Marcelo Carneiro

Latent tuberculosis in nursing professionals of a Brazilian hospital

Tuberculosis (TB) is considered an occupational disease among health-care workers (HCWs). Direct contact with TB patients leads to an increased risk to become latently infected by Mycobacterium tuberculosis. The objective of this study is to estimate the prevalence of latent M. tuberculosis minfection among nursing professionals of a hospital in Rio Grande do Sul, Brazil, assessed by tuberculin skin test (TST). From November 2009 to May 2010, latent M. tuberculosis infection was assessed by TST in 55 nursing professionals. Epidemiological information was collected using a standardized questionnaire. A positive TST result (> or = 10 mm) was observed in 47.3% of the HCWs tested. There was no significant difference in TST positivity when duration of employment or professional category (technician or nurse) was evaluated. The results of this work reinforce the need for control measures to prevent latent M. tuberculosis infection among nursing professionals at the hospital where the study was conducted.

Antibiotic resistance and detection of the sul2 gene in urinary isolates of Escherichia coli in patients from Brazil

INTRODUCTION The present study aimed to assess the antibiotic resistance profiles and detect the presence of the sul2 gene in sulfamethoxazole-susceptible and resistant isolates of Escherichia coli obtained from outpatients and inpatients with urinary tract infections. METHODOLOGY The resistance profiles of 739 strains were assessed and the presence of the sul2 gene in 100 isolates was tested. RESULTS The antibiotics with the highest resistance rates were ampicillin (57.4%) and trimethoprim-sulfamethoxazole (44.7%). The presence of the gene sul2 was detected in 66.7% of outpatient samples and 67.9% of inpatient samples. CONCLUSIONS Our results demonstrate that E. coli isolates exhibit high resistance to various classes of antibiotics, highlighting the need for developing strategies to help in prescribing antibiotics.

Oral Candida colonization in HIV-infected patients in Londrina-PR, Brazil: antifungal susceptibility and virulence factors

INTRODUCTION Host colonization by Candida species is an important predisposing factor to candidiasis, which seems to be more frequent in human immunodeficiency virus (HIV)-infected patients. Knowledge about the distribution, antifungal susceptibility, and virulence of oral Candida isolates is important for effective management of candidiasis. METHODOLOGY Oral rinses were collected from 242 HIV-infected patients without clinical evidence of candidiasis seen at the AIDS referral center in Londrina, Brazil. Species were identified by standard phenotypic and molecular methods, and characterized in vitro according to antifungal susceptibility, cell surface hydrophobicity, biofilm formation, and enzyme activities. RESULTS Oral Candida colonization was detected in 50.4% of patients and combined use of antiretroviral therapy and protease inhibitor had a protective effect against colonization. Candida albicans (75.2%) was the most prevalent species. A high proportion of Candida spp. (39.9%) showed decreased susceptibility to fluconazole. Five isolates were resistant to nystatin. Protease and phospholipase activities were detected in 100% and 36.8% of isolates, respectively. Most isolates displayed a hydrophobic property that was associated with biofilm formation ability. CONCLUSIONS A significant number of oral Candida species exhibiting decreased susceptibility to fluconazole were isolated from colonized HIV-infected individuals. Furthermore, all isolates expressed potential virulence attributes in vitro. Given the high incidence and severity of fungal infections in HIV-infected individuals, the results of this study reinforce the importance of antifungal susceptibility testing, which contributes to therapeutic strategies and highlights the need for continuous surveillance of Candida colonization in this population.

Prevalência de anti-HCV em uma população privada de liberdade

A alta prevalencia da sorologia reagente para o HCV observada entre os internos causa particular preocupacao, uma vez que e bem maior em relacao a populacao em geral. Portanto, e necessaria a realizacao de campanhas de abordagens especificas para mais informacoes sobre doencas infecciosas em ambientes prisionais, alem de um adequado tratamento para evitar a disseminacao viral.

Superdosagem da vacina 17DD contra febre amarela, em uma região do sul do Brasil

INTRODUCTION: Yellow fever is a preventable disease when using a safe, effective vaccine. METHODS: A prospective clinical follow-up of 49 people who received an overdose of the wrong vaccine against yellow fever during the 2009 outbreak in a rural area of the Vale do Rio Pardo, State of Rio Grande do Sul. RESULTS: During 45 days of clinical follow-up, only 1 (2.1%) case presented manifestations of a possible acute viscerotropism as an adverse postvaccination event. CONCLUSIONS: In the group of people monitored following an overdose of anti-yellow fever vaccine, observation confirmed almost total absence of adverse events.

New carbapenases in Brazil

Response to: Maya JJ, Ruiz SJ, Blanco VM et al. Current status of carbapenemases in Latin America. Expert Rev. Anti Infect Ther. 11(7), 657–667 (2013).

Multidrug-resistant Staphylococcus spp and its impact on patient outcome

In order to analyze the outcomes, clinical features, and resistance of Staphylococcus spp infections, a prospective cohort study was conducted at a 234-bed, tertiary care teaching hospital. Multidrug-resistant (MDR) infections were associated with increased mortality and length of hospital stay (LOS), whereas methicillin resistance (MRS) was correlated with prolonged LOS after infection. These data highlight the importance of infection control and antibiotic stewardship to prevent the emergence and spread of MRS and MDR health care-associated infections.

Comparação do teste tuberculínico e do ensaio de liberação de interferon-gama para diagnóstico de tuberculose latente em agentes comunitários de saúde do Sul do Brasil, Rio Grande do Sul, 2012

OBJETIVO:comparar a capacidade de deteccao de infeccao latente por Mycobacterium tuberculosis em agentes comunitarios de saude (ACS) com uso do teste tuberculinico (TT) e do ensaio de liberacao de interferon-gama (IGRA).METODOS:estudo transversal realizado no municipio de Santa Cruz do Sul, Rio Grande do Sul, Brasil, com aplicacao do TT e do IGRA em 47 ACS no periodo de marco a junho de 2012; o TT foi considerado positivo na presenca de uma induracao ≥10 mm, assim como o IGRA, se houvesse concentracao ≥0,35 UI/ml de interferon-gama.RESULTADOS:12 ACS apresentaram TT positivo e 6 tiveram IGRA positivo; a concordância entre os testes foi avaliada como pobre (κ=0,063).CONCLUSAO:apesar do numero limitado de amostras, a alta discordância entre os testes evidencia a necessidade de desenvolver mais estudos que busquem encontrar uma explicacao biologica para tais diferencas e avaliem a relacao de custo-beneficio na utilizacao do IGRA.Objective: to compare the ability to detect latent Mycobacterium tuberculosis infection among community health workers using the tuberculin skin test (TST) and Interferon-gamma release assay (IGRA). Methods: this was a cross-sectional study conducted in Santa Cruz do Sul-RS, Brazil, applying TST and IGRA to 47 community health workers between March and June 2012. TST was considered positive when induration was ≥10mm. IGRA was considered positive when interferon-gama concentration was at least 0.35 IU/mL. Results: 12 community health workers presented positive TST and 6 had positive IGRA, the agreement between the tets was considered poor (k=0.063). Conclusion: despite the limited number of samples there is a high discrepancy between the tests, what emphasize the need for more studies to find a biological explanation for these differences and to examine the cost-benefit of using IGRA.

Infection control and monitoring after discharge in orthopedic surgery

Aprovechamos para felicitar los colegas de la UFMG por el estudio “Riesgo para infeccion de sitio quirurgico en pacientes sometidos a cirugias ortopedicas”, que relata la incidencia de infeccion de sitio quirurgico con un significativo muestreo (3.543 pacientes). La incidencia de infeccion ortopedica fue del 1,8% (IC 95% y p<0,05) a traves de un grupo historico. All infection control officers know that notifications by passive methodology - that is, through re- hospitalization figures or notifications by the doctor providing treatment - do not represent the true incidence of the issue. This method tends to provide information only about the most serious cases, excluding cases of superficial infection of the surgical site - the majority of cases are of this type - as well as patients who are re- hospitalized in other institutions. In the authorsinstitution, after the completion of a retrospective cohort made up of 262 orthopedic procedures involving implants, through an active post-discharge search between January 2009 and March 2011 involving the randomized contacting by telephone of 82 patients (CI 99.9%, p <0.05), the authors found an infection frequency of 11.1%. Analysis with the application of this active search was 7.3. The epidemiological difference demonstrated by changing the method is considerable. However, inherent difficulties must be exposed: important limiting factors for this sampling system include the fact of it being a retrospective study, where forgetting depends on the interviewee, the changing of telephone contact details, being or not at home at the time of the contact, the interviewees understanding of the issue and the reliability of the information passed on. Despite this, this method provides greater security in the analysis of the data, making it possible to estimate an infection rate which is closer to reality. However, situations such as being re-hospitalized in a different hospital or simply being dealt with in the outpatients department provide indications of a lower infection rate, lulling health care professionals into a false sense of security such that they fail to take preventive measures or control measures.

Neuropatia por hanseníase: atraso no diagnóstico ou um diagnóstico difícil?

Caro editor, Inicialmente, parabenizo os colegas do Ceara pelo interessante artigo 1, Neuropatia Silenciosa em Portadores de Hanseniase na Cidade de Fortaleza, Ceara, Brasil, visto a importância social desta patologia no Brasil, sendo negligenciada em locais de baixa prevalencia (1,4/100.000 habitantes) como o Rio Grande do Sul 2. Esse fato e preocupante, pois as queixas de alteracao de sensibilidade cutânea sao menosprezadas pela equipe de saude, que realiza outros diagnosticos diferenciais, ocasionando o diagnostico tardio e com incapacidades estigmatizantes e impacto nas relacoes biopsicossociais e economicas 3. Em uma analise retrospectiva de 38 (100,0%) casos de hanseniase, na cidade de Santa Cruz do Sul (Rio Grande do Sul), do periodo de 1995 a 2005, verificou-se uma idade media de 50,5 (± 8,2) anos, variando de 20 a 75 anos. O predominio da cor branca em 33 (86,8%) casos e uma caracteristica regional devido a imigracao alema antes da segunda guerra mundial. O diagnostico da forma clinica 4 mais frequente, de acordo com a Classificacao de Madri, foi a virchowiana em 20 (52,6%) casos e, baseado na classificacao operacional da Organizacao Mundial da Saude, 27 (71,1%) casos foram incluidos no grupo multibacilar. A proporcao de incapacidade verificada em 15 (40%) casos foi maior do que a relatada por Leite et al. 1. Dentre os identificados com incapacidades, 4 (26,7%) pacientes apresentavam grau I e 11 (73,3%) grau II. Infelizmente, nao foi possivel determinar a frequencia de neuropatia silenciosa nesta analise. Na avaliacao pos-alta as deformidades mais observadas foram ulceras plantares (13%), artropatia de Charcot (9%) e flexao fixa (“garra”) dos dedos das maos (6%). As reacoes hansenicas ocorreram em 7 (18,4%) pacientes apos a alta, sendo que 3 (42,8%) apresentaram reacao reversa e 4 (57,1%) desenvolveram eritema nodoso hansenico. A neurite aguda foi verificada em 30,2% dos casos de reacoes dos tipos 1 e 2. O predominio dos casos nas formas multibacilares e com incapacidades motoras/neurologicas demonstra o atraso no diagnostico em uma area de baixa prevalencia e, consequentemente, o subdiagnostico da neuropatia silenciosa. Essas evidencias permitem supor o despreparo para o reconhecimento das complicacoes dessa micobacteriose, questionando-se o controle epidemiologico da doenca nesta localidade.