Jorge Luiz Nobre Rodrigues

Clinical-Epidemiological Features of 13 Cases of Melioidosis in Brazil

ABSTRACT The aim of this work was to catalog the clinical and ecoepidemiological characteristics of melioidosis in Brazil. The clinical-epidemiological features of melioidosis in Ceará are similar to those in other regions where the disease is endemic. These findings support the inclusion of this Brazilian state as part of the zone of endemicity for melioidosis.

Conhecimento dos profissionais de saúde na Unidade de Terapia Intensiva sobre prevenção de pneumonia associada à ventilação mecânica

A Pneumonia Associada a Ventilacao Mecânica (PAVM) e a mais importante e comum infeccao que acomete os pacientes criticos ventilados mecanicamente nas Unidades de Terapia Intensiva (UTI). Este estudo, de natureza quantitativa, objetivou avaliar o conhecimento dos profissionais de saude sobre a prevencao da PAVM em duas UTI de dois hospitais publicos de Fortaleza (CE), de junho a julho de 2006. Aplicou-se um questionario a 104 profissionais, utilizando a escala de conceitos de Likert, que serviu de parâmetro e referencia para avaliacao. Foram calculadas as medias e desvio padrao e analisou-se o conhecimento dos profissionais em relacao a PAVM. Verificaram-se as associacoes entre o conhecimento sobre a prevencao da PAVM e as demais variaveis, por meio dos testes de χ2, de Fisher-Freeman-Halton, sendo fixado o nivel de significância de 5%. Os resultados obtidos sugeriram que o conhecimento dos profissionais de saude das duas UTI a respeito da prevencao da PAVM se mostrou insuficiente. Concluimos que, de maneira geral, independentemente da categoria profissional, o conhecimento sobre a PAVM e fatores de risco a ela associada foi apenas regular e que a preparacao dos profissionais estava abaixo do esperado, sendo em algumas situacoes bastante preocupante.The Pneumonia Associated to Mechanical Ventilation (PAMV) is the more important and more common infection in critic mechanically ventilated patients in the Intensive Care Unit (ICUs). This quantitative research has aimed to assess the knowledge of the health professionals about the prevention of PAMV in two public hospitals of Fortaleza, Ceará State, from June to July, 2006. A questionnaire was applied to 104 professionals, by means of the concept scales of Likert which was used as a parameter and reference to the assessment. It was calculated the average and standard digression and analyzed the knowledge of professionals in relation to the PAMV. It was observed the association between the knowledge about prevention of PAMV and other variables through the chi2 tests from Fisher-Freeman-Halton, fixing the significance level in 5%. The results obtained had suggested that the knowledge of health professionals of the two ICUs about prevention of PAMV was insignificant. We conclude that, in general, despite the professional category, the knowledge about PAMV and risk factors associated to it was only regular lower than expected and, in some cases, the situation was considerably worrying.

Molecular epidemiology and antimicrobial susceptibility testing. Testing of quinolone-resistant Staphylococcus aureus strains isolated in Brazil.

An outbreak of 20 oxacillin-resistant Staphylococcus aureus (ORSA) bloodstream infections (BSIs) was detected in the intensive care unit (ICU) at Hospital Sao Paulo, Brazil. In a surveillance study, 10% of ICU personnel were defined as chronic nasal carriers of ORSA. Thirteen BSIs and five nasal isolates were available for phage typing, restriction endonuclease analysis of plasmid (REAP) and chromosomal DNA hybridized with 32P rRNA gene probe. Susceptibility testing against select antimicrobial agents, including 11 quinolones, six glycopeptides, and five topical agents, was performed by broth microdilution and the disk diffusion tests. Ten of the 13 BSI isolates and four of the five nasal strains were oxacillin and quinolone resistant. The new fluoroquinolones CI-960 and WIN57273, the glycopeptides, and the topical agents ramoplanin, bacitracin, mupirocin, and novobiocin were most active. Fourteen strains, 12 BSI isolates, and three nasal isolates showed the same REAP profile. Moreover, the same REAP and chromosomal profile was detected in at least nine BSI isolates and in two nasal isolates. These strains were nontypable by phage typing. We concluded that nosocomial cross-transmission of a single, multiresistant strain of S. aureus occurred and that the epidemic reservoir was nasal carriage by ICU personnel.

Structure for prevention of health care–associated infections in Brazilian hospitals: A countrywide study

BACKGROUND Minimal structure is required for effective prevention of health care-associated infection (HAI). The objective of this study was to evaluate the structure for prevention of HAI in a sample of Brazilian hospitals. METHODS This was a cross-sectional study from hospitals in 5 Brazilian regions (n = 153; total beds: 13,983) classified according to the number of beds; 11 university hospitals were used as reference for comparison. Trained nurses carried out the evaluation by using structured forms previously validated. The evaluation of conformity index (CI) included elements of structure of the Health Care-Associated Prevention and Control Committee (HAIPCC), hand hygiene, sterilization, and laboratory of microbiology. RESULTS The median CI for the HAIPCC varied from 0.55-0.94 among hospital categories. Hospitals with >200 beds had the worst ratio of beds to sinks (3.9; P < .001). Regarding alcoholic product for handrubbing, the worst ratio of beds to dispensers was found in hospitals with <50 beds (6.4) compared with reference hospitals (3.3; P < .001). The CI for sterilization services showed huge variation ranging from 0.0-1.00. Reference hospitals were more likely to have their own laboratory of microbiology than other hospitals. CONCLUSION This study highlights the need for public health strategies aiming to improve the structure for HAI prevention in Brazilian hospitals.

Bacillary angiomatosis in HIV-positive patient from Northeastern Brazil: a case report

It is a report of disseminated bacillary angiomatosis (BA) in a 23-year-old female patient, who is HIV-positive and with fever, weight loss, hepatomegaly, ascites, and papular-nodular skin lesions. The clinical and diagnostic aspects involved in the case were discussed. Bacillary angiomatosis must always be considered in the diagnosis of febrile cutaneous manifestations in AIDS.

Salmonella typhi Liver Abscess Overlying a Metastatic Melanoma

Pyogenic liver abscesses caused by Salmonella enterica serotype Typhi, although rare, can occur especially in patients with pre-existing hepatobiliary disease, hepatocellular carcinoma, and metastatic liver tumors. We present a case of Salmonella liver abscesses complicating metastatic melanoma in a 24-year-old alcoholic male.