN La distrofia muscular de Duchenne (DMD) es una distrofinopatía rápidamente progresiva con herencia ligada al cromosoma X. Este reporte describe el caso de una mujer con historia familiar de hermano y sobrinos con DMD, que acudió a consulta para orientación e información sobre riesgos inherentes a una eventual planificación familiar. Le propusimos participar en un programa piloto de asesoramiento genético para determinar su estado de portador o no de la variante causal de DMD en la familia. Esta primera experiencia ilustra la importancia de tener un programa de asesoramiento genético para el diagnóstico de portadores asintomáticos de enfermedades neurogenéticas en regiones con bajos recursos. Se incluyen reflexiones y comentarios sobre aspectos positivos y retos presentados durante el proceso, las políticas de apoyo presente y futuro para el afronte de los complejos problemas planteados por éste y similares diagnósticos.

Colonización nasal por Staphylococcus aureus resistente a la meticilina en pacientes sometidos a cirugía cardiovascular en un hospital universitario de Bogotá, Colombia / Methicillin-resistant Staphylococcus aureus nasal colonization in cardiovascular surgery patients at a university hospital in Bogotá, Colombia

Introducción. Staphylococcus aureus resistente a la meticilina (SARM) es un microorganismo que coloniza las fosas nasales y diferentes partes del cuerpo, lo cual se considera un factor de riesgo para adquirir infecciones invasivas, especialmente en pacientes sometidos a cirugía cardiovascular. Objetivo. Determinar la colonización nasal por SARM y establecer las características clínicas en pacientes programados para cirugía cardiovascular. Materiales y métodos. Se hizo un estudio descriptivo entre febrero y diciembre de 2015. Se incluyeron pacientes adultos programados para cirugía cardiovascular en el Hospital Universitario San Ignacio de Bogotá. La colonización se identificó mediante reacción en cadena de la polimerasa (Polymerase Chain Reaction, PCR) en tiempo real en muestras obtenidas mediante hisopados nasales. Los pacientes fueron descolonizados con mupirocina al 2,0 % intranasal dos veces al día y baños con gluconato de clorhexidina al 4 % del cuello hacía abajo durante cinco días, al cabo de lo cual se hizo una PCR de control. Resultados.Se incluyeron 141 pacientes, 52 hospitalizados y 89 ambulatorios. Del total, 19 (13,4 %) tenían colonización nasal por SARM, correspondientes a 9 (17,3 %) de los 52 hospitalizados y 10 (11,2 %) de los 89 ambulatorios. Todos los pacientes sometidos a descolonización tuvieron resultado negativo en la PCR al final del proceso y ninguno presentó infección del sitio operatorio por S. aureus. Conclusiones.Se demostró colonización nasal por SARM tanto en los pacientes hospitalizados como en los ambulatorios. La descolonización con mupirocina fue efectiva para erradicar el estado de portador a corto plazo, lo que podría tener efecto en las tasas de infección del sitio operatorio en las cirugías cardiovasculares.

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a microorganism that colonizes nostrils and different parts of the body, which is considered a risk factor to acquire invasive infections, especially in cardiovascular surgery patients. Objective: To determine the frequency of nasal colonization by MRSA and to establish the clinical characteristics in patients scheduled for cardiovascular surgery. Materials and methods: This was a descriptive study conducted between February and December, 2015. We included adult patients scheduled for cardiovascular surgery at the Hospital Universitario San Ignacio in Bogotá, Colombia. Colonization was identified by real-time PCR from nasal swabs. Colonized patients were treated with mupirocin 2.0% intranasally twice a day and bathed with chlorhexidine 4% from the neck downwards for five days. At the end of this treatment, PCR control was carried out. Results: We included 141 patients with a percentage of nasal colonization of 13.4% (19/141). There were 52 hospitalized patients and 89 outpatients with a percentage of nasal colonization of 17.3% (9/52), and 11.2% (10/89), respectively. All colonized patients who received treatment had a negative PCR at the end of the regime and none of the participating patients had a surgical site infection by S. aureus at the end of the study. Conclusions: Nasal colonization was observed both in hospitalized patients and outpatients. Decolonization treatment with mupirocin was effective to eradicate the carrier state in the short term, which could impact the rates of surgical wound infection associated with cardiovascular surgery.

The direct and indirect effects of the pneumococcal conjugated vaccine on carriage rates in children aged younger than 5 years in Latin America and the Caribbean: a systematic review / Efeitos diretos e indiretos da vacina pneumocócica conjugada no estado de portador em crianças menores de 5 anos, na América Latina e no Caribe: uma revisão sistemática

ABSTRACT Objective To demonstrate the impact of pneumococcal conjugate vaccine in Streptococcus pneumoniae carriage status in children younger than 5 years in Latin America and the Caribbean. Methods A systematic literature review was carried out on the direct and indirect effects of pneumococcal vaccine in the carriage status, after implementation in childhood immunization programs. Studies carried out in children younger than 5 years were selected from the PubMed® and Virtual Health Library databases, and data collected after implementation of pneumococcal vaccine in Latin America and the Caribbean, between 2008 and 2018. Results From 1,396 articles identified, 738 were selected based on titles and abstracts. After duplicate removal, 31 studies were eligible for full-text reading, resulting in 6 publications for analysis. All selected publications were observational studies and indicated a decrease in the carriage and vaccine types, and an increase in the circulation of non-vaccine serotypes, such as 6A, 19A, 35B, 21 and 38. We did not identify changes in the antimicrobial resistance after vaccine implementation. Conclusion A decrease in the carriage status of vaccine types and non-vaccine types was detected. The continuous monitoring of pneumococcal vaccine effect is fundamental to demonstrate the impact of the carriage status and, consequently, of invasive pneumococcal disease, allowing better targeting approaches in countries that included pneumococcal vaccine in their immunization programs. Our study protocol was registered in PROSPERO (www.crd.york.ac.uk/prospero) under number CRD42018096719.

RESUMO Objetivo Demonstrar o impacto das vacinas pneumocócicas conjugadas no estado de portador de Streptococcus pneumoniae em crianças menores de 5 anos na América Latina e no Caribe. Métodos Foi realizada revisão sistemática da literatura sobre os efeitos diretos e indiretos da vacina pneumocócica no estado de portador em crianças menores de 5 anos, após a implantação da vacina nos calendários de imunização infantil. A partir de dados da PubMed®e da Biblioteca Virtual da Saúde, foram selecionados estudos de portador em crianças menores de 5 anos, com dados coletados após implementação da vacina de 2008 a 2018, na América Latina e no Caribe. Resultados Dos 1.396 artigos identificados, 738 foram selecionados mediante leitura de títulos e resumos. Após a extração dos duplicados, 31 foram elegíveis para leitura do texto completo, restando 6 artigos para análise. Todos os estudos selecionados eram observacionais e indicavam diminuição do portador e tipos vacinais, e aumento da circulação de sorotipos não vacinais, como 6A, 19A, 35B, 21 e 38. Não foi observada alteração na resistência antimicrobiana após a introdução da vacina. Conclusão Detectou-se redução no estado de portador, dos tipos vacinais e não vacinais. O monitoramento contínuo do efeito das vacinas pneumocócicas é fundamental, para demonstrar o impacto do estado de portador e, consequentemente, da doença pneumocócica invasiva, permitindo o melhor direcionamento nas ações em saúde para os países que incluíram a vacina no calendário de imunização. Nosso protocolo de estudo foi registrado no PROSPERO (www.crd.york.ac.uk/prospero) sob o número CRD42018096719.

Staphylococcus aureus resistentes a meticilina (SARM) y productores de enterotoxina A aislados de portadores nasales asintomáticos entre estudiantes universitarios de México / Methicillin resistant Staphylococcus aureus (MRSA) and enterotoxin A producer isolated from asymptomatic nasal carriage among undergraduate students of Mexico

El objetivo de este estudio fue determinar la frecuencia de S. aureus, incluyendo resistentes a meticilina y la producción de enterotoxina A en fosas nasales de estudiantes universitarios en México. Este fue un estudio transversal realizado en 471 estudiantes universitarios de una ciudad del suroeste de México. Las muestras nasales y los datos sociodemográficos fueron obtenidos de los pacientes. Las cepas fueron identificadas como S. aureus basándose en la morfología, tinción de Gram, prueba de catalasa, prueba de coagulasa y fermentación en agar manitol salado. Las cepas se biotipificaron, se determinó la resistencia a meticilina por difusión en agar y la producción de enterotoxina A por Dot- Blot. La frecuencia de portadores nasales de S. aureus fue 10,40 %; 73,46 % resistentes a meticilina; 36,73 % producen enterotoxina A. En un análisis bivariado, se encontraron diferencias estadísticamente significativas en pacientes que viven cerca de aguas residuales y granjas con el estado de portador de S. aureus, (p=0,01, OR 2,59 [1,06-5,81]; p=0,01, OR 3,18, [1,07- 8,33]). Los portadores nasales muestran una diversidad de cepas de S. aureus, mayormente resistentes a meticilina, pero no todas producen enterotoxina A.

The aim at this study was determine the frequency of S. aureus, including methicillin-resistant and enterotoxin A production in nostrils of university students in Mexico. This was a cross-sectional study conducted in 471 university students from a city in southwestern Mexico. Nasal samples and sociodemographic data were obtained from the patients. Strains were identified as S. aureus based on morphology, Gram stain, catalase test, coagulase test and fermentation on salted mannitol agar. Isolated strains were subjected to biotyping, their methicillin resistance was analyzed using the agar diffusion method and examined their enterotoxin A (SEA) production by a Dot-blot analysis. The nasal carriage rate of S. aureus was 10.40%; 73.46% of the isolates were resistant to methicillin; 36.73% of the strains produced enterotoxin A. In the bivariate analysis, a statistically significant difference was found in patients who lived near sewage and farms with S. aureus carriage (p=0.012, odds ratio 2.59, [ 1.06-5.81]; p=0.009, odds ratio 3.18, [1.07- 8.33]) and the first group also associated with methicillin resistant S. aureus carriage (p=0.020, odds ratio 3.38, [1.30-8.06]). Nasal carriers show a wide variety of strains of S. aureus, mostly MRSA strains, but not all produce enterotoxin A.

Cobertura de inmunización contra el virus de la hepatitis B en hijos nacidos de madres portadoras de la infección: Huanta, Ayacucho, 2014-2018 / Immunization coverage against the hepatitis B virus in children from chronic carrier mothers: Huanta, Ayacucho, 2014-2018

Introducción. En el marco del plan de eliminación de la infección por virus de la hepatitis B (HBV) es necesario conocer la cobertura de inmunización en los hijos de madres portadoras. Objetivo. Determinar el nivel de cobertura de inmunización en los hijos nacidos de madres portadoras de la infección por HBV en el Hospital de Huanta, Ayacucho, entre los años 2014 a 2018. Métodos. Se realizó un estudio observacional descriptivo. La población incluyó a los hijos nacidos de madres portadoras de la infección por HBV. Se utilizaron fuentes de información secundaria de registro de inmunización contra HBV. Resultados. Se registraron 90 madres portadoras de la infección por HBV cuyos hijos nacieron en el lugar de estudio. La cobertura total de inmunización contra HBV fue 64,47%, la cobertura de la dosis de nacimiento de la vacuna fue 100% y la cobertura de aplicación de la inmunoglobulina antihepaitis B de 77,78%. Conclusiones. La cobertura total de inmunización contra HBV se encuentra por debajo de lo esperado según las recomendaciones de la OMS.

Introduction. In the framework of the plan for the elimination of infection with hepatitis B virus (HBV), it`s necessary to know the immunization coverage in the children of carrier mothers. Objective. To determine the level of immunization coverage in children born to mothers with HBV infection at the Hospital de Huanta, Ayacucho, between 2014 and 2018. Methods. A descriptive observational study was carried out. The population included children born to mothers with HBV infection. Secondary information sources of immunization record against HBV were used. Results There were 90 mothers carrying the HBV infection whose children were born at the study site. The total immunization coverage against HBV was 64,47%, the coverage of the birth dose of the vaccine was 100% and the coverage of application of immunoglobulin antihepaitis B of 77,78%. Conclusions. The total immunization coverage against HBV is below what was expected according to WHO recommendations.

Streptococcus pneumoniae: prevalence in nasopharyngeal carriers of more than 50-years-old, in a Mexican rural community.

INTRODUCTION: Streptococcus pneumoniae (Sp) is the main cause of community-acquired pneumonia in the elderly, hence the importance to establish the prevalence of nasopharyngeal colonization by different Sp serotypes in adults. METHODS: from December 2009 to June 2010, nasopharyngeal cultures were taken from adults living in rural communities in Mexico for the isolation and serotyping of Sp by the Quellung reaction. Penicillin and ceftriaxone susceptibility tests were performed by the microdilution method. RESULTS: two hundred and thirty-six adults over 50 years old, were included. The prevalence of colonization by Sp was 21.6%. The most frequent serotypes were 19A (21%), 6A (13%), 6B and 11A (11%). All isolates were susceptible to ceftriaxone, and 52.8% of the isolates showed penicillin minimal inhibitory concentrations ≥0.12mg/L. CONCLUSION: this is the first study analyzing the nasopharyngeal colonization by Sp in adults in Mexico. Serotypes not included in any of the pneumococcal vaccines were frequently identified.

Perioperative management of a female diagnosed with heterozygous X-linked adrenoleukodystrophy scheduled for shoulder arthroscopy. / Manejo perioperatorio de una mujer portadora del gen de la adrenoleucodistrofia ligada al X para artroscopia de hombro.

X-linked adrenoleukodystrophy (X-ALD) belongs to a family of rare diseases due to inborn errors of metabolism. It has a wide spectrum of clinical manifestations that anaesthesiologists should recognise during the perioperative period (respiratory centre dysfunction, hypotonia, adrenal or hepatic failure, gastroesophageal reflux disease, osteopenia, seizures).The case is presented of a 42-year-old X-linked adrenoleukodystrophy female carrier, who underwent combined general and an ultrasound-guided interscalene brachial plexus block anaesthesia for shoulder arthroscopy. Induction was performed with thiopentone and fentanyl, and sevoflurane was used as inhaled maintenance agent. No events were recorded during the procedure. Her post-operative recovery was satisfactory and she was later discharged home.

"Cell ELISA" como ferramenta auxiliar no controle da adenite equina / "Cell ELISA" as an auxiliary tool for the control of equine adenitis

Este trabalho relata o desenvolvimento e a avaliação de um ensaio imunoenzimático (ELISA) como ferramenta auxiliar no controle da adenite equina. Foi avaliada a presença de anticorpos anti-Streptococcus equi subsp. equi em equinos com doença clínica de garrotilho, portadores assintomáticos e potros vacinados. Equinos doentes demonstraram absorbâncias médias superiores (P<0,05) às médias observadas nas demais categorias examinadas. Equinos portadores assintomáticos apresentaram valores médios de absorbância superiores (P<0,05) aos animais com cultura negativa. Logo após a vacinação, potros apresentaram elevação nos níveis de anticorpos, seguida de um decréscimo nos níveis 90 dias após a segunda vacinação. O "Cell ELISA" foi eficiente para a detecção de anticorpos em equinos expostos a antígenos de S. equi, diferenciando-se de infecções por S. zooepidemicus. O "Cell ELISA" mostrou-se uma alternativa clínica para o diagnóstico indireto da adenite equina, diferenciando-se, entre equinos assintomáticos, os potenciais portadores da infecção. Os resultados observados em potros vacinados confirmam o potencial de utilização desse teste como ferramenta em programas de vacinação contra garrotilho pelo monitoramento de rebanhos pós-vacinação. Esses resultados sugerem que o "Cell ELISA" é uma promissora ferramenta auxiliar no controle da adenite equina.(AU)

This study reports the development and evaluation of the use of "Cell ELISA" as a tool for clinical interpretation for the control of strangles. The presence of anti-S. equi antibodies was evaluated in horses with strangles, in asymptomatic carriers and in vaccinated foals. Equine positive for strangle showed higher average of absorbance (P<0.05) when compared with the average for the other categories of horses studied. Asymptomatic S. equi equine carriers had higher average of absorbance (P<0.05) than equines with negative culture. After vaccination, foals presented an increase in antibody levels, followed by a decrease in antibody levels 90 days post the second vaccination. The "Cell ELISA" was efficient for the detection of antibodies in horses exposed to S. equi antigens, differentiating infections with S. zooepidemicus. Thus, the test might be a clinical tool for indirect diagnosis of the strangles, differentiating, between the asymptomatic horses, the potential carriers of infection. The results observed in vaccinated foals confirm the potential use of this test as an auxiliary instrument for strangles vaccination programs based in the serological monitoring of the herd after immunization. These results suggest that the "Cell ELISA" is a promising auxiliary tool in the control of equine adenitis.(AU)

[Antibiotic susceptibility of Staphylococcus aureus and Streptococcus pneumoniae in healthy carrier individuals in primary care in Barcelona area]. / Sensibilidad antibiótica de Staphylococcus aureus y Streptococcus pneumoniae en personas portadoras nasales sanas en atención primaria en el área de Barcelona.

INTRODUCTION: The information available on antibiotic resistance patterns are generally based on specimens from hospitalised individuals. This study was aimed at evaluating the antibiotic resistance rate of nasal carriage strains of Staphylococcus aureus and Streptococcus pneumoniae in healthy individuals, in accordance with age and gender, attended in Primary Care Centres (PCC). DESIGN: Cross-sectional study. SETTING: Seven PCC in the Barcelona area. PARTICIPANTS: Healthy nasal carriers aged 4years or more who did not present with any sign of infectious disease, and had not taken any antibiotic or had been hospitalised in the previous 3months. MAIN MEASUREMENTS: A total of 3,969 nasal swabs valid for identification were collected between 2010 and 2011 and were sent to one central microbiological laboratory for isolation of both pathogens. Resistance to common antibiotics was determined on the basis of the current European Committee on Antimicrobial Susceptibility Testing guidelines on cut-off points. RESULTS: The prevalence of methicillin-resistant S.aureus was 1.3% (95%CI: 0.5-2.1%), with resistance rates of 87.1% to phenoxymethylpenicillin and 11.6% to azithromycin, with no significant differences with age and gender. A total of 2.4% (95CI%: 0.1-4.7%) of the pneumococcal strains were highly resistant to both phenoxymethylpenicillin and macrolides, whereas the highest resistance rates were to cefaclor (53.3%), followed by tetracycline (20%) and cefuroxime (12.1%). CONCLUSIONS: These pathogens have lower resistance rates in the community than in the hospital setting. Primary Care physicians must be more aware of the current antimicrobial resistance, in order to ensure prudent use of antibiotics.

Tipificación SARM en trabajadores asistenciales de las unidades de cuidados intensivos en una institución hospitalari / MRSA Typing in health care workers from intensive care units of a Hospital Institution

Objetivo. Caracterizar microbiológicamente SARM en trabajadores asistenciales de las Unidades de Cuidados Intensivos en una institución hospitalaria de la ciudad de Montería. Materiales y métodos. Se realizó un estudio descriptivo longitudinal, en 52 trabajadores de dos unidades de cuidado intensivo; se tomaron hisopados nasales y faríngeos a cada individuo, con una periodicidad de 15 días/cinco meses. Mediante pruebas convencionales como fermentación de manitol, catalasa y coagulasa se realizó la identificación de S. aureus, con el disco de cefoxitín por Kirby- Bauer se evaluó la resistencia a Meticilina mediada por el gen mecA; antibióticos como Vancomicina, Eritromicina y Clindamicina fueron evaluados por esta prueba y confirmados por MicroScan ®. Resultados. se obtuvieron 88 aislamientos de S. aureus y 21 aislamientos SARM, una prevalencia de portación de SARM del 25%. El 90,5 % de las cepas de SARM fueron recuperadas de la faringe, en mayor proporción (50%) en el personal de enfermería. Conclusiones. La evidencia de su circulación de SARM en el personal asistencial dentro de una institución hospital, genera una alerta que le permite a la misma establecer políticas de contención para evitar la diseminación de estas cepas y evitar la aparición de brotes o infecciones hospitalarias asociadas a este patógeno.

Objective. To characterize microbiologically MRSA in health care workers of the Intensive Care Units at a hospital institution in the city of Montería. Materials and methods. A longitudinal descriptive study was carried out in 52 workers from two intensive care units; nasal and pharyngeal swabs were taken from each individual, with a periodicity of 15 days / five months. Examined through microbiological methods such as fermentation of mannitol, catalase and coagulase the identification of S. aureus was performed, with the cefoxitin disc by Kirby-Bauer disc-diffusion method the methicillin resistance mediated by the mecA gene was evaluated; antibiotics such as Vancomycin, Erythromycin and Clindamycin were evaluated by this test and confirmed by MicroScan ®. Results. we obtained 88 isolates of Staphylococcus aureus and 21 MRSA, a prevalence of MRSA of 25%. 90.5% of strains Of SARM were recovered from the pharynx, in a greater proportion (50%) in nursing staff. Conclusions. Evidence of MRSA circulation in care staff within a hospital institution generates an alert that allows it to establish containment policies to avoid the dissemination of these strains and to avoid the appearance of outbreaks or hospital infections associated with this pathogen.

Selected lactobacilli and bifidobacteria development in solid state fermentation using soybean paste.

At present, consumers are looking for more natural foods so as to improve health through their active compounds. Within this context, soybean is an excellent substrate due to its beneficial effects on consumers' health. Moreover, lactic cultures are widely used in the food industry to improve the technological, nutritional and functional characteristics of fermented foods. It is interesting to find new matrices in which to transport these starter cultures (potentially probiotic microorganisms). The aim of this research was to obtain a solid state fermentation system from soybean to analyze the behavior of selected lactobacilli and bifidobacteria, with the potential to develop a functional vegetarian food to serve as carrier for the microorganisms. A soybean solid substrate system was optimized by selecting the relationship of the main processing parameters. Homogeneous soybean pastes with different moisture content (60-80%) were obtained and used as substrate and support for solid substrate fermentation. Moisture, inoculum size and temperature were optimized: 80%, 4%, 37°C, respectively. L. rhamnosus CRL 981 was chosen as the best starter to use in this kind of fermentation, showing high acidification and cell counts at 24h of fermentation and increased specific growth rate in tested soybean pastes. It was demonstrated that the selected soybean paste could be used as a carrier of these microorganisms having probiotic potential for the production of vegetarian foods. Moreover, these microorganisms are able to modify the substrate to enhance their nutritional and functional characteristics, which would change the soybean into a more attractive product for consumers.

Selected lactobacilli and bifidobacteria development in solid state fermentation using soybean paste / Desarrollo de lactobacilos y bifidobacterias seleccionadas en fermentación en estado sólido utilizando pasta de soja

At present, consumers are looking for more natural foods so as to improve health through their active compounds. Within this context, soybean is an excellent substrate due to its beneficial effects on consumers' health. Moreover, lactic cultures are widely used in the food industry to improve the technological, nutritional and functional characteristics of fermented foods. It is interesting to find new matrices in which to transport these starter cultures (potentially probiotic microorganisms). The aim of this research was to obtain a solid state fermentation system from soybean to analyze the behavior of selected lactobacilli and bifidobacteria, with the potential to develop a functional vegetarian food to serve as carrier for the microorganisms. A soybean solid substrate system was optimized by selecting the relationship of the main processing parameters. Homogeneous soybean pastes with different moisture content (60-80%) were obtained and used as substrate and support for solid substrate fermentation. Moisture, inoculum size and temperature were optimized: 80%, 4%, 37 °C, respectively. L. rhamnosus CRL 981 was chosen as the best starter to use in this kind of fermentation, showing high acidification and cell counts at 24 h of fermentation and increased specific growth rate in tested soybean pastes. It was demonstrated that the selected soybean paste could be used as a carrier of these microorganisms having probiotic potential for the production of vegetarian foods. Moreover, these microorganisms are able to modify the substrate to enhance their nutritional and functional characteristics, which would change the soybean into a more attractive product for consumers.

Actualmente los consumidores están en la búsqueda de alimentos naturales, a fin de mejorar la salud a través de sus compuestos activos. En este contexto, la soja es un excelente sustrato debido a sus efectos beneficiosos sobre la salud del consumidor. En la industria alimentaria se emplean cultivos lácticos para mejorar las características tecnológicas, nutricionales y funcionales de los alimentos fermentados. Es interesante encontrar nuevas matrices para transportar estos cultivos iniciadores, que potencialmente son microorganismos probióticos. El objetivo de este estudio fue obtener un sistema de fermentación en estado sólido a partir de soja para analizar el comportamiento de lactobacilos y bifidobacterias seleccionadas, con potencial para desarrollar un alimento vegetariano funcional que sirva de portador de los microorganismos. El sistema de sustrato sólido de soja se optimizó mediante la selección de la relación de parámetros principales de procesamiento. Se obtuvieron pastas de soja homogéneas con diferente contenido humedad (60-80%) y se utilizaron como sustrato y soporte para la fermentación en sustrato sólido. Las variables humedad, tamaño del inóculo y temperatura fueron optimizadas en 80%, 4% y 37°C, respectivamente. Lactobacillus rhamnosus CRL 981 fue elegido como el mejor cultivo iniciador para utilizar en este tipo de fermentación; este mostró acidificación y recuentos celulares altos en 24 horas de fermentación, y mayor velocidad específica de crecimiento en las condiciones evaluadas. Se demostró que la pasta de soja seleccionada podría ser utilizada como portadora de estos microorganismos con potencial probiótico para la elaboración de alimentos vegetarianos. Además, estos microorganismos son capaces de modificar el sustrato y mejorar sus características nutritivas y funcionales, lo que convertiría a la soja en un producto más atractivo para los consumidores.

Atendimento do paciente com DRC na média e alta complexidade

Este recurso educacional integra o conjunto de objetos autoinstrucionais ofertados pela UNA-SUS/UFMA na área temática de Nefrologia. Trata-se de um e-book que apresenta a organização da rede SUS para o atendimento ao paciente com DRC e descreve os diferentes níveis de complexidade da assistência aos pacientes com DRC, de acordo com a Política Nacional de Atenção ao Portador de Doença Renal. Além deste, há mais 31 e-books tratando sobre diversas questões relacionadas à Nefrologia. Todos eles fornecem conteúdos interessantes para a formação dos profissionais da saúde que atuam no SUS e dos acadêmicos da área.

Microbiological methods for surveillance of carrier status of multiresistant bacteria. / Métodos microbiológicos para la vigilancia del estado de portador de bacterias multirresistentes.

The presence of colonised patients is one of the main routes for the spread of multiresistant bacteria, and its containment is a clinical and public health priority. Surveillance studies are essential for early detection of colonisation by these bacteria. This article discusses the different microbiological methods, both based on culturing and molecular methods, for detection of carriers of multiresistant bacteria. Those species with a high clinical/epidemiological impact or generating therapeutic difficulties are included: Methicillin-resistant Staphylococcus aureus, Enterococcus spp. resistant to glycopeptides, enterobacteriaceae producing extended spectrum ß-lactamases and plasmid-mediated AmpC, carbapenemases producing enterobacteriaceae, Acinetobacter baumannii and multiresistant Pseudomonas aeruginosa. The information in this document should be considered as a structure matrix to be tailored to the specific needs of each centre.