Marcelo de Carvalho Ramos

Overlapped Sequence Types (STs) and Serogroups of Avian Pathogenic (APEC) and Human Extra-Intestinal Pathogenic (ExPEC) Escherichia coli Isolated in Brazil

Avian pathogenic Escherichia coli (APEC) strains belong to a category that is associated with colibacillosis, a serious illness in the poultry industry worldwide. Additionally, some APEC groups have recently been described as potential zoonotic agents. In this work, we compared APEC strains with extraintestinal pathogenic E. coli (ExPEC) strains isolated from clinical cases of humans with extra-intestinal diseases such as urinary tract infections (UTI) and bacteremia. PCR results showed that genes usually found in the ColV plasmid (tsh, iucA, iss, and hlyF) were associated with APEC strains while fyuA, irp-2, fepC sitDchrom, fimH, crl, csgA, afa, iha, sat, hlyA, hra, cnf1, kpsMTII, clpV Sakai and malX were associated with human ExPEC. Both categories shared nine serogroups (O2, O6, O7, O8, O11, O19, O25, O73 and O153) and seven sequence types (ST10, ST88, ST93, ST117, ST131, ST155, ST359, ST648 and ST1011). Interestingly, ST95, which is associated with the zoonotic potential of APEC and is spread in avian E. coli of North America and Europe, was not detected among 76 APEC strains. When the strains were clustered based on the presence of virulence genes, most ExPEC strains (71.7%) were contained in one cluster while most APEC strains (63.2%) segregated to another. In general, the strains showed distinct genetic and fingerprint patterns, but avian and human strains of ST359, or ST23 clonal complex (CC), presented more than 70% of similarity by PFGE. The results demonstrate that some “zoonotic-related” STs (ST117, ST131, ST10CC, ST23CC) are present in Brazil. Also, the presence of moderate fingerprint similarities between ST359 E. coli of avian and human origin indicates that strains of this ST are candidates for having zoonotic potential.

Paracoccidioidomicose e infecção pelo virus da imunodeficiência humana

Sao apresentados dois casos de paracoccidioidomicose, um em paciente com a sindrome da imunodeficiencia adquirida e o outro em paciente com infeccao pelo HIV. Trata-se dos primeiros relatos em que esta associacao e descrita na literatura. No primeiro, a micose se evidenciou durante o acompanhamento de paciente com AIDS, que passou a apresentar hepato-esplenomegalia e febre elevada. A ecografia, radiografia simples e tomografia computadorizada do abdomen, demonstraram nodulos solidos, alguns calcificados, no parenquima esplenico. A puncao aspirativa da medula ossea confirmou o diagnostico; o conjunto dos achados caracterizou a forma aguda disseminada da paracoccidioidomicose, a qual levou o paciente ao obito. No segundo relato, em paciente com infeccao pelo HIV, a proposito de investigacao de tumoracao na regiao inguinal e fossa iliaca a direita, constatou-se a associacao de doenca de Hodgkin, tipo celularidade mista e paracoccidioidomicose. Avalia-se a importância destes relatos frente a expansao da infeccao pelo HIV e estima-se que mais casos venham a ser relatados em pacientes com AIDS, procedentes de areas endemicas desta micose. Propoe-se a inclusao da paracoccidioidomicose como infeccao oportunistica potencial em pacientes HIV positivos nestas areas.We present two cases of paracoccidioidomycosis, one occurring in an AIDS patient and the other in an HIV infected man. This is the first report of such association. The first patient, which was already followed for HIV infection (group IV-A) presented with high fever and hepatosplenomegaly. Plain X-ray, ultrasound and CT-scan of the abdomen showed solid nodules in the spleen, some of them with calcification. Both the direct smear and the culture of a bone marrow aspiration revealed Paracoccidioides brasiliensis. The patient died of acute disseminated Paracoccidioidomycosis. The second patient, a man anti-HIV seropositive presented with a mass on the right lower abdomen and inguinal region. A biopsy of the mass showed the association of Hodgkins disease of the mixed cellularity type and paracoccidioidomycosis. With the expanding AIDS epidemic we believe this report emphasizes the need to consider Paracoccidioidomycosis in HIV infected persons in countries where this mycosis is endemic. We also suggest the inclusion of Paracoccidioidomycosis as a potential opportunistic infection in these areas.We present two cases of paracoccidioidorrvycosis, one occurring in an AIDS patient and the other in an HIV infected man. This is the first report of such association. The first patient, which was already followed for HIV infection (group IV-A) presented with high fever and hepatosplenomegaly. Plain X-ray, ultrasound and CT-scan of the abdomen showed solid nodules in the spleen, some of them with calcification. Both the direct smear and the culture of a bone marrow aspiration revealed Paracoccidioides brasiliensis. The patient died of acute disseminated Paracoccidioidomycosis. The second patient, a man anti-HIV seropositive presented with a mass on the right lower abdomen and inguinal region. A biopsy of the mass showed the association of Hodgkins disease of the mixed cellularity type and paracoccidioidomycosis. With the expanding AIDS epidemic we believe this report emphasizes the need to consider Paracoccidioidomycosis in HIV infected persons in countries where this mycosis is endemic. We also suggest the inclusion of Paracoccidioidomycosis as a potential opportunistic infection in these areas.

Risk factors for recovery of imipenem- or ceftazidime-resistant Pseudomonas aeruginosa among patients admitted to a teaching hospital in Brazil

BACKGROUND The prevalence of resistance to imipenem and ceftazidime among Pseudomonas aeruginosa isolates is increasing worldwide. OBJECTIVE Risk factors for nosocomial recovery (defined as the finding of culture-positive isolates after hospital admission) of imipenem-resistant P. aeruginosa (IRPA) and ceftazidime-resistant P. aeruginosa (CRPA) were determined. DESIGN Two separate case-control studies were conducted. Control subjects were matched to case patients (ratio, 2:1) on the basis of admission to the same ward at the same time as the case patient. Variables investigated included demographic characteristics, comorbid conditions, and the classes of antimicrobials used. SETTING The study was conducted in a 400-bed general teaching hospital in Campinas, Brazil that has 14,500 admissions per year. Case patients and control subjects were selected from persons who were admitted to the hospital during 1992-2002. RESULTS IRPA and CRPA isolates were obtained from 108 and 55 patients, respectively. Statistically significant risk factors for acquisition of IRPA were previous admission to another hospital (odds ratio [OR], 4.21 [95% confidence interval {CI}, 1.40-12.66]; P=.01), hemodialysis (OR, 7.79 [95% CI, 1.59-38.16]; P=.01), and therapy with imipenem (OR, 18.51 [95% CI, 6.30-54.43]; P<.001), amikacin (OR, 3.22 [95% CI, 1.40-7.41]; P=.005), and/or vancomycin (OR, 2.48 [95% CI, 1.08-5.64]; P=.03). Risk factors for recovery of CRPA were previous admission to another hospital (OR, 18.69 [95% CI, 2.00-174.28]; P=.01) and amikacin use (OR, 3.69 [95% CI, 1.32-10.35]; P=.01). CONCLUSION Our study suggests a definite role for several classes of antimicrobials as risk factors for recovery of IRPA but not for recovery of CRPA. Limiting the use of only imipenem and ceftazidime may not be a wise strategy to contain the spread of resistant P. aeruginosa strains.

Molecular typing of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated in two metropolitan areas of São Paulo State, southeast Brazil

One hundred and fifty-one methicillin-resistant z (MRSA) strains have been isolated from patients admitted in tertiary care hospitals in two metropolitan areas (Campinas City and Ribeirão Preto City) in the southeast region of Brazil and analyzed through PCR-based techniques [(PCR amplification of spa, coa, and housekeeping genes (arcC, aroE, gmk, pta, tpi, yqiL)] and further restriction fragment typing of coa and of housekeeping genes. The heterogeneity of spa gene was determined directly by agarose gel electrophoresis migration. The results obtained indicate the existence of three (A, B, C) main clusters. Since the strain distribution in these three clusters is much characteristic, it denotes the existence of three main clones. All strains isolated in Campinas were grouped in clusters A and B, while most of the strains isolated in Ribeirão Preto were grouped in cluster C. This distribution denotes the existence of different founder strains that undergo independent genetic variability. The strains considered representative of the Brazilian Epidemic Clone (BEC) were categorized as cluster A. These results indicate a possible higher variability among Brazilian MRSA strains than currently described and indicate that the techniques herein used can be used as an alternative to Pulsed Field Gel Electrophoresis (PFGE).

Simultaneous monitoring of CMV and human herpesvirus 6 infections and diseases in liver transplant patients: one-year follow-up

OBJECTIVE: The aim of this study was to simultaneously monitoring cytomegalovirus and human herpesvirus 6 active infections using nested-polymerase chain reaction and, together with clinical findings, follow the clinical status of patients undergoing liver transplant. INTRODUCTION: The human β-herpesviruses, including cytomegalovirus and human herpesvirus 6, are ubiquitous among human populations. Active infections of human herpesvirus 6 and cytomegalovirus are common after liver transplantation, possibly induced and facilitated by allograft rejection and immunosuppressive therapy. Both viruses affect the success of the transplant procedure. METHODS: Thirty patients submitted to liver transplant at the Liver Transplant Unit, at the Gastro Center, State University of Campinas, SP, Brazil, were studied prospectively from six months to one year, nested-polymerase chain reaction for cytomegalovirus and human herpesvirus 6 DNA detections. Two or more consecutive positive nested-polymerase chain reaction were considered indicative of active infection. RESULTS: Active infection by cytomegalovirus was detected in 13/30 (43.3%) patients, median time to first cytomegalovirus detection was 29 days after transplantation (range: 0-99 days). Active infection by human herpesvirus 6 was detected in 12/30 (40%) patients, median time to first human herpesvirus 6 detection was 23.5 days after transplantation (range: 0-273 days). The time-related appearance of each virus was not statistically different (p = 0.49). Rejection of the transplanted liver was observed in 16.7% (5/30) of the patients. The present analysis showed that human herpesvirus 6 and/or cytomegalovirus active infections were frequent in liver transplant recipients at our center. CONCLUSIONS: Few patients remain free of betaherpesviruses after liver transplantation. Most patients presenting active infection with more than one virus were infected sequentially and not concurrently. Nested-polymerase chain reaction can be considered of limited value for clinically monitoring cytomegalovirus and human herpesvirus 6.

Premenstrual seizure increase influence of age, duration of disease, seizure frequency, previous complaint of perimenstrual accentuation, eeg and ct scan findings

UNLABELLED We selected prospectively 80 mentally healthy women at menacme age, with chronic epilepsy and at least one seizure in the month preceding this study. They underwent four EEGs weekly. CT scan of the skull was done in 57 patients (71.25%). Seven patients were excluded because they had no seizures or menses. We registered 5630 seizures during 579 regular menstrual cycles over a 30 month period. RESULTS there was a higher incidence of seizures in the premenstrual period (p less than 0.001); age did not influence the distribution of seizures during the menstrual cycle in the group studied; patients with 11 or more years of disease showed more accentuation of premenstrual seizures than patients with 10 or less years of disease; there was no relation between the patients frequency of seizures and the occurrence of premenstrual seizures; the patients impression of the incidence of seizures not related to menstruation was not confirmed; patients with abnormal skull CT scans had more accentuation of premenstrual seizures than patients with normal exams; patients with abnormal EEGs had more premenstrual seizures than patients with normal exams. Our findings suggest that the female sexual hormones alter cerebral excitability when there is an underlying structural pathology shown by CT scan or an electrical cerebral dysfunction revealed by EEG.

Polirradiculoneurite e malária: relato de um caso

Case report of a patient who three weeks after a Plasmodium falciparum malaria presented the Guillain-Barre syndrome. There was a severe type of polyradiculoneuritis with tetraplegia and involvement of several cranial nerves (VI, VII, IX, X) evolving to death. The Guillain-Barre syndrome has been considered a immune disorder with several eliciting antigenic stimuli. The case suggests that protozoan may be one these antigenic factors.Case report of a patient who three weeks after a Plasmodium falciparum malaria presented the Guillain-Barré syndrome. There was a severe type of polyradiculoneuritis with tetraplegia and involvement of several cranial nerves (VI, VII, IX, X) evolving to death. The Guillain-Barré syndrome has been considered a immune disorder with several eliciting antigenic stimuli. The case suggests that protozoan may be one these antigenic factors.

Transmission of tuberculosis among patients with human immunodeficiency virus at a university hospital in Brazil.

This study evaluated the IS6110-RFLP patterns of 109 Mycobacterium tuberculosis isolates of patients with HIV cared for at a Brazilian university hospital. Thirteen clusters involving 35 (32.1%) individuals were identified. Nosocomial transmission was possible in 5 cases. Strategies to prevent M. tuberculosis transmission should be implemented in hospitals in developing countries.

Hepatites pós-transfusionais na cidade de Campinas, SP, Brasil: I. Incidência, agentes etiológicos e aspectos clínico-epidemiológicos da hepatite por vírus C

We have followed up 111 transfusion receptors in the ambulatory, for at least 180 days, in order to evaluate the occurence of post-transfusional hepatitis and the etiological agents involved in the disease in the city of Campinas, state of Sao Paulo, Brazil. At the end of the study we have diagnosed this hepatitis in 18 (16.2%) subjects. Out of these 18 subjects, 16 (89%) were caused by hepatitis C virus, 1 (5.5%) caused by hepatitis B virus and 1 (5.5%) with undetermined etiology, 15 months after transfusion. The average incubation period of HCV was 71 days and 23% of the HCV positive receptors remained with increased AST/ ALT for more than 6 months. Late serum conversion was observed for anti-HCV in 71.4% of the subjects, averaging 135 days after the transfusion. An ALT dosage and anti-HCV determination, 3 and 6 months after transfusion would diagnose, respectively, 71 and 93% of the cases which developed post-transfusional HCV.

Sintomas respiratórios na população da cidade de Ribeirão Preto, SP (Brasil): resultados da aplicação de um questionário padronizado

As doencas respiratorias constituem expressiva parcela da morbidade na populacao da cidade de Ribeirao Preto, como comprovam alguns autores. Em particular, as doencas pulmonares cronicas nao-especificas motivam numero grande de internacoes a cada ano. Tais doencas podem ser detectadas atraves de sintomas relatados em entrevistas pessoais, quando se usa um questionario padronizado. Em uma amostra de 3.353 individuos de mais de 3 anos de idade, correspondendo a 878 domicilios visitados, foi feito levantamento de sintomas respiratorios, na populacao do municipio de Ribeirao Preto, SP (Brasil), utilizando-se questionario padronizado. Os resultados mostraram: 3,4% de pessoas do sexo feminino e 2,4% do sexo masculino com sintomas sugestivos da asma bronquica; 5,5% do sexo masculino e 3,3% do sexo feminino com sintomas sugestivos de bronquite cronica; 15,5% dos homens e 11,3% das mulheres referiram tosse; dispneia com limitacao funcional foi relatada em 0,96% dos homens e 2,48% das mulheres.As doencas respiratorias constituem expressiva parcela da morbidade na populacao da cidade de Ribeirao Preto, como comprovam alguns autores. Em particular, as doencas pulmonares cronicas nao-especificas motivam numero grande de internacoes a cada ano. Tais doencas podem ser detectadas atraves de sintomas relatados em entrevistas pessoais, quando se usa um questionario padronizado. Em uma amostra de 3.353 individuos de mais de 3 anos de idade, correspondendo a 878 domicilios visitados, foi feito levantamento de sintomas respiratorios, na populacao do municipio de Ribeirao Preto, SP (Brasil), utilizando-se questionario padronizado. Os resultados mostraram: 3,4% de pessoas do sexo feminino e 2,4% do sexo masculino com sintomas sugestivos da asma bronquica; 5,5% do sexo masculino e 3,3% do sexo feminino com sintomas sugestivos de bronquite cronica; 15,5% dos homens e 11,3% das mulheres referiram tosse; dispneia com limitacao funcional foi relatada em 0,96% dos homens e 2,48% das mulheres.The prevalence of asthma, chronic bronchitis and some other respiratory symptoms was estimated on the basis of a standardized questionnaire. Three thousand three hundred and fifty-three people were interviewed at home. On the basis of the criteria adapted 3.49% of the females and 2.4% of the males were considered asthmatic. Likewise, in 5.54% of the males and 3.37% of females the symptoms were strongly suggestive of chronic bronchitis. Shortness of breath was recorded in 0.96% of the males and 2.48% of the females.